Agenda Document Pack - Integration Joint Board - 20/08/2026
North Ayrshire Council · 20 August 2026
Back to Integration Joint Board — 20 August 2026 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Integration Joint Board Meeting Thursday, 20 August 2026 at 10:00 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 18 June 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 2026-27 – Month 3 Financial Performance Submit report by Eleanor Currie, Chief Finance Officer, providing an overview of the Integration Joint Board’s financial performance as at month 3 (June) (copy enclosed). 6 Ayrshire Transformation Board – Right Care, Right Place Transfer of Care Programme Update 1
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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). 7 Distress Brief Intervention Service Funding Submit report by Caroline Cameron, Director (NAHSCP), seeking approval of options presented in relation to the funding arrangements for the above service (copy enclosed). 8 IJB Standing Orders Review Submit report by Aileen Craig, IJB Monitoring Officer, seeking the IJB's approval of revised Standing Orders relative to Board meetings and associated governance. 9 Recruitment of Stakeholder Representatives to the Integration Joint Board Submit report by Caroline Cameron, Director (NAHSCP) on the progress in recruiting stakeholder voting members and seeking relevant delegated authority for next steps (copy enclosed). 10 North Ayrshire HSCP Clinical and Care Governance Report 2025-26 Submit report by Julie Barrett, Lead Nurse/Associate Director (NAHSCP), providing an update and overview of governance activity for the period August 2025 – July 2026 for consideration by the Integration Joint Board (copy enclosed). 11 Strategic Risk Register Submit report by Eleanor Currie, Chief Finance Officer, presenting the updated IJB Strategic Risk Register for consideration and approval (copy enclosed). 12 Annual Performance Report 2025-26 Submit report by Caroline Cameron, Director (NAHSCP), on the Annual Performance 2025-26 (copy enclosed). 13 Whistleblowing Quarter 4 Report: January – March 2026 Submit report for information in relation to whistleblowing concerns raised in Quarter 4 (January – March 2026) (copy enclosed). 14 Urgent Items Any other items which the Chair considers to be urgent. 2
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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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IJB Sederunt Voting Members Joyce White (Chair) NHS Ayrshire & Arran Cllr Margaret Johnson (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 Auld Third Sector Representative 4
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North Ayrshire Health and Social Care Partnership Minute of Integration Joint Board meeting held on Thursday 18 June 2026 at 2.00 p.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 Margaret Johnson, North Ayrshire Council (Substitute) (Agenda Item 1 - 5) Councillor Anthea Dickson, North Ayrshire Council (Agenda Item 6 – 14) 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 Julie Barrett, Associate Nurse Director/ Lead Nurse Stakeholder Representative Lynda McFarlane, Staff Representative Present (Remote Participation) Voting Members Councillor Tom Marshall, North Ayrshire Council Tom Hopkins, NHS Ayrshire and Arran Professional Advisers Iain Jamieson, Clinical Director Stakeholder Representative Vicki Auld, Third Sector Representative Lorna Sim, Staff Representative NHS Ayrshire and Arran In Attendance (Physical Participation) Elizabeth Stewart, Head of Service (Children, Families & Criminal Justice) Kerry Logan, Head of Service (Health and Community Care) Michelle Sutherland, Partnership Facilitator (Health and Community Care) Karen Andrews, Team Manager (Governance) Stuart MacMillan, Principal Manager (Planning, Performance and Transformation) Lauren McMath, Planning Manager Jan Thomson, Senior Manager Learning Disability Kimberley Mroz, Team Manager SDS Agenda Item 3 5
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Ruth Wilson, Team Leader (Litigation) Sally Amor, Public Health Consultant (NHS Ayrshire and Arran) Adele Davidson, Digital, Media & Marketing Analyst (Communications) Hayley Young, Senior Committee Services Officer Apologies Councillor Nairn Angus-McDonald, North Ayrshire Council Councillor Chloe Robertson, North Ayrshire Council (Vice-Chair) Marc Mazzucco, NHS Ayrshire & Arran Linda Semple, NHS Ayrshire and Arran Lisa Davidson, Public Health Representative Wendy Van Riet, Director of Psychological Services 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. Director of Public Health Annual Report Submitted a report and received presentation by Sally Amor, Public Health Consultant (NHS Ayrshire and Arran) on the Director of Public Health Annual Report. Officers responded to members’ questions on various aspects of the report. Noted. 6. Children’s Service Plan Performance Report Submitted report by Lauren McMath, Policy Officer (Children’s Services) on the Children’s Service Plan Performance Report, set out at Appendix 1 to the report. 6
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Officers responded to members’ questions on various aspects of the report. The Board agreed 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. 7. 2025-26 – Year End Financial Performance Submitted report by Eleanor Currie, Chief Finance Officer and Section 95 Officer (HSCP) on the IJB’s financial performance for the year ended 2025-26 and the implications for the IJB’s overall financial position Risk Appetite Statement, set out at Appendix 1 to the report. Appendix A to the report provided the financial overview of the partnership position, Appendix B provided an overview of those service changes that have financial savings attached to them and the BRAG status around the deliverability of each saving, Appendix C highlighted the movement in the budget position following the initial approved budget, Appendix D provided further details on the reserves, Appendix E provided further details on the Bank and Agency costs and Appendix F detailed the new Lead Partnership reporting template. Officers responded to members’ questions on various aspects of the report. The Board agreed to (a) note 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) note the progress with delivery of agreed savings; (c) approve the budget reductions detailed at paragraph 2.10; (d) approve the proposed earmarking as detailed in the report, leaving a balance of £2.126m in earmarked funds and £0.696m in unearmarked funds. 8. Eligibility Criteria Implementation Submitted report by Scott Hunter, Chief Social Work Officer on HSCP’s implementation of the changes to the Eligibility Criteria to critical only. 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. Officers responded to members’ questions on various aspects of the report. Noted. 9. Self-Directed Support (SDS) Policy Submitted report by Scott Hunter, Chief Social Work Officer on the Self-Directed Support Policy set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. The Board agreed to (a) approve the SDS Policy; (b) support the implementation approach; and (c) note the impact of the policy in strengthening consistency, transparency and sustainability in SDS practice. 10. Ayrshire Transformation Board – Right Care, Right Place 7
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Submitted report by Caroline Cameron, Director (NAHSCP) on the Ayrshire Transformation Board (ATB), specifically in relation to the Right Care, Right Place programme of work. Officers responded to members’ questions on various aspects of the report. The Board agreed to (a) 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; (b) 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; and (c) note that a full update on the plan will be presented to the IJB after the summer recess. 11. Trindlemoss Court Submitted 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. The proposed timetable was set out at Appendix 1 and the Equality & Children’s Rights Impact Assessment set out at Appendix 2 to the report. Officers responded to members’ questions on various aspects of the report. The Board agreed to (a) approve the proposal to develop a single care provider model within Trindlemoss Court; (b) approve the commencement of procurement processes associated with the change in delivery model; and (c) note the potential impact on NAC, external care provider and Personal Assistant staff groups. 12. Ward 7A Option Appraisal Submitted report by Thelma Bowers, Head of Service (Mental Health) on the Option Appraisal process and the commencement of next steps towards Delivery. A variety of review and information gathering was undertaken to inform consideration of future provision and a summary of the work was included in the Background Document prepared for the Option Appraisal 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 outcome of the Option Appraisal process and the commencement of next steps towards delivery. Councillor Marshall and Tom Hopkins left the meeting at this point. 13. Whistleblowing Quarter 3 Report: October – December 2025 Submitted report for information in relation to whistleblowing concerns raised in Quarter 3 (October – December 2025). Noted. 14. Strategic Planning Group Meeting Minutes 8
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Submitted for information the minutes of the Strategic Planning Group Meeting on 26 November 2025 and 25 February 2026. Noted. The meeting ended at 4.35 p.m. The full meeting proceedings can be viewed at https://north-ayrshire.public-i.tv/core/portal/home 9
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Integration Joint Board 20th August 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 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. 2. BACKGROUND 2.1 This report provides IJB with up to date information on recent activity across the HSCP since the last IJB. Agenda Item 4 11
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3. CURRENT POSITION National Developments 3.1 Care Leaver Payment The Scottish Government has recently introduced a Care Leaver Payment of £2,000 for young people as they move from care into adulthood and more independent living. The payment will be made to those who are legally defined as looked after on or after their 16th birthday and leave care after 1st April 2026 (i.e. those who do not remain in continuing care) or those who leave continuing care after 1st April 2026. The Scottish Government is providing full funding to all local authorities to deliver the Care Leaver Payment on its behalf. This payment will sit alongside the broader package of support that is already in place for care leavers, which includes - but is not limited to - setting up home payments, Continuing Care and Aftercare Support, the Care Experience Bursary, and Council Tax Exemption for care leavers. 3.2 Consultation on proposed changes to SSSC registration requirements The Scottish Government is seeking views on proposed changes to Scottish Social Services Council (SSSC) registration requirements, including three new groups of workers to be considered for registration – workers in adult day care services, workers in offender accommodation services, and social work assistants. This follows extensive engagement and consultation run directly by the SSSC to shape these proposals in 2025. The social services workforce is one of Scotland's largest sectors, providing vital support to some of the country's most vulnerable people every day. It is therefore essential that those working in the sector have the support, skills, and values needed to deliver high quality care and positive outcomes for those they are working with. The consultation is open until Thursday 24 September, and all individuals and organisations with an interest in these proposals are encouraged to share their views. 3.3 UK COVID -19 Inquiry – Module 5 Report (Procurement) The UK Covid-19 Inquiry's Module 5 Report (Procurement), was published on 14 July 2026, examining how healthcare related equipment and supplies (PPE, ventilators, oxygen equipment, and testing supplies) were procured and distributed across the UK during the pandemic. The Inquiry found that many procurement and PPE problems experienced during Covid-19 stemmed from inadequate preparedness before the pandemic rather than the emergency response alone. 12
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The key findings from the report were :- • The UK was inadequately prepared before the pandemic. National PPE stockpiles contained shortages, expired items, and unsuitable equipment. There were no effective plans for emergency procurement or distribution. • Frontline health and social care workers were left without adequate protection, particularly during the early stages of Covid-19. PPE shortages created significant risks for staff and patients. • Procurement processes were rushed and inconsistent. Governments and public bodies had to compete globally for scarce supplies, resulting in inefficiencies and significant waste. • Distribution systems were weak. Even where equipment had been obtained, getting it to hospitals, care homes, GPs and other frontline settings was often problematic. • Billions of pounds were wasted due to procurement failures, poor planning, unusable equipment and stock management weaknesses. The report makes 11 recommendations aimed at improving preparedness for future health emergencies, including: • Better management and maintenance of national stockpiles. • Pre-planned procurement frameworks for emergencies. • Stronger UK-wide coordination. • Improved distribution arrangements. • Ensuring PPE is suitable for a diverse workforce. • Regular testing and review of preparedness plans. 3.4 Envision – Blueprint for a Smart Home of the Future Envision The Digital Blueprint for a Smart Home of the Future is a flagship project within DHI’s Rural Centre of Excellence in Moray. The Digital Blueprint for a Smart Home of the Future sets out a practical, evidence- led framework for delivering homes that support health, wellbeing, independence and sustainability. Developed through DHI's Rural Centre of Excellence for Digital Health & Care Innovation, the report explores how digital health, low-carbon construction and adaptive design can be integrated to create future-ready homes that are affordable to run, aligned with net zero ambitions and designed around the needs of their residents. Colleagues in Housing and the HSCP plan to take forward together learning points from the framework. 13
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3.5 Proposed Extension of FOISA in the Care Sector The Scottish Government have now published an analysis of the responses from the consultation to explore whether providers of care homes and care at home services could be considered to provide functions of a public nature. The findings would then inform whether to extend the Freedom of Information (Scotland) Act 2022 (FOISA) to those services. The consultation ran from 5th January to 30th March 2026, comprising of 14 questions seeking views on various aspects of how such a FOISA extension would work in practice, if implemented. A total of 136 consultations responses were received from 67 individuals and 69 organisations. The report and analysis of those responses can be found here : https://www.gov.scot/publications/extension-freedom-information- scotland-act-2002-foisa-private-third-sector-providers-care-home-care-home- services-consultation-analysis-responses/pages/1/ Ayrshire Wide Developments 3.6 MenB Vaccination Programme for Young People From Monday 6 July, eligible young people in Ayrshire are able to book an appointment to receive their meningococcal B disease (MenB) vaccination ahead of the 2026-27 academic year. Meningococcal disease is a serious illness that can cause meningitis (infection around the brain) or blood poisoning. It can be life-threatening and may lead to long-term problems like loss of limbs, hearing loss, or brain damage. Starting university or college, especially when living in shared accommodation, is a higher-risk time because close contact with lots of new people makes it easier for the disease to spread. More information, including who is eligible and how to book an appointment, is available on the NHS Ayrshire & Arran website. North Ayrshire Developments 3.7 New facility will offer a stepping stone towards independent living for young people A new facility to help care experienced young people make the transition to independent living is opening this month. Boyle Street in Irvine will provide a safe, homely and supportive environment for young people aged 16 to 21 who no longer require full time care, but who would benefit from some additional support in learning the life skills and gaining the confidence required for fully independent living. 14
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The service, which will be operated and staffed by our commissioned provider Blue Triangle, will provide comfortable individual bedrooms with ensuite or private bathroom, shared living spaces, and 24/7 dedicated staff support on site. Young people will receive practical help around developing skills such as budgeting, cooking, and tenancy management, with further support available from a range of services and agencies - including housing, employability and Money Smart. 3.8 Carers Community Fund The Carers Community Fund is designed to support projects and activities that make a meaningful, positive difference to carers and their wellbeing. Applicants can apply for up to £2,000 towards the cost of their project, helping to bring ideas to life and create real impact within their communities. Applications closed on Friday 14 August, with funding for successful applicants released by Friday 25 September. All funding awarded must be fully spent by March 2027. The fund is administered by the North Ayrshire Carers Champions Board – a group of carers and service providers working together to shape services and supports. Funding can be used for projects and ideas that can: • Promote wellbeing and reduce isolation • Create opportunities for connection and peer support • Encourage rest, recovery and positive experiences • Help carers access new services, skills or environments Champions Board meetings have been paused over summer to allow members to focus on Carers Community Fund applications, with the next meeting being held on Tuesday 1 September from 10am to 12.30pm at the Carers Gateway Office in Irvine. 3.9 Beam Notes Roll Out Beam Notes (previously known as Magic Notes) is now being rolled out across NAHSCP social work services. Training sessions are under way, with the first use with further service users from Monday 20 July. This AI-supported tool helps staff create draft records and documentation more efficiently, reducing time spent on administration and allowing practitioners to focus more on conversations with the people they support. In order to update members of the public, a news article has been created on the NAHSCP website to provide more information about the use of Beam Notes, service users’ rights, and links to our privacy policy. The article also includes a link to an easy read version. 15
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3.10 Positive Inspection Report for Trindlemoss House Trindlemoss House in Irvine has received an extremely positive report from the Care Inspectorate after an unannounced inspection in March. The service provides care for up to six adults with learning disabilities in self-contained accommodation, where residents have 24 hour access to care staff, as well as support to access their community. Of the six areas evaluated, five were graded as ‘Very Good’, including how well we support residents’ wellbeing, our leadership and staff team, and how well care and support is planned. The inspection report highlights “consistent, high-quality support from a skilled and motivated team who promoted independence, maintained health needs, and ensured meaningful, person-centred care”, as well as effective leadership. The full report is available on the Care Inspectorate website. 3.11 North Ayrshire ADP Newsletter North Ayrshire Alcohol and Drug Partnership has published its latest newsletter, full of information on recent activities in the community and available supports, as well as news on this year’s Overdose Awareness Day event. 3.12 Milestone Award reached by Telecare team We have been working on a project to switch our telecare equipment from analogue to digital ahead of next year’s UK-wide switch-off of analogue telephone lines. We are delighted to confirm that NAHSCP has now been awarded the Gold Level Two Digital Telecare Implementation Award from Digital Telecare for Scottish Local Government in recognition of the progress we have made to date. To receive this award, telecare service providers must have successfully rolled out a live digital telecare service to 50 per cent of service users and operated successfully without serious issues or call failures for at least six weeks. Achieving this Award is a significant milestone and robustly demonstrates the overall functionality and effectiveness of our digital telecare solution. The team will now work towards achieving the Platinum award. A huge well done to all involved. 16
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3.13 Health Visitor shortlisted for Sands Bereavement Care Award Marie Purdie, one of our Health Visitors based in Largs, has been shortlisted for the Sands Elaine Thorp Award for Bereavement Care. The award recognises the vital work done by midwives, nurses, and other health professionals to care for parents affected by pregnancy loss or the death of their baby. The awards ceremony will take place in the Houses of Parliament on Tuesday 8 September. 3.14 Scottish Learning Disabilities Nurses Network Awards The Community Nurses from our North Community Learning Disabilities Team, recently won the Team Award at the Scottish Learning Disabilities Nurses Network Awards. Staff members were recognised for their work in reducing health inequalities amongst people with learning disabilities in North Ayrshire, and their hard work, dedication and innovative practice is deserving of this national recognition by their peers. The award was collected by Laura Stevenson on behalf of the team, and was presented by Kerry Anderson, Co-chair of the Lead Nurse Group. Well done to all involved in this fantastic achievement. 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 17
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4.6 Community Wealth Building None 4.7 Key Priorities None 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 18
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Integration Joint Board 20th August 2026 Subject: 2026-27 – Month 3 Financial Performance Purpose: To provide an overview of the IJB’s financial performance as at Month 3 (June). Recommendation: It is recommended that the IJB: (a) notes the overall integrated financial performance report for the financial year 2026-27 and the current overall projected year- end overspend of £5.146m; (b) notes the progress with delivery of agreed savings; (c) approves the budget reductions in para 2.10; and (d) notes the remaining financial risks for 2026-27. 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 MDT 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 Partnership and outlines the projected year-end outturn position informed by the projected expenditure and income commitments; these have been prepared in conjunction with relevant budget holders and services. It should be noted that, although this report refers to the position at the end of June further work is undertaken following the month end to finalise projections, therefore the projected outturn position is as current and up to date as can practicably be reported. Agenda Item 5 19
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1.2 The projected outturn is a year-end overspend of £5.146m (1.4%). 1.3 From the core projections, overall, the main areas of pressure are: residential placements for children and supplementary staff in wards including within the lead partnership for mental health. There remains a significant risk of delivering the financial savings required from the change to social care eligibility criteria and this remains the substantive plan for further financial recovery. 1.4 The projected 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 3 IJBs to be aware of the position for Lead Partnership services and plans to deliver services from within allocated budget. 2. CURRENT POSITION 2.1 The report includes an overview of the financial position including commitments against the available resource, explanations for the main budget variances and an update on progress in terms of savings delivery. 2.2 FINANCIAL PERFORMANCE – AT MONTH 3 At month 3 against the full-year budget of £360.587m there is a projected year-end overspend of £5.146m (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 position consists of a projected overspend of £5.042m in social care services and a projected overspend of £0.104m in health services. Appendix A provides the financial overview of the Partnership position. The sections that follow outline the significant variances in service expenditure compared to the approved budgets. Appendix E provides information on the costs of bank and agency staff. 2.3 Health and Community Care Services Against the full-year budget of £111.624m there is a projected underspend of £0.121m (0.1%) and the main variances are: Care home placements – net projected underspend of £0.459m. This includes an underspend on placements of £0.330m and an income recovery from charging 20
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orders and gross funded placements which is projected to be £0.130m over recovered. This income is challenging to predict as it depends on the length of the legal process and time taken to sell the property that the charging order is registered to and access to the funds or estate of service users. The budgeted number of permanent placements was 765 and at month 3 there were 760. The underspend is due to lower placement numbers and less gross funded cases than in previous years. A further 25 Placements have been funded via Whole Systems Funding monies which will be cost neutral and reflected in the month 4 projection where the funded placements will increase to 790. b) Care at home is projected to be £1.221m underspent. The underspend reflects the full year impact of the action taken to reduce the overall level of provision to reduce the 2025/26 overspend. The level of vacancies in the service has increased and whilst favourable it is coupled with continued levels of unmet need. c) Physical Disability Services – projected overspend of £0.285m split as follows: £0.818m over in residential placements, £0.215m under in direct payments due to increased clawbacks and £0.318m under in community care packages. d) Integrated Island Services is projected to overspend by £0.079m across various service areas. e) Specialist Rehab wards – projected overspend of £0.361m (Redburn ward £0.097m overspend and Douglas Grant £0.264m overspend). The overspend is due to cover costs for vacancies as well as supplementary staffing for patients who require one to one support. f) Wards 1 and 2 – Projected overspend of £0.680m. The overspend is due to increased use of supplementary staffing. All rehabilitation wards are operating at 100% occupancy supporting a high level of patient needs/complexity, which places pressure on staffing levels and the use of bank and agency staff to support additional patient observations. The number of patients is being managed in the wards in line with ward formal admission criteria to maximise opportunities to reduce the overspend in-year. 2.4 Mental Health Services Against the full-year budget of £126.517m there is a projected overspend of £0.402m (0.3%) prior to the re-allocation of the Lead Partnership variance to East and South HSCP. The main variances are: • Learning Disabilities are projected to overspend by £0.362m. This covers Children and Adults - residential placements, community packages, direct payments, property costs and an under recovery of charging income. 21
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• Community Mental Health services are projected to underspend by £0.004m. The main reason for underspend in community packages is the availability and capacity of adult community providers to deliver new packages of care. • There is a projected underspend of £0.353m in relation to the unused funds arising from the Hospital Based Complex Continuing Care (HBCCC) service, this reflects the impact of change in provision for these services. • The Lead Partnership for Mental Health is projected to be £0.393m overspent and the main variances are as follows: • Adult Inpatients – projected overspend by £1.454m 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, 2:1 and 3:1) and use of bank staff. Absence levels are also impacting this area. • The UNPACS (Unplanned Activities) budget – projected overspend of £0.375m) 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. • Learning Disability Services – projected to underspend by £0.161m. The underspend relates to saving made until the new service to replace Ward 7A commences offset by legacy costs of the Ward 7A staff who have still to be redeployed. • Elderly Inpatients – projected overspend of £0.332m 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 – projected to be £0.100m overspent. This service is currently being reviewed and options considered. 22
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• Enhanced Mental Health Outcome Framework (EMHOF within CAMHS) – projected underspend of £0.253m. This is the balance of the remaining funding from the 25/26 review. • Psychiatry – is projected to overspend by £0.318m across all specialities including some agency locum costs. A wholescale workforce review has been commissioned to determine longer term solutions for sustainability. • MH Pharmacy/Substitute Prescribing – is projected to underspend by £0.368m. This is partly due to a rebate and expected drug price increases are not evident at month 3. • 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 a projected over recovery of the vacancy savings target of £0.452m in 2026-27. Further information is included in the table below: Vacancy Savings Target (£1.250m) Projected to March 2027 £1.802m Over/(Under) Achievement £0.452m 2.5 Children and Justice Services Against the full-year budget of £46.913m there is a projected overspend of £2.893m (6.2%) and the main variances are: a) Care Experienced Children and Young People is projected to overspend by £2.891m. 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: • The children’s residential placements are projected to overspend by £2.794m based 37 placements in month 3. There are several factors leading to this challenging position: o We have 32 places available in our internal children’s houses, due to demand these have been operating at 100% occupancy or over for some time, leading to increased use of external placements where residential care is required. o There remains an acute shortage of foster carers leading to residential care being necessary in emergency placement situations. o The 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. 23
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o A number of young people in residential care have requested Continuing Care, whereby a young person can remain in their placement until age 21. o Where appropriate young people are placed to meet their educational needs, the cost of Residential School Placements in the most cases is shared 50/50 with Education services. o Contractual inflation has still to be agreed for 1 provider. If this is higher than the assumed contractual inflation and it is likely that this will increase the projected costs of residential places which is outwith the control of the service. o Delays with the opening of Boyle Street supported accommodation development which has in turn delayed planned moves from placements for young people. A full report on the ‘Brighter Pathways’ Programme will be presented to the October 2026 IJB, this will include more detailed information on the operational and financial impact and progress with plans. Note that the costs associated with mobilising Boyle Street are being finalised and will be funded by the Service Redesign Funds in the earmarked reserves. • Looked After and Accommodated Children (fostering, adoption, kinship etc) is projected to be £0.238m underspent. • Employee costs – are projected to overspend by £0.267m largely due to staffing levels in the children’s houses. • Care Leavers – projected underspend of £0.022m in rent costs. • Section 29 Payments (all Teams) are projected to overspend by £0.075m. b) Head of Service – is projected to overspend by £0.006m. This consists of a projected overspend of £0.144m in relation to the previous staff reconfiguration saving in the children’s houses which was not achieved and this is offset by the grant funding in relation to Unaccompanied Asylum-Seeking Children (UASC), which is projected to amount to £0.143m and which contributes to costs incurred across a number of C&F service areas. c) C&F Health Team – is projected to underspend by £0.057m mainly due a seconded post that has not yet been backfilled. d) Lead Partnership – Children’s Services – projected overspend of £0.017m within the immunisation budget. 2.6 ALLIED HEALTH PROFESSIONALS (AHP) 24
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The non-employee costs element of the AHP services are projected to be on-line. All underspends in employee costs have contributed to payroll turnover. 2.7 CHIEF SOCIAL WORK OFFICER This is projected to underspend by £0.018m. 2.8 MANAGEMENT AND SUPPORT Management and Support Services are projected to overspend by £2.172m and the main areas of variance are: • There is projected slippage on the LD and MH transition funding of £0.315m due to delays in children transitioning into adult services and updated costing of care packages. 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 overachieved savings of £0.052m. • The 2026/27 budget included additional approved savings to contribute towards the 2025/26 overspends that would continue into 2026/27. These savings were £1.4m for social care and £0.245m for non-lead health services. This shows as a total underspend of £1.645m. • As outlined in para 2.9 there remains £4.628m of social care eligibility criteria savings to be achieved and these are reported as a projected overspend under management and support. This figure will be updated and reduced each month to reflect the outcome of re-assessments. • An over-recovery of payroll turnover of £0.165m for social care services and an over-recovery of £0.207m 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 is noted below: Social Care Health Vacancy Savings Target (£3.507m) (£1.628m) Projected to be achieved by March 2027 £3.672m £1.835m Over/(Under) Achievement £0.165m £0.207m 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. The turnover target for the North Lead Partnership for Mental Health services is detailed separately within the Lead Partnership information at section 2.4. 25
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2.9 Savings Progress The 2026-27 savings are detailed within Appendix C. The savings are RAG rated informed by an overall assessment of the ease of delivery and the impact on services, indicating an overall risk of deliverability. The savings are split into: • Previously agreed savings • Adjustments (payroll turnover and recharges) • Operational savings • Policy – Models of care or efficiency • Policy – Service reduction or cessation The approved 2026-27 budget included £2.816m of savings that were not related to the eligibility criteria saving. BRAG Status Position at Budget Approval £m Position at Month 3 £m Red - 0.043 Amber 0.141 0.564 Green 2.675 0.640 Blue - 1.569 TOTAL 2.816 2.816 Any shortfall in relation to the red and amber rated savings are already reflected in the projected outturn. In relation to the Eligibility Criteria Review savings the progress achieved at month 3 is: Full Year £m Part Year £m Target (5.828) (5.828) Achieved at month 3 1.481 1.200 Still to be Delivered (4.347) (4.628) The part year saving to be achieved of £4.628m is reflected as an overspend in the month 3 projections. There remains a significant risk of delivering the financial savings required from the change to social care eligibility criteria and this remains the substantive plan for further financial recovery. Progress is being monitored through the programme board, with a more detailed progress update planned for the IJB in October 2026. 2.10 Budget Changes 26
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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 following the initial approved budget. Reductions Requiring Approval: Ref Description Amount (£’m) 1 Primary Care prescribing CRES 1.464 2 Primary Care 26/27 Savings 0.507 3 Training Grade adjustment 0.008 4 Reduced Working Week – transfer to pan Ayrshire posts 0.018 5 Transfer to East and South re pan Ayrshire pressures 0.028 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. Full detail on the Lead Partnerships is given in the report in 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 of the historic baseline at 2024/25 prices. The 2025/26 actual usage information is not known until later in the year. IJB 2024-25 Activity at 2025-26 prices inflated by 2% for 2026-27 East 34,003 North 42,670 South 34,844 27
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Total 111,517 The annual budget for Acute Services is £520.5m. The directorate is overspent by £3.3m after 3 months. 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 are a number of ongoing financial risk areas that may impact on the 2026-27 budget during the year, these include: • 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 are minimal, there is limited scope to absorb in-year variances, with any overspends requiring 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 the decisions taken to reduce the Board’s deficit may have impacts on other parts of the health and care system. • The overall sustainability of commissioned care providers • 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. • Risk related to NHS Reform investment being allocated by Scottish Government on a payment by results basis and in arrears. 28
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• A risk of delivering an online position at the year-end set against continued increased demand for services, inflationary impacts on the cost of care and the more difficult decisions which are required to reduce spend. • Scarcity of residential placements for children which is being raised on a national level. These risks will continue to be monitored. 2.13 RESERVES The IJB opening reserves position are summarised in the table below. 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 If the IJB ends the financial year with an overspend the Unearmarked Reserves will be drawn down first to offset any overspend position. 2.14 Financial Recovery Plan The Integration Scheme describes the required approach where there is a projected overspend on the IJB integrated budget, which includes 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 available interim funds. Despite being in a projected overspend position additional financial recovery action is not recommended at this stage as the focus remains on achieving the remaining savings relating to the eligibility criteria, if this is successfully delivered year-end financial balance would be delivered, as illustrated below: TOTAL Health/ NHS AA Social Care/NAC Projected Overspend @ mth 3 5.146 0.104 5.042 Assumed eligibility savings still to be achieved (4.628) 0 (4.628) Residual Projected Overspend 0.518 0.104 0.414 29
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Unearmarked GF Reserves (0.696) Net Projected Overspend (0.178) It is anticipated that the management and recovery actions developed in previous years will continue into 2026-27. This includes: • Review of temporary posts and robust vacancy management/approval. The vacancy scrutiny group now has representation from all of the Heads of Service, and a recruitment freeze will be implemented for all but essential frontline posts. • Restrictions on all but essential overtime working. • Ongoing review of future year savings or transformation programmes to identify scope for acceleration. • Continued focus through the ‘Finance Working Group’, chaired by the IJB Chair or Vice Chair. The Director and Heads of Service are members of the group. It meets monthly to facilitate increased oversight and scrutiny of the financial position and transformation programme as well as detailed budget planning for future financial years. • Recruitment delay – there will be a recruitment drag with vacancy scrutiny approved vacancies being held for four weeks before they are advertised to create more payroll turnover. This will be for all vacancies except clinical or registered services vacancies or those which will incur cover costs. • High-cost care package group – the remit of this group expanded to include care packages for children with a disability and all UNPACs placement requests. • Oversight group for looked after and accommodated children in residential care – this group meets fortnightly to actively review all placements. • All care packages (outwith in house care at home and older people placements agreed via CARG) will be considered for approval by the high- cost care package group. 3. 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 in 2026-27 from within the available resource, thereby limiting the financial risk to the funding partners. The transformational change programme, along with the revised eligibility criteria, will have the greatest impact on the financial sustainability of the partnership, the IJB require to have a clear understanding of progress with the delivery of the transformation plan. 3.3 Measuring Impact The final outturn will be reported to the IJB. 30
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4. IMPLICATIONS 4.1 Financial There is a projected overspend of £5.146m (1.4%). The report outlines the main variances for individual services. 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 are 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 falls in line with the agreed risk appetite statement which is a low-risk appetite in respect to adherence to standing financial instructions, financial controls and financial statutory duties and a high-risk appetite in relation to finance and value for money. The ‘financial viability of the HSCP’ risk is on our 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. 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. 31
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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] 32
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2026-27 Budget Monitoring Report–Objective Summary as at 30th June 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 COMMUNITY CARE AND HEALTH 89,140 87,997 (1,143) 22,484 23,506 1,022 111,624 111,503 (121) : Locality Services 34,685 34,469 (216) 6,191 6,190 (1) 40,876 40,659 (217) : Community Care Service Delivery 48,761 47,656 (1,105) 0 0 0 48,761 47,656 (1,105) : Rehabilitation and Reablement 2,316 2,365 49 0 0 0 2,316 2,365 49 : Long Term Conditions 978 1,037 59 11,458 12,499 1,041 12,436 13,536 1,100 : Community Link Workers 426 417 (9) 0 0 0 426 417 (9) : Integrated Island Services 1,974 2,053 79 4,835 4,817 (18) 6,809 6,870 61 MENTAL HEALTH SERVICES 44,760 45,122 362 81,757 81,797 40 126,517 126,919 402 : Learning Disabilities 34,760 35,122 362 864 864 0 35,624 35,986 362 : Community Mental Health 7,469 7,465 (4) 1,912 1,912 0 9,381 9,377 (4) : Addictions 2,531 2,535 4 2,138 2,138 0 4,669 4,673 4 : HBCCC 0 0 0 353 0 (353) 353 0 (353) : Lead Partnership Mental Health NHS Area Wide 0 0 0 76,490 76,883 393 76,490 76,883 393 CHILDREN & JUSTICE SERVICES 40,331 43,265 2,934 6,582 6,541 (41) 46,913 49,806 2,893 : Irvine, Kilwinning and Three Towns 3,690 3,706 16 0 0 0 3,690 3,706 16 : Garnock Valley, North Coast and Arran 3,833 3,852 19 0 0 0 3,833 3,852 19 :Intervention Services 2,186 2,188 2 0 0 0 2,186 2,188 2 : Care Experienced Children & Young people 25,178 28,069 2,891 0 0 0 25,178 28,069 2,891 : Head of Service - Children & Families 1,510 1,516 6 0 0 0 1,510 1,516 6 : Justice Services 3,493 3,492 (1) 0 0 0 3,493 3,492 (1) : C&F Health Team 441 442 1 5,700 5,642 (58) 6,141 6,084 (57) : Lead Partnership NHS Children's Services 0 0 0 882 899 17 882 899 17 CHIEF SOCIAL WORK OFFICER 2,140 2,122 (18) 0 0 0 2,140 2,122 (18) PRIMARY CARE 0 0 0 53,830 53,819 (11) 53,830 53,819 (11) ALLIED HEALTH PROFESSIONALS 0 12,379 12,379 0 12,379 12,379 0 MANAGEMENT AND SUPPORT COSTS 2,410 5,317 2,907 4,774 4,039 (735) 7,184 9,356 2,172 OUTTURN ON A MANAGED BASIS 178,781 183,823 5,042 181,806 182,081 275 360,587 365,904 5,317 TOTAL Partnership Budget - Objective Summary Council Health 2026/27 Budget 33
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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 Return Hosted Over/Underspends to East 0 0 0 0 (132) (132) 0 (132) (132) Return Hosted Over/Underspends to South 0 0 0 0 (122) (122) 0 (122) (122) Receive Hosted Over/Underspends South 0 0 0 0 0 0 0 0 0 Receive Hosted Over/Underspends East 0 0 0 0 83 83 0 83 83 OUTTURN ON AN IJB BASIS 178,781 183,823 5,042 181,806 181,910 104 360,587 365,733 5,146 Partnership Budget - Objective Summary 2026/27 Budget Council Health TOTAL 34
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2026-27 Savings Tracker Appendix B Council NHS (non lead) NHS (lead) TOTAL BRAG Deliverability Status BRAG Deliverability Month 3 Description Adjustments and Previously Agreed Savings: Inflate Payroll Turnover 107,348 60,150 90,225 257,723 Green Green Increased target to reflect the pay award Recharge to East for Ward 2 beds - 25,000 - 25,000 Green Blue Increased charge to reflect the pay award Financial Inclusion Review 32,500 - - 32,500 Green Blue Full year impact of the 2024/25 saving Social Care Model at Trindlemoss House - 175,000 - 175,000 Green Green Moving from a nursing led model to a social care led model 139,848 260,150 90,225 490,223 Operational Council NHS (non lead) NHS (lead) TOTAL BRAG Deliverability Status BRAG Deliverability Month 3 Description Social Care Fees and Charges 5% increase 100% included 120,000 - - 120,000 Green Green Increased income to reflect the 2026/27 charges LES Payment - Buckreddan Care Home 43,000 - - 43,000 Green Red Service will be ither cease or be funded by the care home LES Payment - Toddhill 22,000 - - 22,000 Green Blue Service will cease Third Sector Capacity Building 34,000 - - 34,000 Green Blue Reduction of a post Business Admin - Phase 1 - Quick wins 251,979 - - 251,979 Green Blue Reduction in 6.8 WTE posts Moving and Handling post 55,000 - - 55,000 Green Blue Reduction of a post Business Admin Team - senior structure - 40,000 - 40,000 Green Blue Saving following a retiral and resultant revised structure Carers UK Annual Subscription 3,500 - - 3,500 Green Blue Cease the subscription NADARS NHS non staffing budget - 26,771 - 26,771 Green Blue Saving in non staffing costs Pan Ayrshire Alcohol & Drug Services Management Team - 16,478 16,478 32,956 Green Blue Saving in staffing costs Removal of SW Trainee Post 54,000 - - 54,000 Green Blue Removal of a SW trainee post Child Health Assessment - Charge for Out of Authority cases - 6,000 - 6,000 Green Amber New charge for Out of Authority health assessments Children and Families Throughcare Review 87,000 - - 87,000 Green Green Reduction in staffing Support Services outwith business support 100,000 - - 100,000 Amber Amber Reduction in staffing (WTE TBC as it is a target) 770,479 89,249 16,478 876,206 35
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Policy - Model of Care or Efficiency Council NHS (non lead) NHS (lead) TOTAL BRAG Deliverability Status BRAG Deliverability Month 3 Description Roslin House - shared respite/residential model 300,000 - - 300,000 Green Amber Moved to respite and residential model. Assumes 4 external placements will move to Roslin House Trindlemoss - review of care delivery model 116,989 - - 116,989 Green Amber Review of care delivery model. Budget reduction regarding the Pan Ayrshire Prevention & Service Support Team - - 40,817 40,817 Green Blue Saving in non staffing costs Phase 1 - Children and Families -quick wins re: retirements, WLB and vacant posts 250,000 - - 250,000 Green Blue Reduction in staffing (7 WTE) Phase 1 - Psychology - - 231,138 231,138 Green Blue Reduction in staffing (2.5 WTE and a reduction in grade for 1 post) 666,989 271,955 938,944 Policy - Service Reduction/Cessation (all agreed with East and South HSCP) Council NHS (non lead) NHS (lead) TOTAL BRAG Deliverability Status BRAG Deliverability Month 3 Description DBI - Distress Brief Intervention service - - 157,500 157,500 Green Blue Cessation of the Distress Brief Intervention service (7mths assumed) MH Innovation Fund (reduction of posts) - - 41,331 41,331 Amber Amber Reduction of Innovation Funded posts. 3mths of savings assumed as the posts will be redeployed. (2.7 WTE) RISE Team - Resilience in Stressful Events - - 192,131 192,131 Green Blue Reduction in the RISE service Mental Health Practitioners (MHPs) in GP practices - - 120,000 120,000 Green Blue Reduction in the MHPs ( est 3 WTE posts) - - 510,962 510,962 TOTAL SAVINGS 1,577,316 349,399 889,620 2,816,335 36
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2026-27 Budget Reconciliation Appendix C COUNCIL Period £'m Initial Approved Budget 151.506 Adjustments to baseline (0.012) Revised Budget 151.494 Resource Transfer 25/26 1-3 25.949 Change Fund - Bank Project 3 0.007 Section 27 Justice Service Grant 3 1.331 Social Care Budget Reported at Month 3 178.781 HEALTH Period £'m Initial recurring base budget exc set aside 149.214 Month 10-12 Adjustments and adjusting for the full year impact of part years amounts and temporary funding. 51.766 Revised Budget 200.980 Resource Transfer 25/26 (25.949) 2% pass through 2026/27 2.891 Pay Awards 2026/27 top up 1.682 Reduced Working Week (1 hour) 2026/27 2.362 PC Prescribing uplift (£1,466,000) 0.537 PC Prescribing cres (£4,000,000) (1.464) PC Prescribing Tariff Adjustment North 0.549 Veterans First Point 0.105 Training Grade Adjustment (Dean Funding) (0.008) Junior Doctors Pay Award - additional 1.75% 0.019 Transfer MAT Standards Psychiatrist 0.2 WTE from South 0.029 ADP Pay Uplifts from South 0.014 School Nursing 6.12 WTE from South 0.377 North Budget Paper - Office 365 to East (0.009) North Budget Paper - Palliative Care to East (0.018) BBV Transfer Band 8B Pharmacist to Addictions (from PH) 0.013 Early Years funding 0.45 WTE Band 4 - MIN Allocation (from PH) 0.019 North Budget Paper - Office 365 to East Adjustment (0.001) RWW Action 15 backfill cover arrangements allocated to South HSCP (0.006) RWW Action 15 backfill cover arrangements allocated to East HSCP (0.012) Training Grade Adjustment (Dean Funding) - Vacancy 0.032 GP Prescribing 2026/27 savings (0.507) Anticipated budgets 0.171 Health Budget Reported at Month 3 181.806 TOTAL COMBINED BUDGET 360.587 37
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26-27 IJB Reserves Position Appendix D Area of Reserves Balance at 31 March 2026 Earmarked Funds Alcohol and Drug Partnership 147 Primary Care Improvement Fund 183 Service Redesign / Challenge Fund 321 Family Wellbeing Fund 906 Telecare / community alarms 180 Magic Notes 88 Adult Social Work Restructure resource 38 LD – Coming Home 212 Early Intervention in Psychosis 51 Total Earmarked 2,126 Unallocated General Fund 696 General Fund 2,822 38
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Bank and Agency Costs to Month 3 Appendix E 2) SOCIAL CARE Month 3 Spend Montrose House Brodick 35,257 Mental Health 58,229 98,486 1) NHS 4863 (Registered) 4864 (Unregistered) 4865 (Agency Locum Consultant) TOTAL WARD 1 WOODLANDS VIEW 13,222 81,309 94,531 WARD 2 WOODLANDS VIEW 15,515 78,431 93,945 ACH REDBURN REHAB WARD NRS 3,013 45,010 48,024 ACH DOUGLAS GRANT REHAB WD NRS 7,378 19,375 26,754 WARD 3 WOODLANDS VIEW NURSING 13,783 135,870 149,653 WARD 4 WOODLANDS VIEW NURSING 37,211 37,211 NEW CLONBEITH NURSING(JURA) 15,866 96,880 112,746 WVIEW THE GLEN ECT 2,423 9,210 11,633 WVIEW WARD 10 ACUTE MH NRS 1,041 91,689 92,730 WVIEW WARD 8 ACUTE MH NRS 15,403 295,229 310,633 WARD 5 WOODLANDS VIEW 5,779 18,476 24,255 WVIEW WARD 7B REHAB MH NRS 2,122 2,122 NEW DUNURE NURSING(CLONBEITH) 24,899 95,354 120,253 MH BED MANAGEMENT 2,358 2,358 TRINDLEMOSS 2,291 78,491 80,782 ARRAN HOSPITAL NURSING 17,323 20,292 37,616 CAMHS UNSCHEDULED CARE 1,377 1,377 EARLY YRS-C/F TEAM 3 1,595 1,595 IMMUNISATION NURSING BANK 525 129 654 PACKAGE OF CARE (P) - AMG 30,284 30,284 PACKAGE OF CARE (P) - LMO 325 325 NC POC TEAM 2 692 692 ARRAN DN 1,525 1,525 THREE TOWNS DN 269 269 IRVINE DN 278 278 NORTH WEST COAST DN 661 661 GARNOCK VALLEY DN 467 467 LADY MARGARET NURSING 4,687 1,915 6,603 NORTH CLDT 263 263 LDS MANAGEMENT 2,122 2,122 MHS ASSOC NURSE DIRECTOR 644 644 MHANPS MH UNSCHEDULED CARE 6,235 6,235 MHS INPATIENT MGT 7,045 7,045 CMHT NURSING-NORTH AYRSHIRE 207 207 WVIEW WARD 7C FORENSIC REHAB N 6,523 62,919 69,442 INTENSIVE COMMUNITY NURSING TEAM 9,974 3,695 13,669 ADULT MENTAL HEALTH LIASION TEAM 4,190 4,190 PCMHT NORTH 3,053 3,053 WVIEW WARD 6 LOW SECURE NRS 27,940 39,677 67,617 WARRIX AVE 26,402 19,148 45,549 FORENSIC PSYCHOLOGY 583- 583- ICFN - COMMUNITY PHLEBOTOMY 2,616 2,616 OLD AGE 69,442 69,442 WVIEW WARD 9 ACUTE MH NRS 5,251 117,530 122,781 WVIEW WARD 11 ACUTE MH NRS 12,342 152,460 164,802 265,202 1,534,425 69,442 1,869,068 Bank Agency 39
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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 40
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1. SUMMARY 1.1 The summary of the financial position month 3 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 Outturn £’000’s Variance £’000’s North £’000’s South £’000’s East £’000’s North Mental Health Month 3 76,490 76,883 (393) (149) (117) (127) North Children Lead Partnership Month 3 882 899 (17) (6) (5) (6) South Community Store Month 3 1,599 1,457 142 53 43 46 South Family Nurse Partnership Month 3 2,125 2,125 0 0 0 0 South Continence Team Month 3 580 722 (142) (53) (43) (46) East Standby Services Month 3 414 414 0 0 0 0 East Primary Care (including Dental) Month 3 141,702 142,393 (691) (256) (215) (220) East Prison and Police Healthcare Month 3 4,301 4,186 115 43 36 37 East Allied Health Professionals (Lead) Month 3 5,717 5,385 332 123 103 106 East Other Lead Services Month 3 2,463 2,444 19 7 6 6 2. North Ayrshire: Month 3 2.1 Services managed under Lead Partnership arrangements by North Ayrshire Integration Joint Board are projected to overspend by £0.410m in total. 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 76,490 76,883 (393) (149) (117) (127) North Children Lead Partnership 882 899 (17) (6) (5) (6) North TOTAL 77,372 77,782 (410) (156) (122) (132) 2.3 The Lead Partnership for Mental Health is projected to be £0.393m overspent and the main variances are as follows: • Adult Inpatients – projected overspend by £1.454m 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. 41
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• The UNPACS (Unplanned Activities) budget – projected overspend of £0.375m 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. • Learning Disability Services – projected to underspend by £0.161m. The underspend relates to saving made until the new service to replace Ward 7A commences offset by legacy costs as the staff are still being redeployed. • Elderly Inpatients – projected overspend of £0.332m 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 – projected to be £0.100m overspent. This service is currently being reviewed and options considered. • Enhanced Mental Health Outcome Framework (EMHOF within CAMHS) – projected underspend of £0.253m. This is the balance of the spare funding from the 25/26 review. • Psychiatry – is projected to overspend by £0.318m across all specialities including some agency locum costs. A wholescale workforce review has been commissioned to determine longer term solutions for sustainability. • MH Pharmacy/Substitute Prescribing – is projected to underspend by £0.368m. The is partly due a rebate and expected drug price increases are not evident at month 3. • 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 a projected over recovery of the vacancy savings target of £0.452m in 2026-27. Further information is included in the table below: Vacancy Savings Target (£1.250m) Projected to March 2027 £1.802m Over/(Under) Achievement £0.452m 2.4 Recovery Plan Action Despite being in a projected overspend position a formal recovery plan is not being recommended at this stage. The projections will continue to be refined and updated to 42
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reflect additional ward costs in month 4. A decision on recovery action will be made in month 4. 2.5 Performance Information To be further developed 3. South Ayrshire: Month 3 3.1 Services managed under Lead Partnership arrangements by South Ayrshire Integration Joint Board are projected to be in line with budget. 3.2 Allocation of Variance IJB Area of Service Budget £000’s Projected Outturn £000’s Variance £000’s North £000’s South £000’s East £000’s South Community Store 1,599 1,457 142 53 43 46 South Family Nurse Partnership 2,125 2,125 0 0 0 0 South Continence Team 580 722 (142) (53) (43) (46) South TOTAL 4,304 4,304 (0) (0) (0) (0) The main variances are as follows: Community Equipment Store – projected underspend of £0.142m. At period 3 there is an underspend of £0.112m. This underspend is to be maintained to offset against overspend in Continence Team. Operational Improvement Plan non-recurring funding of £0.500m to be used in 2026-27 to support whole system improvement outcomes, reducing Delayed Transfer of Care and acute beds. Family Nurse Partnership - projected to come in line with budget. Scottish Government funding allocation of £0.250m has been allocated on a non-recurring basis this financial year to support delivery of outcomes in the Tackling Child Poverty Delivery plan. Confirmation of recurring funding is expected later in the year. The additional funding will support capacity to deliver on offer FNP services to age 20 to 25 with previous care experience. An additional 1.8WTE posts were advertised with 0.8WTE recruited due to start in September. The further post will not be recruited until March 27, to fit in with scheduled training programme. Any underspend of the additional funding will be earmarked for use in 2027-28. Continence Team – projected overspend of £0.142m. Continence Supplies projected overspend of £0.142m based on prior year outturn and current spend to date. The continence team are working with the community nursing teams to reduce spend, and focussed work will commence on review of care home spend. Following this work any recurring financial pressure will be identified for review in the budget setting process for 2027-28. 43
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3.3 Recovery Plan Action No recovery action required, financial pressures within the continence team will be managed through an underspend in the community equipment store budget. Budget setting process for 2027-28 will consider the recurring financial pressure within the continence team for inclusion in the budget. 3.4 Performance Information To be further developed 4. East Ayrshire: Month 3 4.1 Services managed under Lead Partnership arrangements by East Ayrshire Integration Joint Board are projected to overspend by £0.225m in total. This equates to 0.15% of delegated Lead Partnership budget. 4.2 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 East Standby Services 414 414 0 0 0 0 East Primary Care (including dental) 141,702 142,393 (691) (256) (215) (220) East Prison and Police Healthcare 4,301 4,186 115 43 36 37 East Allied Health Professionals (Lead) 5,717 5,385 332 123 103 106 East Other Lead Service (Lead) 2,463 2,444 19 7 6 6 East Total 154,597 154,822 (225) (83) (69) (73) The main variances are as follows: • Allied Health Professions (Lead Partnership) - There is a projected underspend of £0.332m on AHPs services hosted by East Ayrshire for the current year, which mainly relates to staffing savings. Wigs is projected to be in line. • Primary Care and Out of Hours Services (Lead Partnership) - The Primary Care and Out of Hours Services £141.702m budget has a projected overspend by £0.691m at this early stage of the year due to Primary Medical Services projected overspend of £1.005m, largely due to high spend in General medical services and increased pension and sickness cover costs. Primary Medical Services payments also show high spend against premises and additional IT costs. These additional costs were partially offset by a projected underspend of £0.099m against Ayrshire Urgent Care Services and projected underspends within Primary Care Contracting and Support £0.025m. Funding had been allocated to partially offset Urgent Care Pathway costs £0.800m with projected full spend of allocation. Funding had also been allocated to Covid-19 Therapeutics of £0.067m, with projected full spend. 44
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• The projected underspend of £0.189m in Dental services that reflects that staffing numbers are running at less than establishment, alongside reduced equipment costs. • Prison and Police Healthcare (Lead Partnership) – projected underspend of £0.115m is due to reduced staffing costs. • Other Services (Lead Partnership) - The £0.019m projected underspend is due to reduced Palliative Care Services costs. 4.3 Recovery Plan Action No additional Financial Recovery Plan proposals for East Ayrshire hosted services are included within this report. Details and actions to reduce the overspend projections will be included within the next 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 45
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Integration Joint Board 20 August 2026 Subject : Ayrshire Transformation Board – Right Care, Right Place Transfer of Care Programme Update Purpose : To update IJB on the Whole System Flow Plan aligned to the Ayrshire Transformation Board Right Care, Right Place programme following completion of the Transfer of Care Business Case and to seek endorsement of North Ayrshire HSCP's contribution to implementation of the agreed programme. Recommendation : The Integration Joint Board is asked to • Note the approval and progression of the Ayrshire-wide Transfer of Care Business Case. • Note confirmation of the conditions to delegate authority to the Chief Officer to progress with operationally implementing plans as described in the update to IJB on 18 June 2026. • Note and endorse the North Ayrshire investment plans supporting delivery of Home First, Discharge Without Delay and Transfer of Care objectives, with agree performance trajectories and planned benefits/improved outcomes • Agree ongoing monitoring through the existing IJB performance and financial reporting frameworks. 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 ATB Ayrshire Transformation Board D2A Discharge to Assess DWD Discharge Without Delay HSCP Health and Social Care Partnership IJB Integration Joint Board NHS AA NHS Ayrshire and Arran PGC Performance Governance Committee Agenda Item 6 47
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1. EXECUTIVE SUMMARY 1.1 This report provides the Integration Joint Board with an update on the Whole System Flow Plan, developed through the Ayrshire Transformation Board and NHS Ayrshire and Arran Flow Assurance Board. The Ayrshire Transformation Board (ATB) continues to provide strategic leadership and oversight of whole-system transformation across Ayrshire and Arran. The Right Care, Right Place Programme remains a core component of this work and is focused on improving flow through acute and community services, reducing delays in discharge and shifting the balance of care towards community-based support. 1.2 NHS Ayrshire and Arran continues to experience significant operational pressures, including sustained high hospital occupancy, increasing delayed discharges, Emergency Department congestion and the continued use of non-standard capacity across acute hospital sites. These pressures impact on patient experience, safety, quality of care and the ability of the system to meet performance standards. 1.3 To respond to these pressures, NHS Ayrshire and Arran and the three Ayrshire Health and Social Care Partnerships together with acute services have developed a Transfer of Care Business Case. The Business Case is aligned to national policy including the Health and Social Care Service Renewal Framework, the Discharge Without Delay Programme and national priorities for Unscheduled Care. The Business Case and associated programme of improvement activity is a short term, more immediate approach and seeks to implement a Home First approach through the expansion of community capacity and redesign of discharge pathways. It is recognised that this will not fully address systemic issues and a further and final phase of implementation would be required however is seen as a positive step in shifting the balance of care and realignment of resources into community services. 1.4 At its June 2026 meeting, the IJB agreed delegated authority to the Chief Officer to progress operational plans subject to specific conditions being met. These conditions included formal pan-Ayrshire and system-wide endorsement, recurring funding formally underwritten by NHS Ayrshire and Arran or Scottish Government, assurance that there would be zero financial risk or liability to the IJB, and confirmation that plans would improve outcomes in priority areas including delayed transfers of care and unmet need. This report confirms that these conditions have been fully met and that operational plans have begun progressing towards implementation. 1.5 Phase 2 of the improvement programme, set out in the Business Case, proposes a phased approach to reducing hospital occupancy, improving flow and reducing delayed discharge through investment in community services, intermediate care, rehabilitation and discharge to assess pathways. This will support more people to receive care in appropriate community settings while helping to improve performance and sustainability across the health and social care system. 48
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1.6 North Ayrshire HSCP has been actively involved in the development of the Business Case and will contribute through expansion of social care capacity, development of discharge to assess pathways, provision of step-up and step-down care and strengthening of community alternatives to hospital admission and prolonged hospital stays. 2. BACKGROUND AND CASE FOR CHANGE 2.1 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. 2.2 The Scottish Government confirmed £10.079m funding for NHS Ayrshire & Arran in June 2025 for the Operational Improvement Plan aligned to Unscheduled Care, with a programme of initiatives progressed since that time - this is referred to as Phase 1 of the Whole System Implementation Plan. £1.081m was ring-fenced at that time for North Ayrshire to enhance hospital-based MDT capacity (£746k) and Mental Health Officer (MHO) capacity (£335k). This has been fully implemented. 2.3 An Ayrshire Transformation Board has been established in early 2026 by senior partners across Ayrshire to respond collectively to increasing financial, operational and performance pressures across health and social care. 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. 2.4 NHS Ayrshire and Arran has also stepped up a Flow Assurance Board, chaired by the NHS Ayrshire and Arran Chief Executive, to oversee key whole-system improvement areas including Discharge Without Delay, virtual capacity, Adults with Incapacity, integrated discharge hub arrangements, performance and digital, SAFER, the general medicine target model, emergency department operations improvement and mental health flow. 49
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2.5 Following mobilisation of Phase 1 of the Operational Improvement Plan enacted in 2025/26, the Transfer of Care Programme, referred to as Phase 2 of the Whole System Improvement Plan, has been developed in response to evidence demonstrating that Ayrshire and Arran continues to experience: • Higher than average lengths of stay. • High levels of delayed discharge. • Increased Emergency Department waiting times. • Ambulance turnaround delays. • High occupancy within acute hospitals. • Increased reliance on escalation and non-standard capacity. Day of Care analysis undertaken across Ayrshire and Arran identified that a significant proportion of patients occupying acute hospital beds were clinically ready for discharge but unable to leave hospital due to system constraints. The findings demonstrated that many delays are attributable to challenges across community pathways and social care capacity. NHS AA remains in escalation for financial management, the pressures in acute services, where there are unfunded ward areas and the use of additional patient spaces is contributing significantly to the Health Board’s deficit position. The Business Case sets out a programme of phased investment which will support a programme of acute bed closures and support the Health Board’s financial recovery. 2.6 Within North Ayrshire, it is recognised that the principal factors contributing to delayed discharge and reduced flow include: • Financial resource constraints. • Delays associated with complex discharge planning. • Capacity pressures within Care at Home services. • Availability and choice of care home placements. • Discharge to Assess pathway and capacity constraints. • The impact of meeting the needs of our local population with continued high demand for services. • Adults with Incapacity processes and associated legal requirements 2.7 Without significant improvement in patient flow and transfer of care arrangements, the Ayrshire and Arran acute health care system will continue to experience increasing pressure on capacity, performance and workforce sustainability. The Transfer of Care Programme therefore represents a coordinated whole-system approach to addressing some of these challenges through investment in community capacity and redesign of pathways at the interface between acute and community services. 50
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3. TRANSFER OF CARE MODEL 3.1 The Transfer of Care Programme is based upon the principles of Home First and Discharge Without Delay. The programme seeks to ensure that people are supported to return home, or to an alternative community-based setting, at the earliest point of clinical readiness wherever it is safe and appropriate to do so. 3.2 Implementation of the programme will be supported through: • Expansion of Discharge to Assess pathways. • Increased community social care capacity. • Enhanced intermediate care and rehabilitation provision. • Strengthened discharge coordination arrangements. • Improved multidisciplinary working across acute and community services. • Greater utilisation of community alternatives to hospital admission and prolonged stays. 3.3 The programme will be delivered through a phased approach: Phase 1 – Stabilisation • Phase 1 of the improvement plan was enacted in 2025/26 and focused whole system improvements on reducing delayed discharge, reducing long length of stays, improving discharge processed and stabilising existing initiatives. Phase 2 – Scaling • Phase 2 of the programme, as described within the business case, enables stabilisation of Phase 1 activity and mobilisation of short term and immediate plans to expand community social care capacity, to further develop discharge pathways and accelerate flow improvements. Phase 3 – Sustainability • Phase 3 of the programme represents the delivery of full system sustainability and the wider transformation that will be required to meet the totality of system demand. Mobilisation of Phase 3 is dependent on the successful delivery of Phase 1 and 2, and will require further development as the next stage of the programme. 4. NORTH AYRSHIRE IMPLEMENTATION PLAN 4.1 North Ayrshire HSCP's contribution to the programme focuses on expanding community social care capacity and strengthening discharge to assess arrangements to support timely discharge and reduce dependence on acute and community hospital provision. These plans have been directly developed through analysis of the specific North Ayrshire challenges and are intended to directly benefit residents of North Ayrshire. 51
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4.2 The North Ayrshire workstream(s) are focused on expansion of Care at Home and reablement capacity, further development of Discharge to Assess pathways, increased use of intermediate care pathways, development of step-up and step-down care arrangements, access to additional care home capacity where required to support flow and improved integration between acute and community services. This will be delivered through direct investment in the following areas: 1. Additional Care Home Capacity • Investment to secure up to 25 additional care home placements. • This will help reduce delays experienced by people requiring funding for ongoing 24/7 care and support following discharge. 2. Increased Care at Home Capacity • Expansion of Care at Home capacity and Reablement capacity for up to 35 Care at Home packages. • This will support more people to return home safely, linking with the MDT team in the hospital and further promote the Discharge to Assess ethos. 3. Discharge to Assess Step Down beds • Use of the Anam Cara facility, stepping up 5 vacant beds as part of North Ayrshire's integrated discharge pathway. • These beds will provide additional capacity for people who do not require an acute hospital bed but would benefit from further assessment, rehabilitation or recovery support before returning home. 4.3 The North Ayrshire investment plan is expected to deliver benefits for individuals, carers, staff and the wider health and social care system, including: • More people supported to remain at home or return home sooner. • Reduced deconditioning associated with prolonged hospital stays. • Increased access to rehabilitation and recovery-focused support. • Improved patient and carer experience through earlier discharge and reduced transfers between care settings. • Greater utilisation of intermediate care pathways as alternatives to acute admission. • Improved flow through acute hospitals and community services. • Reduced dependence on escalation beds and non-standard capacity. • Better alignment of resources with Home First principles. 52
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5. PERFORMANCE TRAJECTORIES AND IMPROVEMENT MEASURES 5.1 The Transfer of Care Programme is underpinned by a set of phased improvement trajectories which are intended to demonstrate the expected impact of investment in community capacity, discharge pathways and acute flow. These trajectories provide a framework for monitoring whether the programme is delivering the required improvement in delayed discharge, non-delay discharge activity, Emergency Department performance and ambulance turnaround. 5.2 North Ayrshire Health and Social Care Partnership Trajectories The North Ayrshire trajectories show the expected sustained reduction in delayed discharge levels across both acute and community hospital settings during 2026/27. These trajectories will be used to monitor whether the additional community capacity is supporting improved discharge flow and reducing the number of people delayed in hospital or other care settings. The trajectories have been set by the HSCP based on an assessment of when additional capacity will become available, including factoring in recruitment timescales. North Ayrshire Trajectory Jun 26 Jul 26 Aug 26 Sep 26 Oct 26 Nov 26 Dec 26 Jan 27 Feb 27 Mar 27 Acute Delayed Discharge Trajectory 81 62 67 67 67 58 54 52 50 49 Non-Acute Delayed Discharge Trajectory 48 44 43 42 42 39 38 37 36 36 TOTAL 129 106 110 109 109 97 92 89 86 85 For August 2026, delayed discharge performance within the North Partnership is on target and aligned with the agreed trajectory, with 67 acute delays and 41 non-acute delays recorded for the reporting period. 5.3 NHS Ayrshire and Arran Acute Services Trajectories The acute trajectories provide a broader set of whole-system measures, including non-delay discharges, Emergency Department performance, Scottish Ambulance Service turnaround and daily average 8-hour and 12-hour breaches. These measures are included to ensure performance improvements are assessed across the whole urgent and unscheduled care pathway, not solely through delayed discharge performance. 53
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Acute Performance Measure Apr- Jun 26 Jul 26 Aug 26 Sep 26 Oct 26 Nov 26 Dec 26 Jan 27 Feb 27 Mar 27 Non-Delay Discharges 178 189 178 170 160 150 140 142 131 120 4-Hour Target 66% 66% 67% 68% 70% 72% 75% 75% 76% 78% SAS Turnaround Time 54.7% 59% 68% 70% 75% 78% 82% 85% 87% 90% 12-Hour Delays, Daily Average Breaches 31 29 25 23 22 18 14 14 12 8 8-Hour Delays, Daily Average Breaches 57 42 38 34 30 26 22 22 12 10 ED performance continued to be challenged throughout July, with overall performance increasing slightly to 54.7% of all patients being admitted, discharged or transferred within 4 hours. This small improvement also resulted in a decrease in 12 hour waits, however there were still 910 across the month, an average of 29 per day, 11 at UHA and 18 at UHC. In the week ending 2nd August, 4 hour performance increased again to 57.8% overall, however 12 hour waits remain high, with an average of 30 per day, 13.6 per day at UHA and 16.4 per day at UHC. These long waits for admission continue to have a direct impact on the assessment and treatment of newly arriving patients, particularly those arriving by ambulance. The most recent SAS operational publication (5th August) shows that Ayrshire and Arran are still above the Scottish median with a turnaround time of 55 mins, compared to 49 mins nationally. Whilst this is an improvement from the previous week (1 hr 4 mins) challenges remain at both sites but particularly at UHC with a median of 58 mins, compared to 49 mins at UHA. 5.4 A reporting and accountability framework will be established to support delivery of the agreed trajectories, and this will be supported by the development of a local reporting framework. Reporting will be aligned through the Performance Governance Committee, Scottish Government Assurance Board, the 3 Integration Joint Boards and Ayrshire Transformation Board. This framework will require clear ownership, escalation routes and evidence of progress against trajectories, including accountability for the Director of Acute Services and Chief Officers in respect of the agreed areas of delivery. 54
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6. PROPOSALS 6.1 It is proposed that the IJB: • Note the approval and progression of the Ayrshire-wide Transfer of Care Business Case. • Note confirmation of the conditions to delegate authority to the Chief Officer to progress with operationally implementing plans as described in the update to IJB on 18 June 2026. • Note and endorse the North Ayrshire investment plans supporting delivery of Home First, Discharge Without Delay and Transfer of Care objectives, with agree performance trajectories and planned benefits/improved outcomes • Agree ongoing monitoring through the existing IJB performance and financial reporting frameworks. 6.2 Anticipated Outcomes Implementation of the Transfer of Care Programme is expected to deliver improvements across four key domains – Performance, Quality and Safety, Population Health and System Sustainability. 6.3 Measuring Impact Impact will be monitored against the agreed trajectories and delivery milestones included in the approved Right Care, Right Place business case as described in section 5. Regular updates on implementation and performance will be provided and the North Ayrshire IJB will retain responsibility for evidencing impact through its statutory and local governance arrangements. 7. IMPLICATIONS 7.1 Financial The Transfer of Care Programme is supported through a combination of recurring Scottish Government funding, non-recurring transitional funding and planned savings associated with reduced acute bed utilisation. The programme is designed to support a planned transfer of resources from acute services into community-based models of care, facilitating the closure of unfunded acute hospital beds. 55
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The financial planning identifies the following North Ayrshire Phase 2 investment areas: North Ayrshire Phase 2 Investment Area Planned Capacity 2026/27 Cost Full Year Cost Care Home Places 25 placements £600,000 £800,000 Care at Home / In-house Reablement 35 packages £787,500 £1,050,000 Anam Cara Discharge to Assess Step Down Model 5 placements £274,500 £366,000 TOTAL £1,662,000 £2,216,000 This is in addition to the Phase 1 investment of £1,078k for North Ayrshire which has now been confirmed as recurring investment as part of the business case. Bringing the total additional recurring funding to £3,294k for North Ayrshire. This funding has been confirmed as recurring, and whilst we have signed up to shared plans to deliver on performance improvement which the Partnership are confident to deliver on, the provision of funding is not contingent on the performance improvements being delivered in full. Written confirmation has been received that NHS Ayrshire and Arran will meet the agreed recurrent costs of Phase 1 and 2 delivery and that the IJB and Council will not be liable if the anticipated acute savings, occupancy reductions or efficiency assumptions are not achieved. 7.2 Human Resources Delivery of the programme will require expansion and redesign of community-based workforce capacity alongside changes within acute hospital services. Workforce planning will be undertaken on a phased basis to ensure staffing arrangements remain aligned to service redesign and changing patterns of demand. The programme aims to: • Strengthen community and multidisciplinary services. • Support recruitment to priority services. • Improve workforce sustainability. • Reduce reliance on temporary staffing arrangements. • Promote integrated working across organisational boundaries. All workforce implications will be progressed in partnership with staff representatives and in accordance with relevant workforce governance and consultation arrangements. 56
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7.3 Legal The Ayrshire Transformation Board and Flow Assurance Board operate within existing statutory frameworks. They do not alter the statutory responsibilities of the IJB, NHS Ayrshire and Arran or North Ayrshire Council. Any decision requiring IJB approval will continue to be progressed through existing IJB governance routes. 7.4 Equality/Socio-Economic The programme supports the delivery of care closer to home and seeks to reduce the adverse impact associated with prolonged hospital stays, particularly for older people, people with frailty and individuals with complex care needs. The Home First approach promotes independence, rehabilitation and recovery within community settings and aims to improve outcomes and experiences for individuals and carers. Equality and socio-economic impacts will continue to be monitored and assessed as individual service changes are developed and implemented. 7.5 Risk Key risks associated with implementation of the Transfer of Care Programme include: • Community capacity not increasing at the pace required to support discharge trajectories. • Recruitment and workforce challenges impacting service mobilisation. • Delays in implementation of Discharge to Assess pathways. • Ongoing Adults with Incapacity and legal process delays. • Failure to achieve anticipated reductions in delayed discharge and length of stay. • Failure to realise planned reductions in acute bed utilisation. • Financial sustainability risks should recurring funding not be maintained. • System-wide dependencies requiring coordinated delivery across NHS Ayrshire and Arran and all three HSCPs. • Cultural and operational change associated with implementation of Home First approaches. Whilst increased community capacity is expected to improve discharge performance and flow, implementation may also generate increased demand for community assessment, rehabilitation and reablement services as pathways mature and confidence increases. Monitoring arrangements will therefore include measures relating to referral volume, response times, caseloads, throughput and service capacity to ensure that community services remain able to deliver intended outcomes while sustaining performance trajectories. 57
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These risks will continue to be monitored through established governance arrangements including the Ayrshire Transformation Board, NHS Ayrshire and Arran Flow Assurance Board and local IJB governance structures. 7.6 Community Wealth Building There are no direct Community Wealth Building implications arising from this report. Where additional local capacity is commissioned or developed, opportunities to support local procurement, workforce wellbeing and community benefit should be considered. 7.7 Key Priorities The plan supports strategic priorities to shift the balance of care, reduce reliance on acute hospital provision, improve unscheduled care performance, reduce delayed transfers of care and strengthen community-based alternatives. It also aligns with the IJB’s role in ensuring that delegated health and social care functions are planned and delivered in a way that improves outcomes and makes best use of available resources. 8. CONSULTATION Senior officers from North Ayrshire Council, North Ayrshire IJB and NHS Ayrshire and Arran have been involved in development of the proposals through the Ayrshire Transformation Board and NHS Ayrshire and Arran Flow Assurance Board arrangements. Further engagement is ongoing with operational services, staff, partners and governance forums as implementation plans and the reporting and accountability framework are progressed. Caroline Cameron, Director / Chief Officer Author: Kerry Logan, Head of Service (Health and Community Care) Appendices • Appendix 1 - RCRP Business Case 58
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Page 1 of 24 Paper 06p Right Care Right Place 59
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Page 2 of 24 Ayrshire and Arran Delivering Right Care, Right Place: Transfer of Care Business Case 1.0 Introduction NHS Ayrshire and Arran is experiencing sustained system pressure, including high occupancy, delayed discharges, Emergency Department (ED) congestion and insufficient community capacity. These pressures are resulting in escalating patient safety risks, use of non-standard capacity, and challenges in delivering timely, person-centred care across both acute hospital sites. This business case seeks approval for a whole-system transfer of care model, requiring Health and Social Care Partnerships (HSCPs) to expand community-based alternatives to admission and discharge. This will support a planned and sustained reduction in acute hospital occupancy, aligned to the Unscheduled Care Operational Improvement Plan and national policy direction. 2.0. Purpose and Context 2.1 National Context This proposal aligns with: • The Health and Social Care Service Renewal Framework • The Top 10 Priorities for Unscheduled Care (2026/27) • The Discharge Without Delay (DWD) programme Collectively, these policies prioritise a shift in the balance of care from hospital to community, with a focus on improving flow, reducing delays, and delivering care closer to home. Figure 1 – Health and Social Care Strategic Objectives 60
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Page 3 of 24 Figure 2 – Top 10 Areas of Focus for Unscheduled Care Figure 3 – DWD Principles and Priorities 61
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Page 4 of 24 2.2. Local Context - Ayrshire and Arran Unscheduled Care Ayrshire and Arran has been identified as an outlier across a number of key indicators, including: • Higher than average length of stay (LOS) • High levels of delayed discharges • Increased ED waits and ambulance delays • High bed occupancy, particularly in frailty and medicine pathways The Centre for Sustainable Delivery (CfSD) has supported improvement activity since 2023, highlighting the need for system-wide redesign. Progress has been made across key areas; however, sustained improvement is constrained by limited community capacity and whole-system integration challenges The improvement actions from the CfSD Discovery exercise carried out late 2024 are set out below in Table 1 with a current update position. Table 1 - CfSD Recommendations: Summary of Current Position Recommendation Current Status / Position 1. Develop a Realistic Care Improvement Programme A 3-year Realistic Care Improvement Programme launched in April 2025. Progress includes divisional transactional programmes, unwarranted variation projects, income generation initiatives, reduction in unnecessary tests, SAFER rollout acceleration, and specialty-level reviews to improve quality, performance, and productivity. 2. Strengthen strategic and operational system relationships Key processes (e.g. MDT board rounds, LOS reviews) reset at Crosshouse with escalation to HSCP. Progress constrained by financial recovery pressures and high occupancy. Whole Systems funding supporting delayed discharge reduction and capacity improvements. Engagement strengthened via DWD programme and system-wide working. Frontline awareness is high; however, empowerment and culture change require further development. Data and digital tools (e.g. Shrewd platform, dashboards) improving visibility and performance monitoring. 3. Focus on improving patient journeys Being advanced through the multi-agency DWD programme. Work commenced May 2025 with continued engagement sessions and workshops aligned to the Whole Systems Operational Improvement Plan. Improvement resources in place for priority areas such as frailty pathways (linked to HIS workstream). Progress ongoing with strong multiagency involvement. 4. Create meaningful data packs for frontline teams Unscheduled Care (USC) dashboards and data packs developed and routinely shared via Performance and Flow Board. BI support enables analysis of trends and variation. Ward-level data (e.g. 62
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Page 5 of 24 LOS, discharge metrics) established in line with Discharge Without Delay principles. Foundations in place with further refinement underway. 5. Socialise and finalise vision and high-level aims Vision statement co-produced through leadership engagement. Decision taken to align formal launch with Whole Systems Improvement and DWD programmes to maximise impact. Positioned to support multidisciplinary working and delivery of a person-centred, “care closer to home” model. 2.1 Operational Improvement Plan In June 2025, the Scottish Government confirmed £10.079m of non-recurring funding for NHS Ayrshire & Arran to support delivery of the Unscheduled Care Operational Improvement Plan. This allocation was lower than the original submission, which had been developed to fully deliver the agreed objectives. A programme of initiatives has been in progress since late 2025/26. For the purposes of this business case, this initial period is described as Phase 1. The non-recurring nature of the funding has, however, constrained the organisation’s ability to recruit to posts and to mobilise services that require recurrent investment to be sustainable. Additional detail for Phased 1 plans is detailed in Appendix 1 to provide additional background in context of the plans set post funding allocation in August 2025. As a result, while Phase 1 activity has supported progress in specific areas, it has not delivered operational improvement at the scale or pace required to release recurring resource or to materially address the ongoing quality, safety and flow challenges within acute hospital settings across Ayrshire and Arran. The recurring funding requirement to fully deliver Phase 1 is estimated at £4.6m, against an identified recurring budget of £3.2m. There is sufficient funding to support delivery in 2026/27, primarily as a result of in-year slippage; the shortfall along with phase 2 investments will be the first call on acute bed closure savings subject to confirmation of any additional resources in 2027/28. 3.0 Case for Change This section provide the rationale and evidence on why this change is needed to improve pathways and processes across the interface, improve delayed discharges, and reduce length of stay. There are significant challenges facing the EDs and wards on both hospital sites with crowding of patients and this impacts staffs’ ability to provide dignified person-centred care. Addressing the lack of flow through and out of the acute sites is a must for the organisation. 3.1 Current pressures are creating significant risks including: • Patient deterioration and deconditioning associated with prolonged hospital stays • Overcrowding in ED and extended waits for assessment and admission 63
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Page 6 of 24 • Use of non-standard care areas, impacting dignity, privacy and safety • Delays in ambulance offload, increasing risk to patients in the community • Inability to meet key national standards for stroke, critical care and paediatric pathways • Workforce fatigue and challenges with recruitment and retention 3.2 Performance Case for Change Performance remains below national standards, driven by high occupancy and delays in discharge. This impacts: • ED 4-hour and 12-hour performance • Length of stay across key specialties • Hospital flow and patient experience A consistent approach across both acute sites has reduced variation; however, system pressures continue to limit sustained improvement. Appendix 2 provides the supporting performance data for the Transfer of Care Business Case. It outlines key trends across urgent and unscheduled care, including Emergency Department performance, ambulance flow, occupancy, length of stay and delayed discharges. Collectively, the data demonstrates the scale, trajectory and underlying drivers of current system pressures. Outlined below are critical factors highlighting the challenges of the three HSCPs. The tables below show poorer health outcomes for Ayrshire and Arran residents, the variation across HSCP areas and the different solutions to meet local population need. Metric East North South Ayrshire & Arran Scotland Population (000s) 121.5 134 112.3 367.8 5,546.90 Population Share (%) 33.00% 36.40% 30.50% 100% — Over 65s (000s) 25.2 30.9 28.9 85 1,067.00 % Aged 65+ 20.70% 23.00% 25.80% 23.10% 19.20% Population in the Least Deprived (SIMD %) 10.90% 9.70% 19.60% 13.10% 20% Population in the Most Deprived (SIMD %) 30.60% 40.90% 16.70% 30.10% 20% Working Age (16–64, 000s) 76 82.3 66.6 224.9 3,583.00 % Working Age 62.60% 61.40% 59.40% 61.20% 64.60% Male Healthy Life Expectancy (years) 55.8 52.6 58.4 55.4 59.6 Female Healthy Life Expectancy (years) 55.4 52.5 58.9 55.3 60 Children (0–15, 000s) 20.3 20.9 16.7 57.9 896.8 % Under 16 16.70% 15.60% 14.90% 15.70% 16.20% Looked After Children (per 1,000) 18.2 16.9 10.2 — 11.7 64
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Page 7 of 24 This case for change incorporates the change required to shape service redesign from varying service profiles which will need to improve outcomes and experiences for patients, staff and the wider health and care system. 3.3 Whole System Analysis (Day of Care Insight) Day of Care audit findings highlight a fundamental mismatch between acute capacity and patient need, with over a quarter of inpatients clinically ready for discharge but unable to leave hospital. South HSCP – key drivers of delay: • Limited Care at Home capacity • Delays in social work assessment and decision-making • Access to step-down and rehabilitation provision • Legal and placement processes North HSCP – key drivers of delay: • Delays associated with complex discharge planning, including Discharge to Assess (D2A) pathways and social work assessment • Limited community social care capacity (including Care at Home and care home placements) • Access to step-down and rehabilitation provision • Adults with Incapacity considerations, including requirements of associated legal processes East HSCP – key drivers of delay: • Social care capacity in the care home sector which impacts on flow across the system • Flow through social care itself in transitions home from hospital, through reablement and on to locality care at home • Persistent legal, guardianship and decision-making processes (including AWI) which slow discharge pathways • Insufficient community health capacity in district nursing and East Ayrshire Community Hospital to create further flow and rehabilitation/end of life resource Collectively, these factors indicate that current pressures are driven by system-wide capacity and process constraints, rather than hospital demand alone. 65
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Page 8 of 24 Delivery of the planned delayed discharge reduction trajectories for September and December 2026 is dependent on timely mobilisation of Phase 1 activity from early July 2026. There is a direct link between pace of implementation and delivery of trajectory milestones. Any delay to approval or mobilisation will impact the system’s ability to deliver these trajectories and realise the benefits associated with the proposed investment. 3.4 Financial Case for Change Overcrowding across the front doors is driving a financial overspend across both sites. Both the Emergency Departments regularly require additional staffing to care for the higher volume of patients safely as well as an increase in the number of one-to-one supervisions for frail and vulnerable patients. Length of stay across both acute hospital sites continues to challenge the organisation financially with unfunded wards filled with medically fit patients/ delayed discharges waiting on packages of care, placement, or step down community bed provision. Length of stay within the HSCP led community sites are also challenging leading to unavailability of downstream beds, lack of flow as associated costs. It is acknowledged there are financial pressures for the HSCPs, although these do not carry the same risks relating to clinical quality and safety being escalated on a regular bases from staff and staff side colleagues on a regular basis. Without accelerated whole-system transformation, including improved partnership working, seven-day services, reduction in delayed discharges, and investment in community-based alternatives, acute capacity will remain constrained. A coordinated, pan-Ayrshire approach is therefore essential to deliver sustainable improvement, reduce inequalities, and shift care closer to home for an increasingly complex and ageing population 4.0 Proposal This proposal sets out a structured and phased approach to redesigning service delivery across acute and community settings in Ayrshire and Arran. It responds to sustained system pressures by focusing on improving patient outcomes, experience and flow, while establishing a more sustainable and integrated operating model aligned to national policy and local population needs. 4.1 Approval Required Approval is sought for a combined Phase 1 and Phase 2 investment and delivery approach to the Unscheduled Care Programme, recognising that: • Phase 1 requires confirmation of recurring funding to sustain and stabilise existing service developments initiated through non-recurring investment • Phase 2 requires approval to proceed at pace and scale to deliver whole-system transformation and achieve the agreed performance trajectories 66
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Page 9 of 24 Approval is therefore requested to: • Enable immediate mobilisation across both phases, recognising that delivery of the September and December 2026 trajectories is dependent on implementation commencing from early July 2026 • Support the transition to a sustainable, whole-system Transfer of Care model, shifting the balance of care from acute hospitals to community-based provision • Approve the phased transfer of resources from Acute Services to HSCPs, explicitly linked to improvements in flow, length of stay and delayed discharge performance • Approve the planned and controlled reduction in acute bed capacity, including ward closures, with associated reinvestment of released resource into community services on a recurring basis as detailed in the phase 1 and 2 commitments. This approval establishes the financial and operational framework required to deliver a safe, paced transition, ensuring that community capacity is developed in advance of, and alongside, reductions in acute capacity, in line with the phased delivery model set out in this business case. Given the complex landscape in which this business case is presented, the following conditions have been stipulated by Ayrshire Integration Joint Boards (IJBs) in progressing implementation in order to provide sufficient levels of assurance: • The Plan has pan-Ayrshire and system-wide support and is formally endorsed at a meeting of the Ayrshire Transformation Board. • Funding is provided on a recurring basis, with assurance that this is formally underwritten by NHS Ayrshire and Arran or Scottish Government. This ensures there is zero financial risk or liability to the IJBs. • HSCPs are assured that plans will target improvement in performance and patient outcomes in areas of priority for the IJBs, including delayed transfers of care and unmet need. • This business case is finalised and brought back to the IJBs following the summer recess. 4.2 Models of Care The proposal is aligned to the principles of the national Discharge Without Delay programme and supports the consistent adoption of a Home First approach across Ayrshire. This approach recognises and prioritises the importance of sufficient social care capacity within our communities. It will enable individuals to be discharged at the earliest point of clinical readiness and, wherever possible, to be assessed within their usual place of residence. 67
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Page 10 of 24 Delivery will be supported through: • Discharge to Assess (D2A) pathways • Expansion of community social care capacity • Enhanced Intermediate care and rehabilitation provision • Strengthened discharge coordination arrangements 4.3 Phased Delivery Approach Delivery will follow a structured, phased trajectory: • Phase 1 (Stabilisation): Reduce delays and long stays through targeted interventions and improved discharge processes • Phase 2 (Scaling): Expand community capacity and embed new pathways • Phase 3 (Sustainability): Achieve safe reduction in bed capacity and long-term system redesign Phase 3 represents the delivery of full system sustainability and the wider transformation required to meet the totality of system demand. It will require further development of detailed plans beyond phases 1 and 2, including optimisation of community hospital provision, mental health inpatient pathways, and preventative community-based supports. Any movement to a Phase 3 model will be dependent on all stakeholders delivering the benefits articulated within this case. Phase 3 will therefore be developed as the next stage of the programme, building on the foundations established through phases 1 and 2, and will be brought forward for further approval as detailed plans and funding arrangements are confirmed. This will enable a progressive reduction in acute bed base, aligned to improvements in flow and performance which is sustainable. 4.4 Improvement Trajectory The programme will deliver: • Reduction in length of stay across key pathways • Reduction in delayed discharges towards national benchmarks • Improved ED flow and elimination of extended waits • Increased discharge rates and improved ward productivity 68
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Page 11 of 24 4.5 Whole System Transformation Area Key Actions Outputs Impact / Benefit Financial Value East HSCP Enhance community rehabilitation, enablement and advanced practice capacity through: Allied Health Professional capacity within ICT; Increase social care capacity to support flow; Advanced practice and Mental Health Officer support; Care home placements to address flow. Increased discharge capacity, improved flow capacity, improved rehabilitation and enablement availability. Further leverage from existing resource through investment addressing key reasons for delay identified in Scotland (awaiting community support, care home place, assessment/reassessment, equipment/adaptation or family choice). Accelerate flow to enable response to higher acuity needs Reduce unnecessary hospital stays and delayed discharge Increase availability of appropriate useable acute beds/reduce occupancy of high-cost acute capacity Impact on reduced average length of stay Prevention of avoidable admission Enabling functional recovery North HSCP Expansion of community social care capacity and strengthening of discharge to assess pathways including step up/step down and intermediate care Increased availability of community- based care, enhanced utilisation of D2A and intermediate care capacity, improved flow through hospital and community settings Reduction in delayed discharges and overall length of stay, improved outcomes and experience for individuals through timely, person centred discharge and more effective use of hospital capacity Significant cost avoidance through reduced bed days and improved system flow, opportunity to reinvest in sustainable community- based models of care South HSCP Enhanced intermediate care provision; Strengthening of discharge to assess pathways; Advanced practice and nursing resource to support IC and Home First approaches; Moving and Handling, appropriate access to equipment and Increased availability of community based care, access to IC beds, strengthening of pathways to facilitate discharge to assess, expanded care at home capacity, improved access to appropriate equipment, home first Increased discharge capacity and improved flow Reduction in delayed discharges and length of stay; improved outcomes for service users and carers. Efficient use of local resources – community based services aligned to community led supports Care closer to home; financially more sustainable in comparison to acute based care Workforce investment; financial impact from workforce growth/development linked to wellbeing. 69
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Page 12 of 24 person centred care. approach and linkage with acute frailty and community frailty pathways. Acute Services Address gap in service provision with 7 days frailty and COTE MDT workforce provision including psychology and AHP. Key focus on admission avoidance and timely interventions. Admission avoidance, CGAs to support system wide care delivery, 7 day AHP front door and assessment provision. Integrated discharge planning on admission to assessment units. Improved flow and discharge rates Delivery against Emergency Care Standards, GIRFE, achieve frailty standards, improve flow, reduce LOS and as a result reduce occupancy and patient safety risks arising from high occupancy Releases recurring acute costs aligned to reduced bed utilisation Whole System Resource shift/integration - Rebalancing investment towards community- based provision, with strengthened integration across health and social care services Community alternatives established - Expanded community social care capacity, Discharge to Assess (D2A) pathways, and intermediate care enabling Home First delivery Reduced hospital utilisation - Indicative reduction of approximately 129 hospital beds through improved flow and reduced delayed discharge Long-term sustainability - More sustainable whole- system model, supporting improved outcomes, reduced reliance on acute capacity, and system-wide cost avoidance The detailed trajectories against each phase of the investment areas, with timelines for delivery and bed closure plans are included as Appendix 3. Delivery of the delayed discharge reduction trajectories for September and December 2026 is contingent on plans being progressed and mobilisation commencing in early July 2026. Any delay to this timeline will directly impact the ability to deliver in line with the trajectories set out in the appendices. 5.0 Workforce Implications The delivery of the proposed phased reduction in acute bed capacity, alongside the expansion of community-based services, has significant workforce implications across NHS Ayrshire and Arran and partner HSCPs. These changes are aligned to the NHS Scotland policy direction, which supports a shift in the balance of care from hospital to community, improvement in patient flow, and delivery of care closer to home. 70
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Page 13 of 24 Across both acute hospital sites, there are existing vacancies and workforce pressures within nursing and medical staffing establishments. These vacancies, alongside anticipated natural turnover, provide an opportunity to support a planned and managed transition to a reduced inpatient bed base, avoiding the need for large-scale workforce displacement while maintaining safe staffing levels and service continuity. The phased nature of this programme allows time to undertake structured workforce planning between now and the implementation of ward closures, enabling: • alignment of workforce capacity to a smaller, more clinically appropriate inpatient footprint • use of natural attrition and vacancy management to support workforce realignment • redeployment of staff to priority areas, including front door services, frailty pathways, and community interfaces • strengthening of workforce models in areas critical to Discharge Without Delay (DWD) and Home First delivery For nursing workforce, the reduction in both core beds and non-standard escalation capacity will support a transition towards more sustainable staffing models, consistent with Health and Care (Staffing) (Scotland) Act 2019 principles, including: • improved alignment between staffing levels and patient need • reduced reliance on bank and agency staffing, particularly where non-standard beds have required staffing outwith established workforce models • improved working conditions and patient care environments For the medical workforce, the planned reduction in inpatient capacity provides an opportunity to review and optimise Consultant job plans across both hospital sites. This will support: • increased senior decision-making presence within remaining inpatient wards • more timely clinical review, discharge planning, and escalation • improved multidisciplinary team working, supporting patient flow and reduced length of stay Workforce planning will be undertaken in line with NHS Scotland workforce governance expectations and will be delivered through a phased, clinically-led approach, ensuring: • workforce changes are aligned to service redesign and capacity changes, not in advance of them • safe staffing levels are maintained at all times, with oversight through appropriate governance arrangements • workforce risks are actively managed through programme and Board-level assurance structures All workforce planning and implementation will be progressed in full partnership with Staff Side organisations and in collaboration with the operational and professional leads for each area. 71
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Page 14 of 24 This will ensure that all changes are: • professionally led and clinically safe • compliant with national workforce policy and legislation • informed by appropriate engagement, consultation, and communication processes This programme presents an opportunity not only to align workforce to a more sustainable model of care, but also to deliver against wider NHS Scotland ambitions to: • improve staff experience and wellbeing • reduce reliance on temporary staffing • strengthen integrated, multidisciplinary working across health and social care Overall, the proposed approach supports a managed transition of workforce aligned to system transformation, ensuring that staffing models evolve in parallel with the shift towards a Home First, community-focused model of care, while maintaining patient safety, service quality, and workforce sustainability. 6.0 Financial Implications The financial model underpinning the Transfer of Care programme has been developed to provide clear line of sight between investment, delivery of capacity, and the release of recurring savings, ensuring that the proposed transformation is both affordable and low risk at a system level. The programme requires targeted pump-priming investment to expand community services and enable transformation. The model represents a shift from high-cost reactive care to more efficient, preventative community-based provision, delivering long-term financial sustainability. This investment will: • Support safe reduction in acute bed utilisation • Release recurring acute costs • Enable reinvestment across the system 6.1 Funding Position and Profile The programme is supported by a combination of Scottish Government funding, non- recurring carry forward (in 2026/27), and planned system savings, providing a robust funding envelope across the transition period. Total resourcing for 2026/27 is £10.2m, rising This includes: - £3.2m recurring Scottish Government funding aligned to Unscheduled Care priorities - £4.0m non-recurring carry forward supporting transition and pump-priming investment - £2.2m indicative additional funding from 2027/28 - £3.0m–£8.8m of gross savings from acute bed closures, which support the reinvestment in out of hospital services and financial recovery within the Health Board 72
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Page 15 of 24 6.2 Investment Requirements (Spend Profile) The programme requires targeted investment across Phase 1 and Phase 2 to expand community capacity, improve flow, and enable the shift to a Home First model. Total planned spend is £10.2m in 2026/27, reducing to £9.3m on a recurrent basis. 6.3 Savings and Cost Avoidance The financial model is predicated on the progressive release of savings from reduced acute bed utilisation, aligned to improvements in flow and length of stay. The programme supports a total reduction of approximately 129 beds across the acute system, delivered through a combination of whole-system improvements and acute service redesign. Failure to deliver these bed reductions all other things being equal leaves a deficit for the health board to fund of £3m in 2026/27 rising to £4m in 2027/28. Of these, 98 beds are directly linked to the delivery of delayed discharge reduction trajectories and are supported by clearly identified financial savings of £3.0m in 2026/27, rising to £8.8m recurrently. These reductions are dependent on the successful expansion of community capacity and delivery of the Transfer of Care model, enabling patients to be discharged at the point of clinical readiness. The remaining 31 beds relate to non-standard capacity, including escalation beds and additional ward spaces that are routinely opened to manage congestion and variability in demand. The planned reduction of these beds will be achieved through improvements within acute services, including reduced length of stay, more timely clinical decision- making, and improved flow across the inpatient pathway within the financial year. While these 31 beds are not associated with a defined recurrent budget line, they are sustained in practice through increased reliance on bank and agency staffing, reflecting their position outside established ward baselines. As these beds are removed, a corresponding reduction in premium staffing costs is expected, and this will be closely monitored to ensure delivery of the anticipated financial and operational benefits. Taken together, this approach provides a balanced and deliverable plan, where: • 98 beds are released through whole-system change and community capacity expansion, and • 31 beds are released through improved efficiency and patient flow within acute services This ensures that the overall bed reduction is both clinically safe and operationally achievable, while supporting improved patient outcomes, reduced overcrowding, and more sustainable use of resources. 73
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Page 16 of 24 The full funding profile is noted in the table below. 6.4 Overall Financial Position The programme delivers a managed transition from short-term pressure to recurrent sustainability. While 2026/27 reflects a break even in-year position due to the timing of the phased bed closures, a recurring surplus of approximately £4.8m is achieved as transformation benefits are realise, as the Health board is underwriting the IJB’s risk in terms of funding these commitments recurrently the surplus is used to support Health Board financial recovery. The expenditure in phase 2 is assumed to be a nine month in year spend. Late commencement of much of this is likely and this could generate slippage. 6.5 Financial Risk and Assurance The model minimises financial risk through phased investment, conditional bed closures, managed double running, and clear linkage between savings and deliverable service changes. Overall, the programme demonstrates a financially viable and sustainable model, providing assurance that investment will translate into measurable, recurring benefits while maintaining control of financial risk. Funding will be released on a monthly basis subjected to confirmation of associated spend and recruitment activity where applicable as identified in the plan. 7.0 Outcomes and Benefits The programme will deliver measurable improvements across four key domains as outlined below and set out in more detail within Appendix 2. Financial profile East North South Acute Total 26/27 Total Recurring Phase 1 400 258 688 380 1,725 - Phase 2 300 300 - Total Non-recuring costs 400 258 988 380 2,025 - Phase 1 883 1,078 1,180 1,526 4,667 4,667 Phase 2 (9 months 26/27) * 678 1,662 1,148 3,487 3,487 Total Recurring costs (26/27) 1,561 2,740 2,327 1,526 8,154 8,154 Phase 2 (FYE of the 9 months above) 226 554 383 - 1,162 Total Committed Recurring costs (27/28 onwards) 1,787 3,294 2,710 1,526 8,154 9,317 TOTAL COSTS 2,187 3,552 3,698 1,906 10,180 9,317 Funding Available (£000'S) Total 26/27 Total Recurring Non-recurring carry forward 3,986 SG allocation 3,200 3,200 Additional 27-28 SG £30m investment 2,175 Total bed closure savings 3,020 8,807 TOTAL FUNDING - - - - 10,206 14,182 BALANCE (retained) 26 4,865 £000's 74
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Page 17 of 24 Performance • Reduced length of stay • Improved ED performance • Reduction in delayed discharges Quality and Safety • Reduced overcrowding and corridor care • Improved dignity and patient experience • Reduced harm from prolonged stays Population Health • Increased independence • More care delivered at home • Reduced reliance on institutional care System Sustainability • Reduced acute bed dependency • Improved workforce utilisation • Better alignment to safe occupancy levels 7.1 Quality, Safety and Cost Avoidance Benefits The proposed reduction of 129 beds represents a significant quality improvement opportunity and a substantial source of cost avoidance across the whole health and social care system. Current data demonstrates that patients who are clinically ready for discharge can experience prolonged delays whilst awaiting care at home packages, social work assessment, guardianship processes, rehabilitation or longer-term care arrangements. Across Ayrshire and Arran, delays associated with care at home provision range from 5.8 to 37.2 days, whilst delays associated with social work and guardianship processes range from 33.6 to 65.6 days. Consequently, many individuals remain within an acute hospital bed for between one and two months after they have been deemed medically fit for discharge. Prolonged hospitalisation is associated with a range of recognised and avoidable harms including deconditioning, falls, pressure ulcers, healthcare associated infections (HAIs), loss of independence and deterioration in physical and cognitive function. These harms are particularly significant for frail and older people and can result in increased dependency, poorer outcomes and a greater likelihood of requiring ongoing care and support following discharge. National evidence demonstrates that pressure ulcers can increase hospital length of stay by up to 10 days and incur substantial treatment costs, whilst falls continue to represent one of the most significant causes of avoidable harm for 75
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Page 18 of 24 older adults. Importantly, Scottish evidence estimates that approximately 60% of the total costs associated with falls are borne by social care services through increased care needs, care home placements and long-term support requirements. Reducing delayed discharges and supporting earlier transfer of care will therefore deliver benefits that extend well beyond the release of acute bed capacity. Earlier discharge to the right care setting will reduce exposure to hospital-associated harm, maintain independence, support rehabilitation and improve patient experience and outcomes. It will also reduce the risk of escalation in care needs, thereby avoiding additional costs across both NHS Ayrshire & Arran and the three Health and Social Care Partnerships. There is also a direct link between reduced length of stay and infection prevention. NHS Ayrshire & Arran's Infection Prevention and Control review estimates that healthcare associated infections account for approximately 6,758 excess bed days annually and cost in excess of £5.4 million per annum. Extended hospital stays increase patients' exposure to infection risk, antimicrobial treatment and associated complications. By reducing unnecessary hospital days and improving patient flow, the Transfer of Care model will contribute to reducing infection risk, avoiding excess bed days and supporting safer, more effective care. Taken together, the reduction in delayed discharges should be viewed as a whole-system quality and safety intervention that delivers recurring cost avoidance through reduced hospital-associated harm, lower treatment costs, reduced demand for long-term care, improved utilisation of acute and community resources and better outcomes for the population of Ayrshire and Arran. The anticipated benefits will be realised across both health and social care through improved patient flow, reduced dependency, enhanced independence and a shift in the balance of care towards community-based support in line with the Health and Social Care Service Renewal Framework. 8.0 Risks and Mitigations The delivery of the proposed transfer of care model represents a significant whole-system transformation and, as such, carries a number of strategic, operational and financial risks. These risks have been carefully considered within the development of the business case, and mitigating actions have been embedded within the programme design, phased delivery approach, and governance arrangements. 8.1 Strategic and Operational Risks A key risk relates to the ability of community services to scale at the pace required to support increased discharge volumes and the shift towards a Home First model. The business case explicitly recognises that current system pressures are driven by whole- system constraints, particularly limited Care at Home capacity and delays in social care provision. To mitigate this, a phased delivery approach has been adopted, ensuring that increases in discharge activity, including the planned expansion of Discharge to Assess (D2A), are aligned with demonstrable increases in community capacity. Investment in Care at Home, intermediate care and reablement services forms a core component of the proposal, and 76
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Page 19 of 24 progression to acute bed reduction will be conditional on evidence of sustained improvement in flow, length of stay and delayed discharge performance. Daily MDT and IDT processes will provide real-time oversight of patient flow, with escalation through the Flow Assurance Board where constraints are identified. A related risk is the ability to deliver consistent seven-day working across both acute and community services, which is essential to improving patient flow and enabling timely discharge. The programme addresses this directly through the development of Acute Frailty Units operating on a 7-day basis, enhanced weekend discharge processes, and planned consultant job plan changes in Phase 2. These changes are aligned to Discharge Without Delay principles and will be monitored through performance metrics including weekend discharge rates and length of stay variation. Workforce capacity represents a further critical risk, particularly in relation to AHP provision, frailty services, and community-based care delivery. The business case includes a defined workforce plan, with recruitment to Phase 1 posts already underway and a clear focus on addressing gaps at the front door, in frailty pathways and within the medicine bed base. Alongside recruitment, the programme incorporates workforce redesign, including new roles and skill mix changes, to support sustainable delivery. Workforce assumptions and risks will be routinely reviewed through programme governance to ensure alignment with activity and demand. The reduction of the long length of stay (LLOS) cohort is a key enabler within Phase 1, but also presents risk given the complexity of these patients, including legal, housing and care placement challenges. This risk is being mitigated through a targeted, system-wide approach, including dedicated oversight of the top 75 LLOS patients across all three HSCPs, supported by regular review and escalation processes. This work is integrated with the wider Discharge Without Delay programme, ensuring earlier identification and proactive management of delays. Effective implementation of Integrated Discharge Teams (IDTs) is also critical. There is a risk that without consistent application of MDT board rounds and clear accountability for discharge decisions, delays and duplication may persist. To address this, the programme includes a standardised operating model aligned to DWD principles, supported by ward- level performance data, routine LOS reviews at 72 hours and 7 days, and strengthened clinical leadership. These arrangements will ensure discharge planning is embedded as a core component of daily clinical practice. Digital and information sharing constraints are recognised as a further risk, particularly given current system fragmentation and the impact this has on timely discharge planning. The business case outlines ongoing work to improve data visibility, including the development of dashboards and meaningful data packs for frontline teams. This will be supported through a dedicated digital workstream, ensuring improved access to real-time information and consistent documentation across the system. Finally, there are inherent patient safety risks associated with implementing a D2A / Home First model, particularly for individuals with complex needs or where community capacity is under pressure. These risks will be mitigated through robust multidisciplinary assessment, 77
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Page 20 of 24 the use of Comprehensive Geriatric Assessment within frailty pathways, timely capacity assessments, and access to 7-day community support. Patient outcomes, including readmissions and experience, will be closely monitored to ensure that the model delivers safe, person-centred care. 8.2 Financial and Resource Risks A critical risk for the programme relates to the transfer of financial resources from Acute Services to HSCPs, which underpins the shift in the balance of care. There is a risk that funding may be insufficient, non-recurrent, or not aligned to actual demand, potentially leading to financial instability within HSCPs and an inability to sustain community capacity. The business case directly addresses this through a phased and planned transfer of resources, linked to delivery of service change and capacity expansion. Financial risk associated with delivery does not sit with the IJBs provided that the recovery trajectories identified are achieved. Financial modelling has been developed to demonstrate how reductions in acute bed utilisation will release resources for reinvestment in community services. Importantly, no significant reduction in acute capacity will be undertaken without assurance that community capacity is in place and sustainable, ensuring that risks associated with cost shunting or system destabilisation are minimised. There is also recognition of double running costs during the transition period, where both acute and community services may need to operate in parallel. This has been built into the financial planning assumptions, with pump-priming investment identified to support the transformation phase. This is expected to be time-limited, with clear trigger points linked to flow improvements and bed reduction milestones. A further financial risk relates to the ability to realise cash-releasing savings from reductions in length of stay and delayed discharges. The programme mitigates this by focusing on whole ward and service redesign, rather than incremental bed reductions, ensuring that savings are realised at scale and aligned to service change. 8.3 System and Interdependencies and Cultural Change The success of the programme is dependent on strong alignment between acute services and HSCPs. There is a risk that improvements in one part of the system are not matched by capacity or change in another, resulting in continued bottlenecks. This is mitigated through the adoption of a whole-system transformation approach, with shared objectives, joint accountability, and integrated performance monitoring. Cultural change is also a key risk, particularly the need to shift from hospital-based assessment to a Home First model. The programme addresses this through clinical leadership, ongoing engagement, and embedding Discharge Without Delay principles into routine practice, including MDT board rounds, LOS reviews and discharge planning processes. Sustained improvement will depend on consistent application of these principles across all teams. 78
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Page 21 of 24 9. Governance, Oversight and Assurance Robust governance and oversight arrangements are in place to ensure that risks are actively managed and mitigations delivered. As set out within the business case, oversight will be provided through: • Ayrshire Transformation Group – providing strategic leadership and oversight of delivery, including financial alignment and system-wide risk • Flow Assurance Board – providing monthly executive level oversight of delivery, performance and resource transfer. • DWD Programme Board – providing monthly operational oversight of patient flow, discharge performance and escalation of risks • Defined workstreams – responsible for delivery of key enablers and monitoring of associated risks These structures are supported by routine performance reporting, including indicators such as length of stay, delayed discharges, discharge rates and occupancy. This ensures real- time visibility of system performance, early identification of emerging risks, and the ability to take corrective action where required. Overall, the programme is designed as a controlled and phased transformation, with clear dependencies, defined enablers and strong governance. Risks are fully aligned to the case for change and delivery model set out in the business case, and mitigating actions are embedded within programme delivery. The combination of: • phased implementation • conditional financial transfer • investment in community capacity • and robust governance and oversight provides a high level of assurance that risks can be effectively managed, and that the programme can be delivered safely while improving patient outcomes, system performance and long-term financial sustainability. In addition to the above it is proposed that each organisation via their structures will be accountable for the delivery of their element and trajectories identified in the programme. This will include a performance objective for the responsible Director and through the line. Full details outlining roles and responsibilities is set out within Appendix 4. 79
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Page 22 of 24 10.0 Conclusion NHS Ayrshire and Arran continues to experience sustained and escalating system pressure, with overcrowding across both emergency departments and inpatient wards now a persistent feature of daily operations. This is resulting in an increasing number of patients being cared for in non-standard care environments, including corridor spaces and surge areas, which fundamentally compromises privacy, dignity and the ability to deliver safe, person-centred care. Patients who remain in these environments, or who experience prolonged stays in hospital due to delayed discharge, are exposed to avoidable harm, including deconditioning, increased risk of falls, infection, and loss of independence. These impacts are most acutely felt by older people and those with complex needs, who represent a significant proportion of the current inpatient population. The current model is therefore not only operationally unsustainable, but also clinically and ethically unsatisfactory. The position is further compounded by the number of individuals who remain in hospital for extended periods despite being clinically ready for discharge. For these patients, hospital is no longer the most appropriate setting for care. This raises important considerations in relation to: • safeguarding individual rights and wellbeing • avoiding unnecessary institutionalisation • ensuring timely access to appropriate care and support in the community • supporting people to live as independently as possible, in line with a Home First approach Extended delays in discharge represent a system failure to meet these responsibilities, with individuals experiencing prolonged hospital stays due to capacity and process constraints rather than clinical need. This underlines the urgency of shifting to a model that enables timely, safe and person-centred transitions of care. Phase 1 of the Unscheduled Care Programme has provided important insight and has enabled progress in targeted areas; however, the non-recurring nature of the funding has limited the scale, pace and sustainability of improvement. As a result, the programme has not yet delivered the system-level change required to reduce length of stay, eliminate delays, or relieve pressure on acute services. Approval of a combined Phase 1 and Phase 2 approach is therefore essential. This will: • secure the recurring investment required to sustain and stabilise Phase 1 • enable rapid progression to Phase 2, delivering transformation at the scale required • support immediate mobilisation to meet the September and December 2026 trajectories • establish a whole-system Transfer of Care model, aligned to Discharge Without Delay and Home First principles 80
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Page 23 of 24 Central to this transformation is the planned and phased reduction of acute bed capacity, including ward closures, enabled by: • demonstrable improvements in flow and discharge performance • expansion of community and intermediate care capacity • strengthened partnership working across Acute Services and HSCPs This will be accompanied by a phased transfer of resources from acute services to HSCPs, ensuring that investment follows the patient and supports the shift in the balance of care. This approach will enable the system to move from a position of reactive, high- cost acute provision to a more sustainable, preventative and community-focused model. While this business case focuses on Phases 1 and 2, it is recognised that further transformation will be required to deliver full system sustainability. This will be progressed through Phase 3 of the programme, which will set out the longer-term investment and service redesign required across the wider system. Critically, this programme is not solely about performance improvement or financial sustainability. It is about restoring the quality, safety and dignity of care for patients, ensuring that: • patients are treated in appropriate care environments • unnecessary hospital stays are avoided • discharge is timely, planned and supported • care is delivered as close to home as possible Without approval and immediate mobilisation, the organisation will be unable to deliver the required trajectories, and the risks associated with overcrowding, delayed discharge and poor patient experience will continue to escalate. This business case therefore sets out a clear, phased and deliverable plan to address current system pressures, improve outcomes and experiences for patients and staff, and establish a sustainable whole-system model of care for the future 11. Recommendation It is recommended that the Board: 1. Approve the full programme of investment and delivery across Phase 1 and Phase 2 of the Unscheduled Care Programme, recognising that: • Phase 1 requires confirmation and approval of recurring funding to sustain and stabilise existing improvements • Phase 2 requires approval to proceed at pace and scale to deliver the planned whole-system transformation and associated performance trajectories 81
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Page 24 of 24 2. Approve the transition to a whole-system Transfer of Care model, enabling delivery of a Home First approach through: • Expansion of community-based capacity • Embedding Discharge to Assess (D2A) and Discharge Without Delay (DWD) principles • Strengthened integration between Acute Services and HSCPs. • The planned and controlled reduction in acute bed capacity, including ward closures • Demonstrable establishment of sustainable community capacity 3. Note that delivery of the September and December 2026 performance trajectories is contingent upon immediate approval and mobilisation, including: • Implementation commencing from early July 2026 • Timely recruitment and service mobilisation across Phase 1 and Phase 2 • Coordinated system-wide execution 4. Support the governance and assurance arrangements outlined within the business case, including oversight of: • Phased delivery and associated risks • Financial performance and resource transfer • Achievement of agreed outcomes and benefit 82
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Integration Joint Board 20 August 2026 Subject : Distress Brief Intervention Service Purpose : Approval of options presented in relation to the funding arrangements for the above service. Recommendation : The Integration Joint Board is asked to: (i) determine firstly whether to suspend Standing Orders in accordance with Standing Order 11.1 in order to consider this Item, given the terms of Standing Order 10.1 (limit on IJB’s ability to alter, delete or rescind a decision of the IJB within six months from the decision); and if so (ii) consider the Scottish Government request to continue the Distress Brief Intervention Service to 31 March 2027 with Scottish Government funding of £157,500 for the period 1 September 2026 to 31 March 2027; and (iii) agree one of the options set out in section 3 of this report. 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 IJB Integration Joint Board DBI Distress Brief Intervention 1. EXECUTIVE SUMMARY 1.1 In March 2026, as part of the approved budget, the Integration Joint Board agreed that the Distress Brief Intervention Service would cease on 31 August 2026. Following that decision, the Health and Social Care Partnership undertook the necessary planning and contractual arrangements to bring the service to an end in accordance with the IJB’s decision. Agenda Item 7 83
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1.2 Any decision to alter, delete or rescind that decision (of 13 March 2026) would fall within scope of Standing Order 10.1 given that it was taken within six months. If the Integration Joint Board wishes to consider the substance of this matter, it requires, prior to consideration of the Item, to suspend the applicable Standing Order, in accordance with the procedure set out at Standing Order 11.1. 1.3 The Scottish Government has now written to the Chief Officer requesting that the IJB reconsider continuation of the DBI Service. The correspondence confirms that Scottish Government can provide £157,500 for the seven-month period from 1 September 2026 to 31 March 2027 and will work with the DBI Central Team and Ayrshire and Arran partners to consider arrangements for 2027/28. 1.4 In the interim, and to allow the IJB to consider the request from Scottish Government, delegated authority has been exercised to extend the current contract with the service provider to 30 September 2026 to maintain continuity of provision while the IJB considers its position. 2. BACKGROUND 2.1 The Distress Brief Intervention Programme provides a structured response for people experiencing emotional distress. The model involves an initial compassionate response by trained frontline staff, followed where appropriate by referral to a commissioned Level 2 service which contacts the person within 24 hours and provides time-limited community-based support, including problem solving, distress management planning, supported connections and signposting. The budget proposal to cease the service from the end of August was brought forward in response to the significant financial challenges facing the Integration Joint Board (IJB). The proposal followed a robust options appraisal undertaken by Mental Health Services, which included engagement with colleagues from East and South Ayrshire HSCPs. An Equality Impact Assessment (EQIA) accompanied the proposal and clearly recognised both the value of the service and the potential adverse impact of its withdrawal. The recommendation was therefore presented as the least detrimental option available within the circumstances, rather than as a reflection on the quality, effectiveness or importance of the service itself. The proposed saving formed just one element of a wider package of savings measures approved by the IJB in March as part of its statutory duty to set a balanced budget. The decision should therefore be viewed within the context of the broader financial recovery measures required across the Partnership, rather than as an indication that the service was not delivering positive outcomes for those who used it. The Scottish Government has advised that it is able to provide £157,500 to support continuation of the Ayrshire and Arran DBI Programme for the remainder of 2026/27. 84
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The funding relates to the seven-month period from 1 September 2026 to 31 March 2027. The correspondence also confirms a commitment to work with the DBI Central Team and Ayrshire and Arran to consider how DBI may be continued during 2027/28. The offer of funding from Scottish Government is specifically to continue to deliver the DBI programme and is not available to support any of the wider IJB financial pressures. 3. PROPOSALS 3.1 IJB is asked to consider the following options :- Option 1: Agree to accept the Scottish Government funding of £157,500 and continue the DBI Service from 1 September 2026 to 31 March 2027, subject to completion of any necessary contractual arrangements with the current provider. This would maintain the service for the remainder of the financial year and allow NHS Ayrshire and Arran partners to work with Scottish Government and the DBI Central Team on potential arrangements for 2027/28. Any continuation of the service beyond 31 March 2027 would be reliant on further funding being made available. Option 2: Agree to continue the DBI Service only to 30 September 2026, reflecting the temporary contract extension already put in place, and thereafter proceed with the cessation of the service. This would allow short-term continuity but would not take up the full funding offer from Scottish Government. Option 3: Confirm the previous decision made in March 2026 and proceed with cessation of the DBI Service. The Partnership would continue to manage the implications of ending the service, including communication with the provider, referring agencies, staff and relevant partners. The Scottish Government’s request is brought before the IJB for consideration. However, as this matter was not included within the planned business of the meeting and is within six months of a previous decision by the IJB, consideration of the request will require the suspension of Standing Orders. If required, an appropriate Direction will be issued to NHS Ayrshire and Arran following the IJB decision. 85
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3.2 Anticipated Outcomes If Option 1 is approved, the anticipated outcome is continuity of DBI provision to 31 March 2027, with Scottish Government funding supporting delivery for the remainder of the financial year. This would provide time for further national and local discussion on the longer-term position for 2027/28. Any continuation of the service beyond 31 March 2027 would be reliant on further funding being made available. 3.3 Measuring Impact Impact will be monitored through existing contract management and performance reporting arrangements, including referral activity, response times, service uptake, outcomes reported by the provider, and any issues arising through operational delivery. Any further proposals for 2027/28 would be brought back to the IJB as required. 4. IMPLICATIONS 4.1 Financial Scottish Government has confirmed funding of £157,500 for the period 1 September 2026 to 31 March 2027. Any additional costs, contractual liabilities or funding gap beyond the confirmed Scottish Government allocation would require to be clarified through contract and finance due diligence. There is currently no confirmed Scottish Government funding for 2027/28, although Scottish Government has committed to working with Ayrshire and Arran partners and the DBI Central Team to consider continuation. 4.2 Human Resources There are no direct Health and Social Care Partnership staffing implications identified from the continuation of the commissioned service. There may be implications for the service provider depending on the option approved, particularly in relation to workforce retention, mobilisation or service cessation planning. 4.3 Legal Any decision to extend or vary the current contractual arrangement must be managed in accordance with procurement, contract and governance requirements. The temporary extension to 30 September 2026 has been made under delegated authority to maintain continuity pending IJB consideration. 4.4 Equality/Socio-Economic Continuation of DBI may support people experiencing emotional distress, including those who may face barriers to accessing mainstream services. If the service ceases, there may be equality and socio-economic implications for people who benefit from early, community-based support. Any longer-term proposal should consider whether an equality impact assessment is required. 86
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4.5 Risk The principal risks relate to service continuity, contractual arrangements, public and partner communication, and uncertainty regarding funding beyond 31 March 2027. Accepting the Scottish Government funding reduces the immediate risk of service cessation but does not remove the longer-term sustainability risk. The overall risk is assessed as moderate. 4.6 Community Wealth Building Continuation of the service may contribute to community wellbeing by providing local, person-centred support for people experiencing distress and by strengthening connections with community-based supports and third sector provision. 4.7 Key Priorities The proposal supports strategic priorities relating to early intervention, prevention, mental health and wellbeing, and supporting people to access the right help at the right time. 5. CONSULTATION The Scottish Government request follows recent discussions with NHS Ayrshire and Arran partners. Further engagement will be required with the current provider, DBI Central Team, Scottish Government, operational leads and relevant referring agencies depending on the option approved by the IJB. Caroline Cameron, Director / Chief Officer Author: Karen Andrews, Team Manager (Governance) Appendices • Appendix 1: Letter from Scottish Government regarding Distress Brief Intervention Programme in Ayrshire and Arran 87
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St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot αβχδε αβχδεφγ α Mental Health and Social Care & National Care Service Development Directorate Donna Bell, Co-Director E: donna.bell@gov.scot αβχδ To: Caroline Cameron carolinecameron@north-ayrshire.gov.uk Cc: Karen Andrews kandrews@north-ayrshire.gov.uk 24/07/2026 Dear Caroline, Distress Brief Intervention Programme in Ayrshire and Arran Thank you for the recent discussions regarding the Distress Brief Intervention (DBI) Programme within Ayrshire and Arran. We are able to provide £157,500 for the remainder of the year running through to March 2027. We are also happy to provide a further letter confirming this to allow for an extension with Penumbra to be put in place if that would be helpful. Given the above, I would be grateful if you could engage with your Integrated Joint Board and ask them to consider the request to continue the DBI programme with £157,500 being provided for the 7 months of 1st September 2026 through to 31st March 2027 at their next meeting. Scottish Government would also commit to working, alongside DBI Central team and Ayrshire and Arran, for the following financial year (2027-28) to look at how DBI can be continued. Please let me know if you require any more information to enable you to progress this. Yours sincerely Donna Bell Co-Director of Mental Health and Social Care & National Care Service Scottish Government 88
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Integration Joint Board 20 August 2026 Subject : IJB Standing Order Review Purpose : This report seeks the Integration Joint Board’s:- • Approval Recommendation : That the Integration Joint Board agrees to: (1) approve, with effect from 1 September 2026, the revised Standing Orders relating to meetings of the IJB at Appendix 1. 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 IJB Integration Joint Board 1. EXECUTIVE SUMMARY 1.1 This report seeks the IJB’s approval of revised Standing Orders relative to Board meetings and associated governance. The Standing Orders are one of the key governance documents regulating the operation of the IJB and any committees. 1.2 These revised Standing Orders are brought to the IJB to coincide with the commencement of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Amendment Order 2025 which takes effect on 1 September 2026, extending the Board’s voting membership. 1.3 The proposed revised Standing Orders reflect necessary changes resulting from that amendment but also recommend certain wider changes to strengthen IJB governance. 2. BACKGROUND 2.1 The IJB is legally required to have Standing Orders and is bound to address certain matters through those Standing Orders (Public Bodies (Joint Working) (Integration Agenda Item 8 89
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Joint Boards) (Scotland) Order 2014). The proposed Standing Orders cover all prescribed matters. It is appropriate for the IJB to review the terms of its Standing Orders from time to time. Audit Scotland in national reporting highlight the importance of having governance arrangements that are fit for purpose and up to date. The Standing Orders were last reviewed by the IJB in October 2022. 2.2 The Standing Orders for Meetings set out the rules for fair decision making and define how the IJB and its committees conduct their business democratically. The Standing Orders aim to ensure consistency in decision making and process leading to robust governance. 3. PROPOSALS 3.1 The proposed revised Standing Orders are included at Appendix 1. All proposed changes appear “tracked”. Broadly the proposals should be clear and are intended to clarify matters or questions that have arisen during IJB business in recent years, for the clarity of all involved. 3.2 Substantive proposed amendments include: (i) Clarity regarding membership, voting and non-voting, together with relevant term and deputy arrangements to reflect imminent legislative change (Standing Order 2 and Standing Order 16); (ii) Specific procedure regarding amendment notification and funding implications with a view to ensuring appropriate scrutiny (Standing Orders 5.4 and 5.5, see also Standing Order 15.3); (iii) Further procedure to deal with equality of votes (Standing Orders 16.5 and 16.6). 3.3 Anticipated Outcomes Approval of revised Standing Orders will ensure the IJB is compliant with imminent legislative changes and seeks to promote clarity and transparency for all in the operation of IJB business. 3.4 Measuring Impact As provided for in the Standing Orders, their operation is subject to ongoing review and further amendment, as IJB considers necessary (Standing Order 1.1). 4. IMPLICATIONS 4.1 Financial None arising directly from Standing Order review. 4.2 Human Resources 90
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None arising directly from Standing Order review. 4.3 Legal Approval of the revised Standing Orders is consistent with imminent legislative change. 4.4 Equality/Socio-Economic None. 4.5 Risk Low risk. 4.6 Community Wealth Building None. 4.7 Key Priorities None. 5. CONSULTATION All IJB members were afforded the opportunity to contribute to this Standing Order review during July 2026. Aileen Craig, Head of Democratic Services, North Ayrshire Council, Standards Officer to IJB Author: Ruth Wilson, Litigation Team Manager, Legal Services, North Ayrshire Council ruthwilson@north-ayrshire.gov.uk Appendices • Appendix 1 – revised North Ayrshire Integration Joint Board Standing Orders for Meetings (for approval) 91
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1 North Ayrshire Integration Joint Board Standing Orders for Meetings Date of Agreement – 2nd April 2015 Date of Amendment – 16-4-15 Date of Amendment – 29-8-19 Date of Amendment - [10-2-22] Date of Amendment – [2026] 1. General 1.1 These Standing Orders will apply from and including 1 September 2026 and be reviewed by the Integration Joint Board as required. 1.2 These Standing Orders are made under the Public Bodies (Joint Working) (Scotland) Act 2014 and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. These Standing Orders shall, as far as applicable be the rules and regulations for the proceedings of the Board, its Committees and Sub-Committees and therefore reference to the term ‘Board’ in the said Standing Orders should be interpreted accordingly. The term ‘Chairperson’ shall also be deemed to include the Chairperson of any Committee or Sub- Committee but only in relation to such Committees or Sub- Committees. 1.3 In these Standing Orders “the Integration Board” shall mean the North Ayrshire Integration Joint Board established in terms of the Public Bodies (Joint Working) (Integration Joint Board Establishment) (Scotland) Order 2015 and the Integration Scheme entered into by North Ayrshire Council and NHS Ayrshire & Arran Health Board, as approved by Scottish Ministers. 92
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2 1.4 Any statutory provision, regulation or direction issued by the Scottish Ministers shall have precedence if they are in conflict with the Standing Orders. 2. Membership 2.1 Voting membership of the Integration Board shall comprise: a. four persons nominated by the NHS Board; b. four persons appointed by the Council; c. one person to represent third sector bodies carrying out activities related to health or social care in the area of the Council; d. one person to represent service users residing in the area of the Council; and e. one person to represent those providing unpaid care in the area of the Council. Where the NHS Board is unable to fill its places with non-Executive Directors it can then nominate other appropriate people, who must be members of the NHS Board to fill their spaces, but at least two must be non-executive members. 2.2 Non-voting membership of the Integration Board shall comprise: a. the chief social work officer of the local authority; b. the chief officer of the Integration Board; c. the proper officer of the Integration Board appointed under section 95 of the Local Government (Scotland) Act 1973; d. a registered medical practitioner whose name is included in the list of primary medical services performers prepared by the Health Board in accordance with Regulations made under section 17P of the National Health Service (Scotland) Act 1978; e. a registered nurse who is employed by the Health Board or by a person or body with which the Health Board has entered into a general medical services contract; f. a registered medical practitioner employed by the Health Board and not providing primary medical services; g. The Director of Public Health for the Health Board; h. The Director of Psychology for the Health Board; i. Lead Allied Health Professional for the Health Board; j. one member to represent staff of the constituent authorities engaged in the provision of services under integration functions; and k. such additional members as the Integration Board sees fit although such a member may not be a Councillor or a non-executive director of the Health Board. l. ; m. The members appointed under paragraphs (d) to ( (i) must be determined by the Health Board 2.3 A member of the Integration Board in terms of 2.2 (a) to (c) will remain a 93
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3 member for as long as they hold the office in respect of which they are appointed. Otherwise, the term of office of Members of the Integration Board shall be for three years or until the day of the next ordinary Elections for Local Government Councillors in Scotland, whichever is shorter. 2.4 Where a Member resigns or otherwise ceases to hold office, the person appointed in his/her place shall be appointed for the unexpired term of the Member they replace. 2.5 On expiry of a Member’s term of appointment the Member shall be eligible for re-appointment provided that he/she remains eligible and is not otherwise disqualified from appointment. 2.6 A voting Member appointed under paragraph 2.1 (a) or (b) ceases to be a member of the Integration Board if they cease to be either a Councillor or a non- executive Director of the NHS Board or an Appropriate Person in terms of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. 2.7 A Member of the Integration Board, other than those Members referred to in paragraph 2.2 (a) to (c), may resign his/her membership at any time during their term of office by giving notice to the Integration Board in writing. The resignation shall take effect from the date notified in the notice or on the date of receipt if no date is notified. If this is a voting Member, the Integration Board must inform the constituent authority that made the nomination (if applicable). 2.8 If a Member has not attended three consecutive Ordinary Meetings of the Integration Board, and their absence was not due to illness or some other reasonable cause as determined by the Integration Board, the Integration Board may, by giving one month’s notice in writing to that Member, remove that person from office. 2.9 If a Member acts in a way which brings the Integration Board into disrepute or in a way which is inconsistent with the proper performance of the functions of the Integration Board, the Integration Board may remove the member from office with effect from such date as the Integration Board may specify in writing. If a member is disqualified under article 8 of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 during a term of office they shall be removed from office as a Member of the Integration Board immediately. 2.10 A constituent authority may remove a Member which it nominated by providing one month’s notice in writing to the Member and the Integration Board. 2.11 Named Depute Members for Members of the Integration Board may be appointed by the constituent authority which nominated the Member (for voting members appointed under Standing Order 2.1 (a) or (b)), or the Member (for voting members appointed under Standing Order 2.1 (c), (d) or (e) or Standing Order 2.2.), as appropriate. The appointment of such Deputies will be subject to the same rules and procedures for Members. Deputies t shall be entitled to attend, participate and/or vote at a Meeting only in the absence of the principal Member they represent and relative to the principal 94
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4 Member’s membership. If the Chairperson or Vice Chairperson is unable to attend a meeting of the Integration Board, any Depute Member attending the meeting may not preside over that meeting 2.12 The acts, meetings or proceedings of the Integration Board shall not be invalidated by any defect in the appointment of any Member or any vacancy in the membership of the Integration Board. 3. Chairperson and Vice Chairperson 3.1 The Chairperson and Vice Chairperson will be drawn from the NHS Board and the Council voting members of the Integration Board. If a Council member is to serve as Chairperson then the Vice Chairperson will be a member nominated by the NHS Board and vice versa. The first Chair of the Integration Board will be appointed on the nomination of the Council. 3.2 The appointment to Chairperson and Vice Chairperson is time limited to a period not exceeding two years and carried out on a rotational basis between Council and NHS Board appointed Chairperson. The term of office of the first Chairperson was for the period up to the local government elections in 2017, thereafter the term of office of the Chairperson is a period of two years. The Council or NHS Board may change their appointee as Chairperson of Vice Chairperson during an appointing period. 3.3 The Vice-Chairperson may act in all respects as the Chairperson of the Integration Board if the Chair is absent or otherwise unable to perform his/her duties. 3.4 At every meeting of the Integration Board the Chairperson, if present, shall preside. If the Chairperson is absent from any meeting the Vice-Chairperson, if present, shall preside. If both the Chairperson and the Vice-Chairperson are absent, a Chairperson shall be appointed from within the members present for that meeting. Any Depute Member attending the meeting in terms of 2.11 may not preside over that meeting. 3.5 Powers, authority and duties of Chairperson and Vice-Chairperson. The Chairperson shall amongst other things :- (a) Preserve order and ensure that every Member has a fair Hearing; (b) Decide on matters of relevancy, competency and order, and whether to have a recess during the Meeting, having taken into account any advice offered by the Chief Officer or other relevant officer in attendance at the Meeting; (c) Determine the order in which speakers can be heard; (d) Ensure that due and sufficient opportunity is given to Members who wish to speak to express their views on any subject under discussion; (e) If requested by any Member ask the mover of a motion, or an amendment, to state its terms; 95
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5 (f) Maintain order and at his/her discretion, order the exclusion of any member of the public who is deemed to have caused disorder or misbehaved; (g) The decision of the Chairperson on all matters within his/her jurisdiction shall be final; (h) Deference shall at all times be paid to the authority of the Chairperson. When he/she rises to speak, the Chairperson shall be heard without interruption; and (i) Members shall address the Chairperson while speaking. 4. Meetings 4.1 The Integration Board shall meet at such place and such frequency as may be agreed by the Integration Board. 4.2 The Chairperson may convene Special Meetings if it appears to him/her that there are items of urgent business to be considered. Such Meetings will be held at a time, date and venue as determined by the Chairperson. If the Office of Chairperson is vacant, or if the Chairperson is unable to act for any reason the Vice-Chairperson may at any time call such a meeting. 4.3 If the Chairperson refuses to call a meeting of the Integration Board after a requisition for that purpose specifying the business proposed to be transacted, signed by at least two thirds of the voting Members, has been presented to the Chairperson or if, without so refusing, the Chairperson does not call a meeting within seven days after such requisition has been presented, those Members who presented the requisition may forthwith call a Meeting provided no business shall be transacted at the Meeting other than specified in the requisition. 4.4 Adequate provision will be made to allow for Members to attend a meeting of the Integration Board or a committee of the Integration Board either by being present together with other members in a specified place, or in any other way which enables members to participate despite not being present with other members in a specified place. 5. Notice of Meeting 5.1 Before every meeting of the Integration Board, a notice of the meeting specifying the time, place and business to be transacted at it and signed by the Chairperson, or by a Member authorised by the Chairperson to sign on that person’s behalf, shall be delivered to every Member or sent by post to the usual place of residence of such Members or delivered by electronic means so as to be available to them at least five days before the meeting. Members may opt in writing addressed to the Chief Officer to have notice of meetings delivered to an alternative address. Such notice will remain valid until rescinded in writing. Lack of service of the notice on any Member, or within the five day timescale, shall not affect the validity of anything done at a meeting. 96
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6 5.2 In the case of a meeting of the Integration Board called by Members in default of the Chairperson, the notice shall be signed by those Members who requisitioned the meeting. 5.3 At all Ordinary or Special Meetings of the Integration Board, no business other than that on the agenda shall be discussed or adopted except where by reason of special circumstances, which shall be specified in the minutes, the Chairperson is of the opinion that the item should be considered at the meeting as a matter of urgency. 5.4 Any Member of the Integration Joint Board may submit a proposal or amendment for the agreement of the Integration Board, provided that it relates to a subject on the agenda. This should be submitted in writing to the Clerk by 12pm two working days before the meeting and will require to be moved and seconded during the meeting. 5.5 If any proposal or amendment is likely to incur expenditure or reduce approved savings, or saving proposed to the Integration Board for approval, then it must be submitted in accordance with Standing Order 5.4 above, the source of relevant expenditure, taking account of the Integration Board’s approved budget for the relevant year requires to be identified by the relevant Member and if appropriate, relevant consultation requires to have occurred between the Member and s.95 Officer for the Board to inform the position. 6. Quorum 6.1 No business shall be transacted at a meeting of the Integration Board unless there are present (which shall include remotely if by appropriate means in accordance with Standing Order 4.4), and entitled to vote both Council and NHS Board members and at least one half of the voting Members of the Integration Board are present (for the avoidance of doubt, at least six voting Members). 6.2 If within ten minutes after the time appointed for the commencement of a meeting of the Integration Board, a quorum is not present, the meeting will stand adjourned to such date and time as may be fixed and the minute of the meeting will disclose the fact. 6.3 If less than a quorum is entitled to vote on an item because of declarations of interest, that item cannot be dealt with at that meeting. 7. Codes of Conduct and Conflicts of Interest 7.1 Members of the Integration Board (including any Deputies) shall subscribe to and comply with the Code of Conduct for Members of the North Ayrshire Integration Joint Board (the ‘Code of Conduct’) which is deemed to be incorporated into these Standing Orders. All Members shall be obliged before taking up membership, to agree in writing to be bound by the terms of the Code of Conduct. Failure by any Member to provide such written agreement does not affect the applicability of the Code of Conduct to that Member. Members 97
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7 shall also comply with any relevant guidance issued by the Standards Commission for Scotland. 7.2 If any Member has a financial or non-financial interest as defined in the Code of Conduct and is present at any meeting at which the matter is to be considered, he/she must as soon as practical, after the meeting starts (and certainly before taking part in any discussion on that item), disclose that he/she has an interest and the nature of that interest and if he/she is precluded from taking part in consideration of that matter. 7.3 Where an interest is disclosed, the Member disclosing the interest is to decide whether, in the circumstances, it is appropriate for them to take part in discussion of or voting on the item of business. 8. Adjournment of Meetings 8.1 A meeting of the Integration Board may be adjourned to another date, time or place by a motion, which shall be moved and seconded and put to the meeting without discussion. If such a motion is carried by a simple majority of those present and entitled to vote, the meeting shall be adjourned to the day, time and place specified in the motion. 9. Disclosure of Information 9.1 In the event that a matter is to be considered by the IJB that cannot be considered in public (which shall be by exception), then the relevant provisions of the Local Government (Scotland) Act 1973 shall apply to the Integration Board (specifically including s.50A and Schedule 7A thereof). 9.2 No member or officer shall disclose to any person any information which falls into the following categories:- • Confidential information within the meaning of Section 50A(2) of the Local Government (Scotland) Act 1973. • The full or any part of any document marked “not for publication by virtue of the appropriate paragraph of Part 1 of Schedule 7A of the Local Government (Scotland) Act 1973”, unless and until the document has been made available to the public or press under section 50B of the said 1973 Act. • Any information regarding proceedings of the Integration Board from which the public have been excluded unless or until disclosure has been authorised by the Integration Board or the information has been made available to the press or to the public under the terms of the relevant legislation. 9.2 Without prejudice to the foregoing, no Member shall use or disclose to any person any confidential and/or exempt information coming to his/her knowledge by virtue of his/her office as a Member where such disclosure would be to the advantage of the Member or of anyone known to him/her or which would be to 98
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8 the disadvantage of the Integration Board. 10. Recording of Proceedings 10.1 No sound, film, video tape, digital or photographic recording of the proceedings of any meeting, other than webcasting of the proceedings by the Integration Board itself, shall be made without the prior approval of the Integration Board. All phones should be switched off or on silent and Members should not correspond, whether by email, text, social media or any other electronic means with any other Member or other person during a Board meeting. Research through the internet is permitted providing it is done in a manner which respects the authority of the Chair and does not interfere with the business of the meeting. 11. Admission of Press and Public 11.1 Subject to the extent of the accommodation available and except in relation to items certified as exempt, meetings of the Integration Board shall be open to the public. Members of the public are not permitted to speak at or contribute to meetings of the Integration Board. In this specific respect, reference to the Board should not be interpreted as including reference to the Board’s Committees and/or Sub- Committees, specific provision will be made by the Board regarding the extent of any public access permitted to meetings of its Committees or Sub- Committees. The Chief Officer shall be responsible for giving public notice of the time and place of each meeting of the Integration Board by posting within the main offices of the Integration Board or on the Board’s website not less than five days before the date of each meeting. 11.2 The Integration Board may by resolution at any meeting, exclude the press and public therefrom during consideration of an item of business where it is likely in view of the nature of the business to be transacted or of the nature of the proceedings that if members of the press and public were present there would be a disclosure to them of exempt information as defined in Schedule 7(A) of the Local Government (Scotland) Act 1973 Act or it is likely that confidential information would be disclosed in breach of an obligation of confidence. 11.3 Every meeting of the Integration Board shall be open to the public but these provisions shall be without prejudice to the Integration Board’s powers of exclusion in order to suppress or prevent disorderly conduct or other misbehaviour at a meeting. The Integration Board may exclude or eject from a meeting a member or members of the press and public whose presence or conduct is impeding the work or proceedings of the Integration Board. 12. Alteration, Deletion and Rescission of Decisions of the Integration Board 12.1 Except insofar as required by reason of illegality, no motion to alter, delete or rescind a decision of the Integration Board will be competent within six months from the decision, unless a decision is made prior to consideration of the matter to suspend this Standing Order in terms of Standing Order 13. 99
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9 13. Suspension, Deletion or Amendment of Standing Orders 13.1 Any one or more of the Standing Orders in the case of emergency as determined by the Chair upon motion may be suspended, amended or deleted at any Meeting so far as regards any business at such meeting provided that two thirds of the Members of the Integration Board present and voting shall so decide. Any motion to suspend Standing Orders shall state the number or terms of the Standing Order(s) to be suspended. 14. Procedures for considering Items of Business 14.1 Officers of the Board will speak to the terms of any report drafted by them which is on the agenda for a meeting. Thereafter it will be open to any Member to ask a question or questions concerning the item of business under consideration. Such questions must be relevant to the item of business under consideration and may be directed to any senior officer seeking clarification of the terms of a report. 14.2 When the Chairperson is satisfied that there are no more questions to be raised he or she will invite the Board to discuss the item of business. Such discussion must be relevant to the item of business and should attempt to achieve a decision by consensus. As part of the Chairperson’s role to manage the meeting, the Chairperson shall attempt to ensure that Members who wish to speak have a fair opportunity to do so. The Chairperson shall have power to determine when Members can speak and will determine the number of occasions and length of time that a Member is able to speak. 15. Procedure for determining Items of Business 15.1 Every effort shall be made by Members to ensure that as many decisions as possible are made by consensus. 15.2 When the Chairperson is satisfied that a decision can be made by consensus he or she will clarify the terms of that decision with the Board. 15.3 Notwithstanding the terms of Standing Orders 3.4 and 3.5, minor amendments to recommendations may still be made by agreement during any meeting. 15.4 If the Chairperson is satisfied that a decision cannot be made by consensus or in circumstances where an amendment has been lodged with the Clerk in advance of the meeting, he or she will invite those of differing views to state the decision they wish the Board to make. The first such statement will be known as the recommendation. Any member may seek an amendment to the recommendation. Any recommendation and amendment must relate to the item of business under discussion. No recommendation or amendment will be accepted unless it is seconded. It will be open to any Member to ask a question or questions to the mover of any recommendation or amendment seeking clarity 100
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10 of their recommendation or amendment. 15.5 In the event that discussion on any item has exceeded 30 minutes it will be open to any Member to propose a recommendation. If this is not seconded the recommendation will fall and discussion shall continue, subject to 15.1. If it is seconded, the Chairperson will ascertain if there are any amendments, which also require to be seconded. 15.6 For the avoidance of doubt, non-voting Members can propose or second a recommendation or amendment and speak to its terms, but cannot vote on it. 15.7 Debate - When the Chairperson is satisfied that there are no more recommendations, or amendments to be raised he or she will state that the Board is in debate. 15.8 Subject to the right of the mover of a recommendation, and the mover of an amendment, to reply, no Member will speak more than once on the same question at any meeting of the Integration Board except:- • On a question of Order • With the permission of the Chairperson • In explanation or to clear up a misunderstanding in some material part of his/her speech. 15.9 The mover of an amendment and thereafter the mover of the original recommendation will have the right of reply for a period of not more than 3 minutes in order to sum up. He/she will introduce no new matter and once a reply is commenced, no other Member will speak on the subject of debate. Thereafter the discussion will be held closed and the Chairperson will call for the vote to be taken. 15.10 The Chairperson has discretion in terms of the specific procedure and timescales referenced, in the interests of ensuring fairness, natural justice and the appropriate administration of Integration Board business. 16. Voting 16.1 Only the four Members nominated by the NHS Board, the four Members appointed by the Council and the three stakeholder members detailed at Standing Order 2.1 (c) - (e) shall be entitled to vote. 16.2 Voting shall be by a show of hands, roll call or any other method determined by the Chair. 16.3 In the case of an equality of votes, there shall be no casting or second vote afforded to the Chair or to any other member or group of members. 16.4 Where there is an equality of votes, Voting Members of the Board may agree 101
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11 that the decision will be made by a cut of cards or some other equitable method. If the voting members do not agree to such a method of breaking the deadlock then no decision will be taken and the status quo shall prevail. Standing Order 12 shall not preclude reconsideration of any such item within a 6 month period. 16.5 In the event of an equality of votes and no decision being made the matter will be remitted to the Chief Officer to carry out such further work, provide such further information and make any relevant recommendations as may be required to enable the Board to reconsider the matter at a following Board meeting. 16.6 Where the matter remains unresolved, and the Chair concludes that the equality of votes is effectively a representation of a dispute between the two constituent authorities then the Dispute Resolution procedure set out in the Integration Scheme shall be followed. If the unresolved equality of votes is not a representation of a dispute between the two constituent authorities, then the Chair, Vice Chair and the Chief Officer must work together to arrive at an acceptable position for the Board (subject to Board approval, as may be required). 16.7 Where there is a temporary vacancy in the voting membership of the Integration Board, the vote which would be exercisable by any Member appointed to that vacancy may be exercised jointly by the other Members appointed by the relevant constituent authority. 17. Minutes 17.1 The names of the Members and others present at a meeting shall be recorded in the minutes of the meeting. 17.2 The minutes of the proceedings of a meeting, including any decision or resolution made by that meeting, shall be drawn up and submitted to the next ensuing meeting for agreement by a person nominated by the Chief Officer, after which they will be signed by the person presiding at that meeting. A minute purporting to be so signed shall be received in evidence without further proof. 18. Committees and Working Groups 18.1 The Integration Board may establish any Committee or Working Group as may be required from time to time but each Working Group shall have a limited time span as may be determined by the Integration Board. 18.2 The Membership, Chairperson, remit, powers and quorum of any Committee or Working Groups will be determined by the Integration Board. Terms of Reference for any Committee or Working Group shall be agreed by the Integration Joint Board. 18.3 Agendas for consideration at a Committee or Working Group will be issued by electronic means to all Members no later than two working days prior to the start 102
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12 of the meeting. 18.4 By reason of the relatively limited authority delegated to Committees of the Integration Board, it may be necessary for the Board to reconsider or review matters that have been considered by it previously. In such circumstances, members require to do so objectively, taking account of the specific parameters of any reconsideration or review as will be advised to them at the relevant time. 103
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Integration Joint Board 20 August 2026 Subject : Recruitment of Stakeholder Representatives to the Integration Joint Board Purpose : To update IJB as to progress in recruiting stakeholder voting members and seek relevant delegated authority for next steps. Recommendation : It is recommended, subject to any such other arrangements as the IJB may direct, that the Integration Joint Board: (1) provides delegated authority to the Chief Officer, Chairperson and Vice Chairperson of the IJB to conclude the recruitment procedure as outlined at 3.1 in respect of vacant stakeholder posts and to appoint one successful candidate to each of the two vacant stakeholder posts (namely one IJB member to represent service users and one IJB member to represent unpaid carers) and report thereafter to the IJB; or (2) provides delegated authority to the Chief Officer, Chairperson and Vice Chairperson of the IJB to conclude the recruitment procedure as outlined at 3.1 in respect of vacant stakeholder posts and thereafter nominate successful candidates (namely one IJB member to represent service users and one IJB member to represent unpaid carers) for appointment to the IJB at its next meeting (25 September 2026). 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 Agenda Item 9 105
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1. EXECUTIVE SUMMARY 1.1 This report seeks approval of the proposed arrangements for confirming and recruiting the Third Sector, Carer and Service User representative roles on the Integration Joint Board. These arrangements are required as, from 1 September 2026, these stakeholder representative roles will move from non-voting/advisory membership to full voting membership for Integration Joint Board decisions. 1.2 The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Amendment Order 2025 introduces full voting rights for Integration Joint Board members appointed to represent third sector bodies, service users and unpaid carers from 1 September 2026. This means that these representatives will no longer participate solely in an advisory capacity; they will be able to vote on Integration Joint Board decisions alongside other voting members. IJB Governance arrangements are being updated accordingly. 1.3 The proposal is to adopt different approaches for these roles, recognising existing representative arrangements and the need to ensure appropriate links with wider community networks. The current Third Sector representative will remain in post, becoming a voting member. The other stakeholder posts within scope of the Order are currently vacant and therefore officers are undertaking a recruitment exercise for the Service User and Carer Representative vacancies. 2. BACKGROUND 2.1 Integration Joint Boards are required to include, as part of their minimum membership, representatives for unpaid carers, service users and the third sector. These stakeholder members bring lived experience, community insight and representative perspectives to the strategic planning and decision-making responsibilities of the Integration Joint Board. From 1 September 2026, the Third Sector, Carer and Service User representatives will have voting rights and will therefore require the same induction, support and governance expectations as other voting members. The Scottish Government guidance (whilst it remains in draft form) highlights the need for these members to be recruited through transparent and inclusive local processes. That work has commenced locally, as per the update provided to the IJB in June. 3. PROPOSALS 3.1 In respect of Service User and Unpaid Carer representatives, a recruitment exercise has commenced through press, social media and engagement with existing participation groups who have been asked to share details of the vacancies and encourage applications. These include, but are not exhaustive of, Older People Forum, Learning Disability Groups, Alcohol and Drug Partnership, and Mental Health Participation and Engagement Group. The advert has been appended to the report for IJB member information. 106
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3.2 The legislative changes take effect on 1 September 2026. The IJB meets on 25 September for a special meeting. It has not been possible, given the summer recess, to complete the recruitment process and nominate stakeholder members to the IJB at this August meeting. As such, it is proposed that the Integration Joint Board either delegate relevant authority for those designated to so appoint, or for them to conclude the recruitment and nominate recommended appointments to the IJB at its next meeting. 3.3 Third Sector Representative IJB member - Vicki Auld will continue in that role, which will become a voting role on the IJB. 3.4 Once confirmed or appointed, these representatives will be supported to exercise their voting rights responsibly and in line with the Integration Joint Board’s governance requirements. Officers are mindful of the need to support newly appointed voting members in this regard, and consideration is ongoing as to appropriate training and support. 3.5 Consideration of any arrangements regarding approved deputies (or proxies) will require to be confirmed after the substantive new members have been identified. 3.6 Anticipated Outcomes The anticipated outcomes are improved compliance with the new statutory requirements, strengthened lived experience and stakeholder input to Integration Joint Board decisions, improved transparency in stakeholder appointments, and greater confidence that the perspectives of carers, service users and third sector bodies are represented in formal voting decisions. The proposals will also support more inclusive governance by ensuring that stakeholder representatives have the knowledge, confidence and practical support required to exercise their voting rights responsibly and effectively. 3.7 Measuring Impact Impact will be measured through confirmation of the Third Sector representative, completion of the recruitment process, the appointment and induction of representatives, uptake of training and support, attendance and participation at Integration Joint Board meetings, feedback from representatives, and annual review of ongoing development and succession planning arrangements. The effectiveness of the arrangements will also be monitored through governance feedback, equality and accessibility considerations identified during recruitment, and review of whether representatives are able to draw on wider community networks while maintaining confidentiality and complying with the Code of Conduct. 107
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4. IMPLICATIONS 4.1 Financial There will be financial implications associated with recruitment, induction, training, support, reasonable expenses and any arrangements required to remove barriers to participation, including travel, replacement care, subsistence, communication support or other accessibility requirements. These costs will be managed through existing governance and participation support arrangements where possible, with any additional costs reported through normal financial governance routes. 4.2 Human Resources There are no direct Human Resources implications for North Ayrshire Council or NHS Ayrshire and Arran employees. Officer time will be required to support recruitment, induction, training, administration, ongoing liaison and governance arrangements for the stakeholder representatives. 4.3 Legal The proposal supports implementation of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Amendment Order 2025, which extends voting rights to members representing third sector bodies, service users and unpaid carers from 1 September 2026. The effect of the change is that these representatives will become voting members for Integration Joint Board decisions, rather than participating only in a non-voting advisory capacity. Appointed members will be required to comply with the Integration Joint Board’s Standing Orders, Code of Conduct, registration of interests, confidentiality and other relevant governance requirements. 4.4 Equality/Socio-Economic The proposals have positive equality and socio-economic implications by seeking to widen participation in Integration Joint Board governance and improve representation of people with lived experience. Recruitment materials and processes will be designed to be accessible and inclusive, with reasonable support available to reduce barriers to participation. Consideration will be given to the public sector equality duty and to the diversity of local communities. 4.5 Risk Risk is assessed as Moderate. Key risks include failure to recruit suitable representatives, insufficient support for members once appointed, conflicts of interest, confidentiality issues, and limited time to complete recruitment and induction before voting rights take effect. These risks will be mitigated through clear role descriptions, transparent selection arrangements, robust induction, Code of Conduct training, support from relevant officers, expenses arrangements and succession planning. 108
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4.6 Community Wealth Building The proposals support community wealth building by strengthening local participation in public decision making and creating routes for local community, carer, service user and third sector voices to influence strategic planning. Inclusive recruitment and support arrangements will help ensure participation is not limited by financial, accessibility or caring responsibilities. 4.7 Key Priorities The proposals align with the Integration Joint Board’s strategic planning responsibilities and support the principles of integrated health and social care by ensuring that the voices of carers, service users and the third sector are embedded in decision making. They also support wider priorities around participation, prevention, equality, person-centred planning and community engagement. 5. CONSULTATION The approach and process for recruitment was undertaken in consultation with the Chair of the IJB. Consultation with relevant internal governance, legal, finance, equality and communications colleagues has taken place, and with established participation fora to promote the Service User and Carer Representative vacancies. The recruitment approach will be informed by the Scottish Government draft statutory guidance and by feedback from existing participation and engagement routes, with a focus on transparency, accessibility and support for representatives before and after appointment. Caroline Cameron, Director Karen Andrews, Team Manager (Governance) kandrews@north-ayrshire.gov.uk Appendices • Vacancy Recruitment Advert • IJB Statutory Guidance, SLWG 109
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North Ayrshire Health and Social Care Partnership Involving you in the work of North Ayrshire Health and Social Care Partnership An information pack for carer and service user representatives to North Ayrshire Health and Social Care Partnership’s Integration Joint Board 110
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How to use this information pack This information pack explains the role of carer and service user representatives in the work of North Ayrshire Health and Social Care Partnership (NAHSCP) and its Integration Joint Board (IJB). As a representative, you will bring the perspective of people who use health and social care services, unpaid carers, or both, to the work of NAHSCP and the IJB. This information pack is also available in large print and other formats and languages upon request. 111
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Contents 1. Introduction to North Ayrshire Health and Social Care Partnership 4 2. Your involvement and the role at a glance 4 3. What you can expect from us 5 As a representative what you will be expected to do 6 4. A brief guide to standards of conduct 8 5. A brief guide to Disclosure and the Protecting Vulnerable Groups (PVG) Scheme 9 6. The legal responsibility to involve people 9 7. More information about NAHSCP 9 8. How do I express my interest in becoming a carer or service user representative? 9 9. What if being a representative is not quite what you expected? 10 112
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4 1. An introduction to North Ayrshire Health and Social Care Partnership We want carers and people who use services to have a meaningful voice in decisions about health and social care in North Ayrshire. Your experience can help us understand what works well, what could be better and what matters most to people and families. NAHSCP is responsible for health and social care services across North Ayrshire. It provides health and care services for local children, adults and older people and is a partnership between North Ayrshire Council, NHS A&A, third sector organisations and independent care organisations. NAHSCP is overseen by the Integration Joint Board (IJB), an independent legal body that helps to ensure we are operating efficiently and effectively. North Ayrshire IJB was established in April 2015 and has delegated responsibilities from North Ayrshire Council and NHS Ayrshire & Arran. The IJB consists of :- • 4 North Ayrshire Councillors • 4 Non-Executive NHS Board members. There are also stakeholder representatives and other members who contribute to the work of the Board, including carer representatives, service user representatives, third sector representatives, lead professional officers from North Ayrshire Council and NHS Ayrshire & Arran, and trade union representatives. From 1 September 2026, Scottish Government legislation extended voting rights on the IJB to carer, third sector and service user representatives. 2. The Role at a Glance Meetings •Around 9 per year, •Thursdays from 10am to 1pm, plus 1 or 2 Development Sessions •Face to Face in Cunninghame House, Irvine Preparation •Time to read agenda papers before meetings. •Papers are shared at least one week in advance. Support •Induction •Briefing Support •Accessible formats •Name Contact person •Help to discuss any support needs. Expenses •Eligible travel, parking, subsistence and agreed support costs can be claimed in line with the Members Expenses Policy Experience •No formal qualifications are needed •Lived experience •Listening skills •Willingness to contribute 113
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5 Why apply? • you do not need previous committee or board experience • you will be supported • your views can influence real decisions • your involvement will help improve services for others • expenses and support needs can be discussed 3. Your Involvement No formal qualifications are needed to become a representative. You do not need to be an expert in health and social care. We are looking for people who can share real-life experience, listen to others and help us understand what matters to people locally. We welcome applications from people who use health services, people who use social care services and unpaid carers. We are looking for people who: • have an interest in the NAHSCP and health-related issues • are able to work in a team and with working groups • are able to look at things with an open mind • are able to listen to other people’s points of view or experiences • should live in North Ayrshire Your role will be to: • use your personal, professional or voluntary experience to give a carer and/or service user perspective • be willing to suggest and influence changes to services or plans • take an active role in groups or projects with our support • articulate the views and interests of the stakeholder group you represent, while also contributing to wider discussion and decision making. The approximate time commitment is around nine IJB meetings per year, usually on Thursdays from 10am to 12pm, one or two development sessions per year, and time to read agenda papers before meetings. Attendance at other meetings and events as an IJB member may also be offered, but this is optional. 4. What you can expect from us As someone who has agreed to work as a representative with NAHSCP on the Integration Joint Board, you can expect: • to be treated as an equal partner, with your views taken seriously • to be able to step down at any time, knowing that it will not affect any future care, treatment or services • to be given support or training and any information that you need, free of jargon (or jargon explained) and in a format that is suitable for you • that your involvement will not impact on your care, treatment or services • to have personal information about you kept confidential • to be given a clear remit of your responsibilities, which will include the length of time you are expected to be involved • to be able to opt out of anything you don’t feel comfortable with or find stressful • to be introduced to other board members and have their jobs and roles explained to you 114
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6 • to be consulted about decisions that affect you • to be sent papers of meetings in your preferred format, at least one week before the meeting • to be provided with a named contact person who will give you the support and guidance you need • to be informed about what has happened as a result of your involvement • to receive a full induction package as a new IJB member and briefing support from HSCP officers ahead of meetings, where this would be helpful • to be able to claim your travel and other agreed expenses • to have any support needs discussed with you, including accessibility, transport or replacement carer cover where this is needed to enable participation. 4.1. As a representative you will be expected to: • follow relevant policies and procedures (e.g. no smoking policy, equal opportunities, health and safety). We will ensure you have access to appropriate documents • follow rules of confidentiality and not discuss personal or sensitive information outside of meetings. • take part in an initial induction session and any other briefings or training sessions as required • read papers for meetings before you attend, and if unable to attend give your apologies in good time if possible • attend consistently, noting that members who miss three IJB meetings in a row for any reason other than illness may be removed from the IJB • participate in meetings by asking questions, making comments and taking part in any decision-making votes where applicable • follow the IJB Members’ Expenses Policy where expenses are claimed • remember that any contact with the media (newspapers, television, radio) or through social networking will be handled by Corporate Communications • provide references or complete Scottish Disclosure/PVG Scheme Membership documents if required by us. We will guide you through this process • declare any interests, employment or otherwise, which may conflict with your involvement with NAHSCP and complete a Register of Interests. This will not necessarily stop you joining the board • raise any concerns or difficulties with your contact person • inform your contact person if you no longer wish to be a representative Please be aware that your name may appear on minutes of meetings, which can then go on to the NAHSCP website. The meetings are also publicly webcast so please take this into consideration when applying. Expenses must be incurred wholly, exclusively and necessarily in carrying out IJB duties and must be supported by receipts. Representative members who are not otherwise covered by North Ayrshire Council or NHS Ayrshire & Arran expenses policies may claim eligible costs. Claims should normally be made monthly using the standard claim form and should not be delayed by more than three months. Travel should be by the most economical and efficient method, and car sharing should be considered where appropriate. 115
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7 Mileage is reimbursed at the HMRC rate in force at the time of travel, currently 55p per mile for cars and 24p per mile for motorcycles. Before claiming mileage for the first time, and annually thereafter, members must provide evidence of a valid driving licence and motor insurance covering business travel. Public transport will normally be booked on the member’s behalf; where members make their own arrangements, reimbursement will be for standard class travel only. Parking charges may be reimbursed with receipts, but parking fines or similar penalties will not be paid. When travelling outside Ayrshire on IJB business and meals are not provided, members may claim the actual cost of meals purchased up to the relevant HMRC subsistence limits. From 1 January 2026, these are £5.00 for travel of five hours or more, £10.00 for travel of 10 hours or more, and £25.00 for travel of 15 hours or more and ongoing at 8pm. A £10.00 supplement may apply where travel of five or 10 hours is ongoing at 8pm. Receipts must be provided for all expenditure incurred. Carer representatives who need support with caring responsibilities in order to participate in IJB business will be invited to discuss their needs with a member of the Governance Team so that appropriate support can be considered and provided. This may include support such as replacement carer cover or support worker time where this is directly required to enable participation. 5. A brief guide to standards of conduct Staff within the NAHSCP are required to follow standards of business conduct. We ask that representatives who are involved with the Integration Joint Board should observe these standards too. Members are required to uphold good standards of behaviour in line with IJB Code of Conduct. From time to time, representatives may be involved in activities or projects which will bring them into contact with commercially sensitive information, for example when examining bids or business proposals for service developments. Please do: • be impartial and honest in any official business you carry out on behalf of NAHSCP • ensure the interests of people who use services and their carers are paramount • disclose any of your other interests – employment, business or voluntary, which might conflict with your involvement • ask for advice from your contact person Please do not: • accept any gifts or inducements or inappropriate hospitality • abuse your involvement with NAHSCP for personal gain or to benefit family or friends or to benefit another organisation (voluntary or private), over and above the expenses you are entitled to claim • unfairly advantage one competitor over another or show favouritism • misuse or make available “commercial in confidence” information 116
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8 6. A brief guide to Disclosure and the Protecting Vulnerable Groups (PVG) Scheme As a general guide we will only carry out a Disclosure Check if you are going to be in direct and unsupervised contact with patients, service users, carers and the public. This will normally require a Standard Disclosure. It is not expected that carer or service user representatives will require a disclosure check or to join the PVG scheme, however if this becomes appropriate as the role develops we will help you with your application process and pay any fees. We will also pay for a Scheme Record Update, if required, if you are already a member of the PVG Scheme. NAHSCP can request your membership of the PVG Scheme or a Scheme Record Update at any time, but we will always do this in consultation with you. 7. The legal responsibility to involve people The Public Bodies (Joint Working) (Membership and Procedures of Integration Joint Boards) (Scotland) Order 2014 (“the Order”) sets out requirements about the membership of an Integration Joint Board. This includes minimum required membership, and provision for additional members to be appointed. The Order explains that it is essential that Integration Joint Boards include key stakeholders within decision-making processes to make use of their advice and experience. North Ayrshire IJB therefore includes carer and service user representation so that the voices of people with lived experience are reflected in planning, scrutiny and decision making. From 1 September 2026, Scottish Government legislation extended voting rights on the IJB to carer, third sector and service user representatives. 8. More information about NAHSCP To find out more information about North Ayrshire Health and Social Care Partnership, you can visit our website at http://nahscp.org/ 9. How do I express my interest in becoming a carer representative? If you would like to express your interest in becoming a carer or service user representative on the IJB, you should complete the attached IJB Application Form. If you are interested but unsure whether this role is right for you, we would still encourage you to get in touch. We can talk through what is involved and answer any questions before you decide whether to apply. 117
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9 The form asks for your name, organisation, if applicable, telephone number, email address, postal address and the stakeholder group or groups you belong to. The stakeholder groups include users of health services, users of social care services and unpaid carers. You will also be asked to provide a supporting statement of no more than 800 words explaining how you feel you could contribute to the IJB and to the planning and scrutiny of health and social care services in North Ayrshire. This can include relevant personal, professional or voluntary experience that shows your suitability for membership of the IJB. Please ensure all required information is included, as applications with required fields left blank may not be considered. Completed applications should be sent to Karen Andrews, Team Manager (Governance) : Email: kandrews@north-ayrshire.gov.uk Or by post to: HSCP Governance Team Cunninghame House Friarscroft Irvine KA12 8EE All applications will be considered. If your application is to be taken further you will be contacted to come in for an informal chat with the Director/Chief Officer, Chair or Vice Chair of IJB and a member of the Governance Team. The closing date for application is 21st August 2026 10. What if being a representative is not quite what you expected? Involving people in the work of NAHSCP should go smoothly. However, just occasionally, it may not work out for you, or it may not be what you expected. This may only become apparent after induction and once you have started to attend meetings or meet with other people. In the vast majority of cases, such problems can be sorted out satisfactorily and quickly through an informal discussion with your nominated contact person. Representatives to the IJB will be asked to sign an agreement prior to their appointment to the Board that states what is expected from a carer or service user representative. The representative’s position on the Board will be reviewed after their first year in the role and may then be extended for up to two years. Should there be a problem with a representative that cannot be resolved on an informal basis, it may be necessary for us to put things on a more formal footing. Should this ever happen, a representative will always be kept informed about what to expect. It is rare for us to do this, but we may put in place a process which could lead to a representative being asked to leave. 118
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10 Application Form *denotes required information, applications with these fields left blank will not be considered Basic Information Name* Organisation Telephone* Email* Postal Address* To which stakeholder group(s) do you belong?* Circle / highlight all which apply • Users of health services • Users of social care services • Unpaid Carer Statement in Support of Application Please outline how you feel you could contribute to the North Ayrshire Integration Joint Board and to the planning and delivery of health and social care services in North Ayrshire. You should describe any relevant experience in a personal, professional or voluntary capacity that shows your suitability for membership of the IJB. (Statement should be no more than 800 words – approximately the size of the box below). 119
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11 Completed applications should be returned by Friday 21st August to: Email: kandrews@north-ayrshire.gov.uk Post: HSCP Governance Team, Cunninghame House, Friarscroft, Irvine, KA12 8EE 120
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Draft Version 1 - May 2026 2 DRAFT DISCLAIMER This document is issued in draft form and does not represent the agreed position of Scottish Ministers. Its contents are provisional and subject to ongoing review and amendment. It is intended to support discussion and development with members of the Short Life Working Group for implementing extended voting rights. If shared more widely, it should be clearly identified as draft and not formally endorsed. Any feedback should be appropriately collated and managed through agreed processes. External stakeholders are asked not to submit feedback directly to the Scottish Government at this stage, but rather through relevant members of the short life working group. This document should not be relied upon as a definitive statement of policy, and the Scottish Government reserves the right to revise its contents. 122
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Contents
1. The Aim of this Guidance ................................................................................. 5
2. Role and remit of the Integration Joint Board ................................................ 6
2.1 Duties placed on Integration Joint Boards by the Public Bodies (Joint
Working) (Scotland) Act 2014 and The Public Bodies (Joint Working)
(Integration Joint Boards) (Scotland) Amendment Order 2025 ('the 2025
Order’) .................................................................................................................... 7
2.2 Other key requirements of the Integration Joint Board .......................... 8
2.2.1 The Public Records (Scotland) Act 2011 .......................................... 8
2.2.2 Records Management ......................................................................... 9
2.2.3 Data Sharing ........................................................................................ 9
2.2.4 Data rights requests ........................................................................... 9
2.2.5 The Freedom of Information (Scotland) Act
2002 and Environmental Information (Scotland) Regulations 2004 ........... 10
2.2.6 Publication Scheme .......................................................................... 10
2.2.7 Office of the Scottish Information Commissioner (OSIC) ............. 10
2.2.8 Ethical Standards in Public Life - Code of Conduct ...................... 11
2.2.9 The Standards Commission ............................................................ 11
2.2.10 The Commissioner for Ethical Standards in Public Life in Scotland
11
2.2.11 Equalities Duties ............................................................................... 12
2.2.12 Diversity ............................................................................................. 12
2.3 Liability arrangements for Integration Joint Boards and their members
12
2.4 The relationship between the Integration Joint Board and the strategic
planning group.................................................................................................... 13
2.5 Appointing a Committee of an Integration Joint Board ........................ 14
2.6 Complaints under Integration ................................................................. 14
2.6.1 Complaints about Integrated services ............................................ 14
2.6.2 Complaints about Integration Joint Boards ................................... 15
3. Minimum Membership .................................................................................... 16
3.1 Good Practice in the identification and appointment of members of
Professional and Lived experience members .................................................. 18
3.2 Professional Membership ....................................................................... 18
3.3 Appointment of Lived Experience members ......................................... 19
3.4 Recruitment .............................................................................................. 20
3.5 Induction of Members .............................................................................. 21
3.6 Ongoing Training and Support ............................................................... 23
3.7 Succession Planning ............................................................................... 23
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Draft Version 1 - May 2026 4 4. Application of the Code of Conduct .............................................................. 25 4.1 Registration of interests .......................................................................... 25 4.2 Conflicts of Interest ................................................................................. 26 4.3 Member confidentiality ............................................................................ 27 4.4 Use of social media ................................................................................. 28 4.5 Handling Public Scrutiny......................................................................... 29 4.6 Expenses/Remuneration ......................................................................... 29 124
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Integration Joint Board: roles, responsibilities and membership - gov.scot
1. The Aim of this Guidance
This guidance is intended for use by all members of an Integration Joint Board,
particularly the Chair, Vice Chairs and Standards Officers. It provides advice on best
practice and supplements the existing legislative framework. The document focuses
on the roles, responsibilities and membership of the Integration Joint Board, setting
out principles to support effective and consistent governance.
The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Amendment
Order 2025 (“the 2025 Order”) requires Integration Joint Boards to extend voting
rights to members with lived experience, including service users, unpaid carers and
third sector representatives from September 2026.
Section 53 of the Public Bodies (Joint Working) (Scotland) Act 2014 ("the Act") sets
out an Integration Joint Board is required to have regard to this guidance when
exercising its functions under the Act. This guidance relates to Integration Joint
Boards that must be established when a Health Board and Local Authority choose a
Body Corporate Model of integration (under section 1(4)(a) of the Act)
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Draft Version 1 - May 2026 6 Section 1: Role and Responsibilities of the Integration Joint Board 2. Role and remit of the Integration Joint Board The Act puts in place arrangements for integrating health and social care, in order to improve outcomes for patients, service users, carers and their families. The Act requires Health Boards and Local Authorities to work together effectively to agree a model of integration to deliver quality, sustainable care services. Where a Health Board and a Local Authority agree to put in place a Body Corporate model, an Integration Joint Board will be established. This will see Health Boards and Local Authorities delegate a significant number of functions and resource to the Integration Joint Board, who will be responsible for the planning of integrated arrangements and onward service delivery. The Health Board and Local Authority will set out within their integration scheme which of their functions they intend to delegate to the Integration Joint Board. The scope of the delegated functions will vary depending on local decision making but must adhere to the statutory minimum: • Health Board functions The functions that must be delegated by the Health Board to the Integration Joint Board as per the Act are set out in The Public Bodies (Joint Working) (Prescribed Health Board Functions) (Scotland) Regulations 2014. • Local Authority functions The functions that must be delegated by the Local Authority to the Integration Joint Board as per the Act are set out in The Public Bodies (Joint Working) (Prescribed Local Authority Functions etc.) (Scotland) Regulations 2014. The Integration Joint Board is responsible for the strategic planning of the functions delegated to it and for ensuring the delivery of those functions through the directions issued by it under section 25 of the Act. The Integration Joint Board will also have an operational role as described in the locally agreed operational arrangements set out within their integration scheme. To fulfil its remit the Integration Joint Board will: • Adhere to the content of any future regulations or guidance issued by Scottish Ministers • Ensure stakeholder engagement • Take into consideration national developments in policy and practice 126
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2.1 Duties placed on Integration Joint Boards by the Public Bodies (Joint
Working) (Scotland) Act 2014 and The Public Bodies (Joint Working)
(Integration Joint Boards) (Scotland) Amendment Order 2025 ('the 2025 Order’)
• The Public Bodies (Joint Working) (Scotland) Act 2014, "the Act", places a
duty on Integration Joint Boards to develop a strategic plan for integrated
functions and budgets. For more information, please see the guidance
on Strategic Commissioning Plans.
• Each Integration Joint Board must establish a strategic planning group to
support the strategic planning process. For more information, see section
1.5 of this guidance.
• An Integration Joint Board must review its strategic plan at least every three
years.
• Sections 4 and 31 of the Act set out the integration principles which underpin
delivery of integrated health and social care services. These principles
describe "how" integrated care should be planned and delivered. Integration
Joint Boards are under a duty to have regard to these principles when
preparing a strategic plan. For more information, please see the guidance on
the Integration Planning and Delivery Principles.
• Section 37 of the Act places Integration Joint Boards under a duty to have
regard to the National Health and Wellbeing Outcomes (the Outcomes) when
preparing a strategic plan. These Outcomes are high-level statements of what
Integration Joint Boards are attempting to achieve through integration and
ultimately through the pursuit of quality improvement across health and social
care.
• Integration Joint Boards are required to issue directions to Health Boards and
Local Authorities as to how integration functions are to be carried out. Details
relating to this are set out in sections 26 and 27 of the Act.
• Integration Joint Boards are required to prepare an annual performance
report. This must comply with the requirements of the Regulations on the
Content of Performance Reports.
• An annual financial statement must be published setting out the total
resources included in the plan for that year. For more guidance, please see
the Professional Guidance, Advice and Recommendations for Integration
Arrangements.
• The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland)
Amendment Order 2025 (“the 2025 Order”) requires Integration Joint Boards
to extend voting rights to members with lived experience, including service
users, unpaid carers and third sector representatives from September 2026.
• A full list of guidance and advice published to support the Public Bodies (Joint
Working) (Scotland) Act 2014, is available at http://www.gov.scot/HSCI.
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Draft Version 1 - May 2026 8 2.2 Other key requirements of the Integration Joint Board Integration Joint Boards are public bodies, and as such are subject to a range of other requirements. An Integration Joint Board must ensure that arrangements are established to comply with their duties as set out in legislation. Although the responsibility of compliance sits with an Integration Joint Board; Integration Joint Boards may choose to draw on the experience of and/or request support from their constituent Health Board and/or Local Authority to aid it in complying with the legislative requirements set out below. In such circumstances the Health Board and/or Local Authority would be expected to provide the support requested. 2.2.1 The Public Records (Scotland) Act 2011 Integration Joint Boards are designated as "Bodies Corporate" for the purposes of the Public Records (Scotland) Act 2011. They will be obliged, therefore, to comply fully as public authorities under the legislation. Under the Public Records (Scotland) Act 2011 named public authorities must prepare, implement, and maintain a Records Management Plan that sets out proper arrangements for the management of their public records. Each Records Management Plan must be submitted to, and agreed by, the Keeper of the Records of Scotland (the Keeper) and must be kept under regular review. The plan must cover all public records for which the authority is responsible. The Records Management Plan must detail: • The functions of each authority • The types of records created in carrying out those functions • The policies, procedures, and systems in place for: o Appropriate storage o Retention and disposal o Archiving and security of records To assist public authorities to comply with their obligations, the Keeper has produced a model plan in the form of an annotated list of the elements that might be expected to be covered in a robust records management plan. In addition the Keeper has produced guidance that accompanies the model plan. A Senior Officer of the Integration Joint Board will therefore be responsible for overseeing the development and implementation of the records management plan and for approving it prior to submission for the Keeper's agreement. Further details on the National Records of Scotland and the Public Records (Scotland) Act 2011 Assessment Team and support they provide can be found on their website. 128
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Draft Version 1 - May 2026 9 2.2.2 Records Management Integration Joint Boards must consider how their obligations under the Freedom of Information (Scotland) Act 2002 and the Environmental Information (Scotland) Regulations 2004 impact on records management practices, including how information is created, stored, and accessed. The Code of Practice on Records Management sets out recommended best practice to support compliance with these duties and each Integration Joint Board should have a Records Management Plan which has been agreed by the Keeper of the Records of Scotland. Records Management Plans must clearly specify whether information is: • held by the Integration Joint Board, • owned by the Integration Joint Board, or • held by the Integration Joint Board on behalf of a Local Authority or Health Board. Where an Integration Joint Board receives a request for information that it holds on behalf of a Local Authority or Health Board, the applicant should be informed that the Integration Joint Board does not hold the information for the purposes of the request and should be directed to the relevant Local Authority or Health Board. Integration Joint Boards, Health Boards, and Local Authorities may also wish to put arrangements in place - such as Memoranda of Understanding - to support the effective handling of information requests that relate to joint working, shared interests, or communications between the organisations. 2.2.3 Data Sharing Health Boards and Local Authorities will continue to be responsible for answering data access requests in relation to any data for which they are the Data Controller, however, for requests in relation to any data that Integration Joint Boards are responsible they will be responsible for answering any data access request. 2.2.4 Data rights requests Data rights requests (called Subject Access Requests under the Data Protection Act 2018 ) are requests by individuals relating to their personal data. It is the responsibility of the data controller for that data to respond to these requests. It is possible for the same data to be held by more than one public authority as a result of agreed sharing. Integration Joint Boards must ensure that data sharing arrangements set out in the integration scheme are in place and that it is clear how requests are managed by both parties when shared data is involved. Further information on Data Rights Requests can be found on the ICO website. 129
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Draft Version 1 - May 2026 10 2.2.5 The Freedom of Information (Scotland) Act 2002 and Environmental Information (Scotland) Regulations 2004 The Freedom of Information (Scotland) Act 2002, together with the Environmental Information (Scotland) Regulations 2004 provide any applicant with the right to request - and be provided with - any recorded information held by Scotland's public authorities. If an authority does not wish to provide information it holds, an 'exemption' or (under the Environmental Information (Scotland) Regulations 2004) an 'exception' must be applied, for example, for legal advice or personal data. Integration Joint Boards are a "public authority" for the purpose of Freedom of Information (Scotland) Act 2002. This means they are subject to both Freedom of Information (Scotland) Act 2002 and the related Environmental Information (Scotland) Regulations 2004, as well as other requirements of Freedom of Information legislation, and will be required to respond to information requests accordingly. Integration Joint Boards should be aware of their responsibilities under this Code of Practice which sets out recommended guidance in the handling of information requests. As Health Boards and Local Authorities are already subject to information access legislation, Integration Joint Board members are likely to already have an awareness of the requirements that Freedom of Information (Scotland) Act 2002 and the related Environmental Information (Scotland) Regulations 2004 place on officials and organisations. 2.2.6 Publication Scheme Section 23 of Freedom of Information (Scotland) Act 2002 also requires that all Scottish public authorities subject to the Act maintain a publication scheme. A publication scheme sets out the types of information that a public authority routinely makes available. The Integration Joint Board will need to develop and put in place a publication scheme, along with a guide setting out what information it will make available. It is important that consideration is given to the publication scheme - and associated guides to information - as early as possible. A publication scheme must be approved by the Scottish Information Commissioner. Information on publication schemes is available on the Commissioner's website. 2.2.7 Office of the Scottish Information Commissioner (OSIC) The Scottish Information Commissioner promotes and enforces both the public's right to ask for information held by Scottish public authorities and good practice by authorities. 130
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Draft Version 1 - May 2026 11 The Commissioner's staff have considerable experience in assisting authorities who are new to the Freedom of Information (Scotland) Act 2002 / Environmental Information (Scotland) Regulations 2004 responsibilities and will be pleased to help. They can be contacted on 01334 464610, or by email to enquiries@foi.scot. 2.2.8 Ethical Standards in Public Life - Code of Conduct Integration Joint Boards are "devolved public bodies" for the purposes of the Ethical Standards in Public Life (Scotland) Act. This means that each Integration Joint Board is required to produce a Code of Conduct for members. The code should be based on the model code of conduct for members of devolved public bodies. Each Integration Joint Board is required to review this model code and adopt it, with or without modifications, as its own Code of Conduct; applying to all members and business of the Integration Joint Board. All members are required to sign the Code of Conduct. Some members may have already signed similar Codes of Conduct i.e. Code of Conduct for Councillors; however they are still required to sign the Integration Joint Board's Code of Conduct as their duties as Integration Joint Board members should be independent of the responsibilities that they may have by virtue of other posts. 2.2.9 The Standards Commission The Standards Commission is an independent public body which encourages high ethical standards in public life through the promotion and enforcement of Codes of Conduct for those appointed to the Boards of devolved public bodies. The Standards Commission has published guidance and advice notes which members should familiarise themselves to support their interpretation of, and compliance with the provisions set out in their Integration Joint Board’s Code of Conduct. Members may contact the Standards Commission for advice or clarification regarding their Code of Conduct responsibilities. The Standards Commission can be contacted using the contact us section on their website, or on the following email address: enquiries@standardscommission.org.uk. 2.2.10 The Commissioner for Ethical Standards in Public Life in Scotland The Commissioner for Ethical Standards in Public Life in Scotland is an independent office holder with responsibilities in two areas. • Public appointments – regulating how individuals are appointed to the boards of public bodies in Scotland. • Public standards – investigating complaints about Councillors or members of devolved public bodies who are alleged to have breached the Councillors’ Code of Conduct or the relevant public body’s Code of Conduct. 131
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Draft Version 1 - May 2026 12 It is in relation to this public standards role that the Integration Joint Board falls within the Commissioner’s remit. 2.2.11 Equalities Duties All public authorities in Scotland, including Integration Joint Boards, must comply with the public sector equality duty set out in the Equality Act 2010. The duty places an obligation on public authorities to take action to eradicate discrimination and to pro-actively promote equality of opportunity. The duty has a two tier structure - a general duty set out in the Equality Act 2010, and specific duties set out in regulations made by Scottish Ministers. To better enable public authorities to locate equality data and evidence, the Scottish Government has developed an evidence finder. The Scottish Government has also produced an evidence toolkit to help authorities source supporting evidence to help with their Scottish specific reporting duties. 2.2.12 Diversity Public bodies must champion diversity and embed equal opportunities across all aspects of their governance and operation. Scottish Ministers particularly welcome the participation of individuals from groups that are currently under represented on Scotland’s public bodies. The Gender Representation on Public Boards (Scotland) Act 2018 sets an objective that 50% of a public board’s non-executive members should be women. Public bodies must have due regard to this objective when planning and undertaking recruitment. While the collection of anonymised diversity data at a local level may not always be practicable due to small cohort sizes, monitoring the diversity of Board membership is encouraged as a matter of good practice. This may include using voluntary, anonymous diversity questionnaires during recruitment or contributing to national level data. Diversity and inclusion considerations must be embedded throughout all aspects of Integration Joint Board’s business and governance and must not be treated as a secondary component. 2.3 Liability arrangements for Integration Joint Boards and their members Integration Joint Boards are eligible to join the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) which covers the following areas of liability: • Clinical negligence claims • Non-clinical claims 132
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Draft Version 1 - May 2026 13 • Employers’ liability • Public liability • Product liability • Professional risks • Money • Fidelity guarantee • Work away from NHS premises • External quality assurance • Miscellaneous (i.e. employment practices liability arising out of wrongful employment practices) The National Health Service (Clinical Negligence and Other Risks Indemnity Scheme) (Scotland) Regulations 2000 (as amended) makes provision for Integration Joint Boards to apply to become a member of CNORIS. Membership is not compulsory, but represents a cost-effective alternative to arranging separate insurance. If an Integration Joint Board decides to become a member of CNORIS then they will be indemnified as above. If an Integration Joint Board decides not to become a member of CNORIS then it will be necessary to ensure alternative arrangements are put in place to cover the Integration Joint Board and its members against any claims arising in relation to liabilities listed above. 2.4 The relationship between the Integration Joint Board and the strategic planning group The Public Bodies (Joint Working) (Scotland) Act 2014 places a requirement on Integration Joint Boards to create a strategic plan for the area for which it is established. As part of this process, the Integration Joint Board must establish a strategic planning group. The Integration Joint Board must also determine the processes and procedures for the strategic planning group, subject to the provisions set out in section 32 of the Act. In developing the processes and procedures for the strategic planning group, the Integration Joint Board must be mindful that the work of the strategic planning group does not end with the publication of the strategic plan. After the strategic plan is published, the strategic planning group will continue to review progress of the plan, measured against the statutory outcomes for health and wellbeing, and associated indicators. Strong lines of communication will need to be established between the strategic planning group and the Integration Joint Board. This is needed to ensure that the strategic planning group can effectively communicate its findings to the Integration Joint Board which will help to inform and facilitate revisions to the strategic plan at least every three years. A detailed explanation of the process for the development of the strategic plan can be found in the Strategic plans: Statutory Guidance. 133
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Draft Version 1 - May 2026 14 2.5 Appointing a Committee of an Integration Joint Board Integration Joint Boards can appoint sub-committees should that be desirable. The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 extends the options available to an Integration Joint Board in effectively planning for the provision of services by permitting an Integration Joint Board to form a committee to carry out any of its functions as it sees fit. Any decision of such a committee must be agreed by the majority of the voting members who are members of the committee. A committee of an Integration Joint Board can only exercise the functions conferred upon it by the Integration Joint Board. The purpose of the committee is to support the effective working of the Integration Joint Board on matters which have been devolved to it by the Integration Joint Board. This may be in an advisory capacity or, depending on the remit given by the Integration Joint Board, the committee may have decision making powers to carry out certain functions of the Integration Joint Board. In the interests of fairness and effective working, a committee of an Integration Joint Board must consist of equal numbers of representatives from each constituent authority, as set out in the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 (article 17(3)). An Integration Joint Board can appoint advisory members to sit on a committee from outside the membership of the Integration Joint Board, although, as before, any such decision must be agreed on by the voting members of the Integration Joint Board. 2.6 Complaints under Integration 2.6.1 Complaints about Integrated services Where a Health Board and Local Authority choose a body corporate model of integration, the Health Board and Local Authority will remain the responsible bodies for the delivery of health and social care services. As such, any complaints about service delivery will be dealt with through the existing health, social care and social work complaint handling procedures. These must adhere to the applicable Model Complaint Handling Procedure (MCHP) (NHS or Local Authority). Health Boards and Local Authorities operating a Health and Social Care Partnership must ensure that the complaints process appears integrated from the complainant’s perspective. Integration schemes must set out arrangements for the management of complaints about jointly delivered services and the process by which a service user, and those complaining on behalf of service users may make a complaint. The arrangements set out in the integration scheme cannot alter the underlying position, described above, that complaints are to be dealt with under existing health, social care and social work complaints handling procedures. Complaint handling staff should be familiar with the different procedures for handling complaints depending on the responsible public body. They must adhere to all legal 134
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Draft Version 1 - May 2026 15 requirements and internal policies related to confidentiality and the handling and processing of service user information. The Health Board and Local Authority must ensure that: • Arrangements for complaints are well-publicised and clearly explained. Information on the complaint procedure should be available to service users in all areas of service provision. • The complaint process is accessible. Suitable arrangements must be made for the specific needs of complainants. This may include the provision of interpreting services or alternative formats when required. • Complainants are signposted to independent advocacy services. To support learning and service improvement, it is good practice for Integration Joint Boards to maintain oversight of integrated service complaints. Data on integrated service complaints should be included in regular governance reporting to the Integration Joint Board. 2.6.2 Complaints about Integration Joint Boards Complaints may be made about Integration Joint Boards in relation to particular functions and duties that they have responsibility for, such as strategic planning. Integration Joint Boards are listed in Schedule 2 of the Scottish Public Services Ombudsman Act 2002 and as such fall under the jurisdiction of the Scottish Public Services Ombudsman (SPSO). Integration Joint Boards must adopt the SPSO’s Model Complaint Handling Procedure (MCHP) for Scottish Government, Scottish Parliament and Associated Public Authorities. The SPSO’s MCHPs provide a standardised approach to dealing with service user complaints across the sector in Scotland. In particular, the aim is to implement a standardised and consistent process for service users to follow which makes it simpler to complain, ensures staff and service user confidence in complaints handling and encourages organisations to make best use of lessons from complaints. Further guidance on public bodies’ responsibilities for complaints handling under the relevant MCHP is available from the SPSO. The SPSO has powers to investigate the actions of Integration Joint Boards in carrying out their duties, or any service failure attributable to an Integration Joint Board. It cannot, however, investigate the merits of a decision taken within the Integration Joint Board’s discretion, unless the established processes have not been followed in making that decision. Under Section 53 of the Public Bodies (Joint Working) (Scotland) Act 2014, Integration Joint Boards are required to have regard to the guidance issued by Scottish Ministers 135
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Section 2: Membership of the Integration Joint Board
3. Minimum Membership
The Public Bodies (Joint Working) (Membership and Procedures of Integration Joint
Boards) (Scotland) Order 2014 ("the 2014 Order") and The Public Bodies (Joint
Working) (Integration Joint Boards) (Scotland) Amendment Order 2025 ('the 2025
Order’) set out requirements about the membership of an Integration Joint Board.
This includes minimum required membership, and provision for additional members
to be appointed.
The Integration Joint Board is created as a new legal entity that binds the Health
Board and the Local Authority together in a joint arrangement. The membership of
an Integration Joint Board reflects equal participation by the Health Board and Local
Authority to ensure that there is joint decision making and accountability.
The Local Authority and the Health Board will set out the number of representatives
that will sit on the Integration Joint Board within their integration scheme. The 2014
Order requires that the Local Authority and Health Board put forward a minimum of
three nominees each. This number may be increased by local agreement, but the
same number must be nominated by each party. Local Authorities can insist on
nominating a maximum of 10% of their full number of Councillors. The Health Board
and Local Authority may also agree that they will each nominate a larger number
than this.
The Local Authority will nominate Councillors to sit on the Integration Joint Board.
The Health Board will nominate non-executive directors to sit on an Integration Joint
Board. Where the Health Board is unable to fill all their places with non-executive
directors, they can then nominate other members of the Health Board.
The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Amendment
Order 2025 (“The 2025 Order”) amends The Public Bodies (Joint Working)
(Integration Joint Boards) (Scotland) Order 2014.
The principal change introduced by the 2025 Order is to confer full voting rights at
board meetings on Integration Joint Board members appointed to represent:
• third sector bodies,
• service users, and
• unpaid carers.
These members are collectively referred to as Lived Experience Representatives.
The Integration Joint Board will make decisions about how health and social care
services are planned and delivered for the communities within their areas. To do this
effectively, they will require professional advice, for example, to ensure that the
decisions reflect sound clinical practice. It is also essential that Integration Joint
Boards include key stakeholders within the decision making processes to utilise their
advice and experience.
To ensure this, the 2014 Order sets out a minimum membership, but allows local
flexibility to add additional nominations as Integration Joint Boards see fit. In addition
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Draft Version 1 - May 2026 17 to Health Board and Local Authority representatives, the Integration Joint Board membership must also include: • The Chief Social Work Officer of the constituent Local Authority • A General Practitioner representative, appointed by the Health Board • A Secondary Medical care Practitioner representative, employed by the Health Board • A Nurse representative, employed by the Health Board • A staff-side representative • A third sector representative • A carer representative • A service user representative • The Chief Officer of the Integration Joint Board • The Section 95 Officer of the Integration Joint Board The Chief Social Work Officer will be appointed by the Local Authority and the health professionals will be appointed by the Health Board because of the role they fulfil. The Chief Officer must be appointed by the Integration Joint Board and will provide a single point of accountability for integrated health and social care services. The Integration Joint Board must also appoint the Section 95 Officer who will be the responsible officer for the financial arrangements of the Integration Joint Board The ways in which the members of the Integration Joint Board are to be identified and appointed to the Integration Joint Board will differ. The Integration Joint Board will co-opt the staff-side, third sector, carer and service user representative, and this should be done as soon as practicable once the Integration Joint Board is established. How the Integration Joint Board approaches the appointment of the staff-side, third sector, carer and service user representative members will be dependent on local circumstances, for example, through existing carers networks or the organisations operating within the area of the Integration Joint Board, therefore sets out principles that should be implemented in the identification of members. Section 3.3 and 3.4 below provides guidance and best practice examples on recruitment of lived experience representatives. Whilst there is a required minimum membership for inclusion on the Integration Joint Board, there is also local flexibility for the Integration Joint Board to add additional members. The Independent Sector for example provide a significant proportion of social care services and will therefore play a key role in the successful delivery of integrated services in local areas. As part of their strategic planning responsibilities, Integration Joint Boards should consider their membership cohorts and seek appropriate additional representation as suggested by local priorities. Integration Joint Boards might also seek additional membership to reflect delegation of functions outside the minimum scope, for example additional professional advice. If an Integration Joint Board is established by more than one Local Authority, the 2014 Order makes specific provision for how the minimum membership is to be determined. 137
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Draft Version 1 - May 2026 18 3.1 Good Practice in the identification and appointment of members of Professional and Lived experience members The 2014 Order and Amendment Order 2025 sets out the minimum required membership for the Integration Joint Board. All members hold equal status The 2014 Order also enables the Integration Joint Board to appoint additional professional and/or stakeholder members where this is considered necessary to support its functions. Role descriptors for professional and stakeholder members are developed and maintained locally within individual Standing Orders . However, Integration Joint Boards are encouraged to draw on, and align with, the best practice standards outlined in Annex A for Lived Experience Representatives. To ensure that all members are equipped to fulfil their roles effectively, sections 3.2, 3.3 and 3.4 set out the principles that should be applied when identifying, selecting and appointing members. 3.2 Professional Membership The 2014 Order requires a minimum professional membership on the Integration Joint Board as follows: • Appointment of a GP • Appointment of a Nurse • Appointment of a Secondary Care representative • The Chief Officer of the Integration Joint Board • The Section 95 Officer of the Integration Joint Board • The Chief Social Work Officer of the constituent Local Authority With the exceptions of the Chief Officer, the Section 95 Officer and Chief Social Work Officer, the 2014 Order provides some flexibility in the appointment of professional members. However, due to the particular skills and experience required, and the strategic nature of the professional roles on the Integration Joint Board, the Health Board, Local Authority and the Integration Joint Board should follow the principles below to ensure they identify the appropriate members of professional staff to fill these posts: • The professional members appointed will bring professional experience and knowledge to inform the Integration Joint Board decision making in terms of planning, operational delivery and the effectiveness of major reforms. This advice will ensure the Integration Joint Board can fully take account of safety and quality of care matters. As such, the appointed person must be able to demonstrate the appropriate experience, skills and competencies to fulfil this 138
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Draft Version 1 - May 2026 19 role. The appointed member must demonstrate their ability to work at a senior level and have experience of operating at a strategic level; • Professional members should have a named, appointed deputy, able to demonstrate a similar level of skill and experience as the substantive appointment. Deputies should be expected to attend only where absolutely necessary to ensure continuity of advice from the professional. • The Health Board should ensure the appointed professional members have defined roles that are clearly set out, and held locally. The Health Board and/or Local Authority must ensure that they have time, resource and support to fulfil their responsibilities to the Integration Joint Board for the full term of their appointment. • As effective strategic planning is key, the Health Board and Local Authority must ensure that the appointed professional members are given specific training and support to contribute effectively to the Integration Joint Board, where such training is required. The above principles should also be considered when the Integration Joint Board opts to appoint additional professional members. However, in this case the application of each principle will depend on the nature and basis on which these additional members are appointed. 3.3 Appointment of Lived Experience members In addition to the professional membership, the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 requires that stakeholder members are appointed to the Integration Joint Board as follows: • A staff side member • A third sector member • A carer member • A service user member The Integration Joint Board must appoint at least one member from each of the groups listed above. The minimum representation requirements, including those relating to members with lived experience (such as carer and service user members), are set out in the 2014 Order. 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”) The ways in which lived experience members will be identified and appointed to these positions on the Integration Joint Board will vary due to the local circumstances of each Integration Joint Board, such as type and number of the representative groups working within their area. Although there will not be a uniform approach in appointment of the lived experience members, it is important that they 139
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Draft Version 1 - May 2026 20 are able to appropriately fulfil their roles. The Integration Joint Board should follow the principles set out below: • Lived experience members will reflect the views of the groups they represent on the Integration Joint Board; naturally the individuals that comprise these stakeholder groups will be diverse. As such, the appointed person must be able to demonstrate the appropriate experience and skill to reflect the breadth and diversity of views and situations of the individuals or groups that they represent. • The Integration Joint Board should ensure the appointed member has the resources and support to fulfil their responsibilities to the Integration Joint Board for the full term of their appointment. • As effective strategic planning is key, the Integration Joint Board must ensure that the appointed lived experience members are given specific training and support to contribute effectively to the Integration Joint Board, where such training is required. • Lived experience members have the ability to identify a suitably experienced deputy, or proxy, as required. Deputies should receive the same training and support as substantive members so as to enable them to fulfil their responsibilities. The Integration Joint Boards holds responsibility for determining their own arrangements for identifying suitability experienced proxy members. The appointment and investment in deputies should form part of best practice succession planning. As with professional members, these principles should also be considered when the Integration Joint Board opts to appoint any additional lived experience members. The implementation of each principle will depend on the nature and basis on which these additional members are appointed. 3.4 Recruitment Public bodies are expected to take positive action to increase diversity within their Board appointments. Recruitment practices should be clearly inclusive, transparent, and designed to attract applicants from a wide range of backgrounds, experiences and perspectives. As recruitment is undertaken at a local level, public bodies must ensure that their local recruitment approaches actively reflect and respond to the needs, demographics and experiences of their communities, and that inclusive practice is applied consistently throughout each stage of the process. Examples of positive action include: • ensuring role descriptions use plain and inclusive language, and avoid unnecessary criteria or barriers; • using inclusive advertising channels—such as community media, third sector partners, equality networks and platforms reaching under‑represented groups; • designing application processes that minimise unnecessary formality and allow candidates to demonstrate their suitability in different ways (e.g., guided questions, video submissions, or supported application formats); 140
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Draft Version 1 - May 2026 21 • ensuring recruitment panels include members trained in equality, diversity and inclusion and, where possible, external members to support independent oversight. Public bodies should take proactive steps to broaden the potential applicant pool before recruitment begins. Opportunities should be visible, accessible and appealing to people with diverse skills, experiences and backgrounds. Practical steps include: • engaging with community organisations, carers’ groups, disability networks, advocacy bodies and equality forums—including the use of established forums or representative bodies to support nomination or election‑based approaches where appropriate—to raise awareness of upcoming opportunities; providing pre‑recruitment information sessions or “meet the Board” events to demystify the role; • clearly outlining the skills and experiences genuinely required for the role, emphasising the value of lived, community and professional experience; • offering accessible recruitment materials and ensuring publicity is available in alternative formats and community languages. Inclusive and accessible recruitment practices should be applied, including where recruitment has traditionally been challenging. To support this, public bodies should ensure that appropriate resources, support and—where permitted—remuneration are in place to remove barriers to participation and enable equitable access to Board membership. This may include: • Making accessible technology, communication support, interpreters, or personal assistance available during the recruitment process, including respite support for unpaid carers where needed. • Offering flexible meeting arrangements to candidates as part of the recruitment and selection process, including hybrid or remote options where appropriate. • allowing job‑share arrangements, to be considered during the recruitment process, where appropriate. Diversity and inclusion must be embedded throughout the recruitment model and fully integrated across all aspects of Integration Joint Boards business and governance, rather than treated as an additional or secondary consideration. 3.5 Induction of Members As well as their collective roles in carrying out the responsibilities of the Integration Joint Board, members will have individual roles to carry out to ensure that integrated health and social services are planned and delivered to improve outcomes for the communities they serve. In doing so, Integration Joint Board members must ensure that this is carried out effectively and in line with the integration delivery principles. 141
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Draft Version 1 - May 2026 22 Integration Joint Boards members will come from a wide range of backgrounds, and some may have limited or no previous experience of serving on the board of a public body. All members will therefore require induction training to ensure they are able to carry out their duties to the highest possible standard. Training and development needs will vary between members, and Integration Joint Boards will determine locally how best to organise and deliver induction and ongoing development. All members should receive an induction which, as a minimum, covers their specific role, responsibilities, and relevant organisational policies. In line with best practice, the induction programme should include: • Training covering areas including being an effective board member, conflict of interest management, public scrutiny, financial skills development, including understanding budgets, financial reporting, and the board’s role in financial oversight. • Information about expenses policy • Information about Integration Joint Boards structures, processes and key personnel • Resources that will be provided to support the member to undertake their role • Welcome meetings with Integration Joint Board members, HSCP leadership and personnel • Mentoring and shadowing opportunities • How to access papers, online meetings, and any other IT related matters relevant to the local area. • Members should be issued with a corporate email address to ensure that all Integration Joint Board members can carry out their roles without needing to use their personal email address for public facing business. In addition, all members should complete a Personal Learning Plan (PLP) following their induction training to identify individual learning and development needs. PLPs should be kept under regular review and used to support ongoing learning and development throughout a member’s period of appointment. All members should also be provided with clear contact details for pastoral or wellbeing support, and receive information and guidance on the relevant codes of conduct, including how to raise concerns or seek advice where required. There are also a range of external networks and groups that stakeholder members are encouraged to join to support them in their role. These include: • The Coalition of Carers in Scotland’s Carers Collaborative which supports carer members on Integration Joint Boards. • The ALLIANCE’s Integration Joint Boards Lived Experience Representative which supports service user members Integration Joint Boards. The Role of Third Sector Interfaces Advice Note developed by the Scottish Government sets out the role of the third sector interface organisations on Integration Joint Boards. 142
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Draft Version 1 - May 2026 23 The Scottish Government have produced On Board: A Guide for Board Members of Public Bodies in Scotland which can be used as a standard induction pack covering generic issues such as roles and responsibilities of public bodies, and accountability and governance arrangements to supplement the tailored induction that individual Integration Joint Boards will wish to produce. The Scottish Government has also produced Leading the Journey of Integration: A Guide for Organisational Development Leaders to support the development of Integration Joint Boards. The guide highlights the important roles that are required for the integration of health and social care to be a success. It sets outs key information paired with development exercises which can be used individually or collectively by an Integration Joint Board. The guide can be found on the Adult Health Social Care Integration Implementation Website. 3.6 Ongoing Training and Support All members should attend any ongoing or refresher training as part of their role.12 The Integration Joint Board should conduct an annual self-assessment questionnaire/survey with its members to identify and inform ongoing training and support requirements. The ongoing training and support provided to members may include: • Development sessions covering areas including Finance, Budget Setting, Workforce Development, Housing, Performance, Strategic Plan Development, Business transformation. • Mentoring/buddying • Online training modules 3.7 Succession Planning Succession plans should be put in place to support a structured approach for recruiting, onboarding, developing, and transitioning Lived Experience Representatives on Integration Joint Boards. The aim is to ensure continuity, maintain diverse lived experience perspectives, and support representatives to contribute safely, confidently, and effectively. Transitions should be planned, respectful, and minimise disruption. The use of trained proxies and deputies should form part of the thinking around succession planning, to aid transitions. Local areas should have plans in place for supporting a pipeline of future potential representatives are supported, e.g. through shadowing opportunities or introductory training. 1 The Standards Commission for Scotland, Integrity In Public Life: Advice Note for Members of Health And Social Care Integration Joint Boards. The Standards Commission for Scotland, 2025, 2 The Scottish Government: Model Code of Conduct for Members of Devolved Public Bodies. The Scottish Government, 2021. 143
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Draft Version 1 - May 2026 24 Recruitment processes should be open and accessible, giving as much warning of vacancies becoming available as possible. Handovers and transition periods should be built in, aiming for 3-6 months overlap and joint attendance, to allow knowledge sharing. Outgoing representatives should prepare handover summaries and contribute to induction plans. Outgoing members should be offered exit conversations, feedback, and service recognition. Annual review of the succession plans informed by data and lived experience feedback should be carried out by the Integration Joint Board. Guidance on Succession Planning for Public Body Boards may be a useful resource to inform succession planning. 144
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Draft Version 1 - May 2026 25 Section 3: Code of Conduct 4. Application of the Code of Conduct Members are expected to comply with their Integration Joint Board’s Code of Conduct at all times when they are acting, or could be reasonably regarded as acting, as a member of their Integration Joint Board.3 Members are personally responsible for ensuring that that they are familiar with the Guidance and Advice Notes published by the Standards Commission Scotland to support their application of, and compliance with the Code of Conduct.4 The Standard Commission Scotland’s Advice Note for Members of Health and Social Care Integration Joint Boards provides information on, and specific examples covering the provisions of the Code of Conduct including registration of interests, and declaration of interests. The Integration Joint Board should provide all of its members with training and development to ensure that they are prepared to carry out the responsibilities of their role. The Integration Joint Board’s Standard’s officer should ensure that the training cover areas including the ethical standards framework, the Integration Joint Board’s Code of Conduct and the Standard Commission’s Guidance.5 The Integration Joint Board’s Standards Officer can support members with the application and interpretation of the Code of Conduct. 4.1 Registration of interests Integration Joint Boards have a legal requirement to maintain a public register of their members interest for all of its members. The Integration Joint Board’s Code Of Conduct sets out the financial and non- financial interests which should be registered by all members. The financial interests which members should register include:6 • Remuneration from employment, self-employment or directorships; • Related undertakings i.e. certain unremunerated directorships; • Contracts with the public body; • Gifts and hospitality; 3 The Standards Commission for Scotland, Integrity In Public Life: Advice Note for Members of Health And Social Care Integration Joint Boards. The Standards Commission for Scotland, 2025, 4 The Scottish Government: Model Code of Conduct for Members of Devolved Public Bodies, 2021. 5 The Standards Commission for Scotland, Integrity In Public Life: Advice Note for Members of Health And Social Care Integration Joint Boards. The Standards Commission for Scotland, 2025, 6 The Scottish Government: On Board – A Guide for Board Members of Public Bodies in Scotland. The Scottish Government, 2023. 145
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Draft Version 1 - May 2026 26 • Houses, land and buildings that you own, or have an interest in which are of significant or relevance to, or bear upon the work and operation of, the public body; • Shares and securities – holdings in a company or organisation which are of significance or relevance to, or bear upon the work and operation of the public body; • Election expenses. Non financial interests which members should register include:7 • Membership or holding office in other public bodies, clubs, societies and organisations such as Trade Unions and voluntary organisations. Members are responsible for registering their own interests within one month on being appointed, and are responsible for ensuring that these are kept up-to-date within one month of their circumstances changing.8 Members should contact their Integration Joint Board’s Standards Officer with any questions or queries regarding registration of interests. 4.2 Conflicts of Interest The Integration Joint Board’s Standing Order requires all members to declare interests which may conflict with their role. Members are responsible for declaring their own interests in the following settings: • Formal or committee meetings; • When dealing with Integration Joint Board officers and members. The Standards Commission’s Advice Note for Members on How to Identify and Declare Interests should be used by members to support them to identify declarable interests, and when and how to declare an interest at meetings. Potential conflicts of interest which members should identify include:9 • The potential for competing interests between their Integration Joint Board, council or health board (if applicable); • Any other organisation(s) they are a member of; • Any personal interests they may have. 7 The Scottish Government: On Board – A Guide for Board Members of Public Bodies in Scotland. The Scottish Government, 2023. 8 The Scottish Government: On Board – A Guide for Board Members of Public Bodies in Scotland. The Scottish Government, 2023. 9 The Standards Commission for Scotland, Integrity In Public Life: Advice Note for Members of Health And Social Care Integration Joint Boards. The Standards Commission for Scotland, 2025, 146
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Draft Version 1 - May 2026 27 Other conflict of interest case examples for specific Integration Joint Board member categories can be found in the Standard Commission’s Advice Note for Members of Health and Social Care Integration Joint Boards. Members should contact their Integration Joint Board’s Standards Officer to seek further advice on conflicts on interest. The Advice Note for Members of Health and Social Care Integration Joint Boards published by the Standards Commission provides members with additional information regarding registration of interests, alongside specific case examples. 4.3 Member confidentiality All Members must comply with confidentiality requirements as set out in their Integration Joint Board’s Standing Order, and Code of Conduct. The confidentiality requirements in each Integration Joint Board’s Standing Order, and Code of Conduct are informed by those that are outlined in the model Code of Conduct. These are as follows: • I will not disclose confidential information or information which should reasonably be regarded as being of a continental or private nature, without the express consent of a person of body authorised to give such consent, or unless required to. • I accept that confidential information can include discussions, documents and information which is not yet public or never intended to be public, and information deemed confidential by statute. • I will only use confidential information to undertake my duties as a board member. I will not use it in any way for personal advantage or to discredit my public body (even if my personal view is that the information should be public available). • I note that these confidentiality requirements do not apply to protected whistleblowing disclosures made to the prescribed persons and bodies as identified in statute. An Integration Joint Board Member who is also a member of an outside organisation, or is an elected or nominated member may have access to information that should not be disclosed to both their outside organisation and the Integration Joint Board. Members should contact their Integration Joint Board’s Standards Officer if they have any questions regarding information confidentiality, or to report potential breaches. The Advice Note for Members of Health and Social Care Integration Joint Boards published by the Standards Commission provides members with additional information regarding confidentiality requirements alongside specific case examples. 147
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Draft Version 1 - May 2026 28 4.4 Use of social media The Integration Joint Board’s Code of Conduct sets out provisions covering members’ use of social media. Members are expected to conduct themselves in the same manner on social media as they would when communicating in other ways, for example at face to face meetings, and in writing.10 When using social media, members carefully consider to whether they are acting in their capacity as a member of their Integration Joint Board, or could be reasonably interpreted as doing so by a member of the public. Before interacting on social media, members should also consider whether:1112 • You are representing the body or speaking on behalf of the body; whether you are readily identifiable as a member of your body in the situation/circumstances; • You are using social media where you are identified as a member; • Your conduct could reasonably be regarded as bringing your position as a member, or your body, into disrepute; • You are engaged in activity, or commenting on matters that are within the scope of the Integration Joint Board’s functions; • You understand the immediate and permanent nature of any comment or post they are about to make; • You would make that comment or post in-person, face to face; • You are disclosing any confidential information; and • Are complying with the principles of collective responsibility. Members should contact their Integration Joint Board’s Standards Officer if they have any questions regarding the use of social media. The Standards Commission has published an Advice Note on the Use of Social Media for Members of Devolved Public Bodies, and an e-learning video to support members’ compliance with the social media use provisions set out in their Integration Joint Board’s Code of Conduct. 10 The Standards Commission for Scotland, Integrity In Public Life: Advice Note for Members of Health And Social Care Integration Joint Boards. The Standards Commission for Scotland, 2025, 11 The Standards Commission for Scotland, Integrity in Public Life: Advice note on the Use of Social Media for Members of Devolved Public Bodies, 2026. 12 The Scottish Government: On Board: A Guide for Members of Statutory Boards. The Scottish Government, 2023. 148
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Draft Version 1 - May 2026 29 4.5 Handling Public Scrutiny Integration Joint Boards have a statutory duty to involve people in the planning and development of services, and in the decision making process. 13 The decisions being made by the Integration Joint Board are therefore subject to significant scrutiny by both the public and the media due to their potential impact on local communities. Integration Joint Boards should ensure that members are supported with handling public scrutiny. Support may include: • Providing an email account to all members so as not to require lived experience members to disclose their personal email addresses; • Pastoral support; • Trauma-informed wellbeing support; • Mental health support; • Signposting to other relevant appropriate services. 4.6 Expenses/Remuneration Each Integration Joint Board holds responsibility for developing and implementing its own expenses policy. Board members should submit expenses claims to their Integration Joint Board in accordance with their local expenses policy for expenses that have been incurred due to carrying out/undertaking the duties of their role. The Coalition of Carers in Scotland has developed an expenses policy template as a best practice to support Integration Joint Boards to develop their local expenses policy. Integration Joint Boards can use and adapt the template to suit local processes and needs. The template provides best practice examples of when the expenses policy should be applied, and a list of the expenses which members should be able to claim for. This should include when members undertake work in advance of, and attend: • Integration Joint Board meetings; • Strategic Planning Groups; • Locality Groups; • Other related Integration Joint Board sub-groups; • Integrated Joint Board related duties and events; The suggested expenses which members can claim for include: • Travel Costs; • Subsistence (where no meals or refreshments are provided); • Replacement care/cover; 13 Scottish Government and COSLA: Planning with People: Community engagement and participation guidance. The Scottish Government, 2024. 149
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Draft Version 1 - May 2026 30 • Loss of income to attend meetings; Integration Joint Boards should apply the “out of pocket” basic principle whereby no member should be out of pocket as a result of expenses that have arisen through their role, provided such costs are reasonable.14 Integration Joint Boards can use the Remuneration Policy for Involving People document developed by NHS Education for Scotland when considering/assessing members expenses claims. 14 The Scottish Government: Public sector pay policy: technical guide. The Scottish Government, 2025. 150
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Draft Version 1 - May 2026 31 Annex A Suggested Role Specification and Key Responsibilities for Lived Experience Representatives Lived Experience Representatives contribute to the work of the Integration Joint Board by ensuring that the perspectives of people who use health and social care services inform strategic planning and decision making. Representatives provide insight into real life experiences to support the development of services that are person centred, inclusive, and responsive to community needs. Lived Experience Representatives are expected to: •Provide insight from lived experience: Bring relevant personal perspectives to support the Integration Joint Board’s understanding of what matters to people who use services. •Participate effectively in Integration Joint Board meetings, working groups or thematic sub-committees: Attend scheduled meetings, pre-briefing sessions; review papers where required, listen actively, and contribute constructively during discussions. •Advocate for service users: Provide insights based on the views and experiences of people who use services, including individuals or groups whose voices may not be routinely heard. •Share wider perspectives: Where appropriate, draw on views from networks, community groups, or forums you are connected to, while ensuring that individual confidentiality is maintained. •Maintain confidentiality: Adhere to the Integration Joint Board’s Code of Conduct and protect all sensitive or personal information obtained through your role. •Work collaboratively: Engage respectfully with Board members and officers, contributing to collective decision-making in a balanced and constructive manner. •Support continuous improvement: Provide feedback to help the Integration Joint Board understand how services can be improved to better reflect the needs, preferences, and experiences of people who use them. •Lived Experience Representatives are expected to exercise their vote in the best interests of the whole community, informed by lived experience and the needs of service users. 151
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Integration Joint Board 20th August 2026 Subject : North Ayrshire H&SCP Clinical and Care Governance Report Purpose : • Awareness Recommendation : • Note the establishment and ongoing development of the North Ayrshire H&SCP Clinical & Care Governance Group Governance Assurance Arrangements. • Note progress in implementing Healthcare Improvement Scotland (HIS) Clinical Governance Standards. • Note key governance risks, areas of assurance and improvement activity identified through the Clinical & Care Governance Group during 2026. 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 HIS Healthcare Improvement Scotland ORR Operational Risk Register MAPPA Multi-Agency Public Protection Arrangements IPC Infection Prevention & Control AHP Allied Health Professionals CMHT Community Mental Health Team 1. EXECUTIVE SUMMARY 1.1 The North Ayrshire H&SCP Clinical & Care Governance Group has continued to strengthen governance oversight arrangements throughout 2026. The Group has undertaken a review of its Terms of Reference, considered alignment with the Healthcare Improvement Scotland Clinical Governance Standards and commenced work to map existing governance structures and reporting arrangements across North Ayrshire HSCP services. 1.2 The group has received assurance reports relating to clinical quality, patient safety, professional practice, public protection, infection prevention and control, policy compliance and service developments. Agenda Item 10 153
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Governance oversight has included review of the Operational Risk Register, workforce pressures, Learning Disability services, adult Neurodevelopmental services, complex care provision, Public Protection arrangements and implementation of standards- based improvement programmes. 1.3 Work is ongoing to embed the HIS Clinical Governance Standards within North Ayrshire HSCP Governance Structures, identify areas requiring improvement and strengthen integrated governance arrangements across health and social care services. 2. BACKGROUND 2.1 The Clinical & Care Governance Group was established to provide assurance regarding quality, safety, clinical effectiveness, risk management and professional governance across North Ayrshire H&SCP services. During 2026, under new stewardship, the Group reviewed its governance arrangements and agreed updates to its Terms of Reference, including alignment to newly published Healthcare Improvement Scotland Clinical Governance Standards. 2.2 During 2026 the Group has considered a range of governance matters including, but not limited to: • Operational and Strategic Risks. • Workforce Pressures across Mental Health, Nursing, Social Care and Allied Health Professions. • Learning Disability Inpatient Provision and Ward 7A Service Redesign. • Adult Dysphagia Governance and Staff Competency Assurance. • Public Protection and MAPPA oversight. • Infection Prevention and Control Standards. • Implementation of National Standards, Policies and Guidance 3. PROPOSALS 3.1 The IJB is asked to note: • Progress in developing integrated Clinical and Care Governance arrangements. • Ongoing implementation and self-assessment against the HIS Clinical Governance Standards. • Continued monitoring and escalation of significant operational and strategic risks through established governance structures. • Work underway to strengthen governance assurance relating to workforce sustainability, patient safety, quality improvement and public protection. • Development of governance mapping and reporting arrangements to support integrated assurance across the HSCP. 154
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3.2 Anticipated Outcomes Implementation of the proposals will: • Strengthen governance oversight and assurance arrangements. • Improve compliance with national clinical governance standards. • Enhance identification, monitoring and mitigation of clinical and care risks. • Support continuous quality improvement and learning. • Strengthen integrated working between health and social care governance systems. 3.3 Measuring Impact Impact will be monitored through: • Regular Clinical & Care Governance Group reporting. • Progress against HIS Clinical Governance Standards action plans. • Monitoring of Operational and Strategic Risk Registers. • Audit, Quality Improvement and Assurance Activity. • Monitoring of Incidents, Complaints, Learning Reviews and Public Protection Arrangements. • Reporting to established IJB and NHS Healthcare Governance structures. 4. IMPLICATIONS 4.1 Financial No direct financial implications arise from this report. Financial pressures associated with identified risks and service developments continue to be monitored through normal governance and financial reporting arrangements. 4.2 Human Resources The report highlights a number of workforce-related risks and improvement activities including Psychiatry workforce pressures, Community Nursing staffing, Social Care workforce sustainability, Neurodevelopmental services and AHP workforce planning. These risks are already identified via appropriate risk management processes. 4.3 Legal The work supports compliance with statutory governance duties and national clinical governance requirements. 4.4 Equality/Socio-Economic Implementation of governance standards and quality assurance processes supports the delivery of equitable, safe and effective care across health and social care services. Particular consideration has been given to equality, inclusion and wider socio-economic factors, with a focus on reducing inequalities, improving access to services and supporting meaningful involvement of individuals, carers and communities in line with Healthcare Improvement Scotland Standards. 155
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4.5 Risk The report highlights a number of high and very high residual operational risks, including adult neurodevelopmental services, children's placements, NHS workforce sustainability and Arran service pressures. These risks continue to be actively monitored through established risk management and governance arrangements, with mitigation plans in place and progress reported separately through Integration Joint Board governance processes to support oversight, assurance and scrutiny. 4.6 Community Wealth Building No direct implications identified. 4.7 Key Priorities The proposals support delivery of the HSCP Strategic Plan through improving quality, safety, governance, integrated care, workforce sustainability and continuous improvement. 5. CONSULTATION This report reflects discussions and assurance activity undertaken through the North Ayrshire HSCP Clinical & Care Governance Group, with representation from Heads of Service, Professional Leads, Operational Managers, Finance, Quality Improvement, Medical, Nursing, Psychology, Allied Health Professional, Pharmacy and Social Work Services. Director: Caroline Cameron, Chief Officer Author Name, Designation: Julie Barrrett, Associate Nurse Director/ Lead Nurse, North Ayrshire H&SCP Appendices • Appendix 1: Clinical & Care Governance Group Key Assurance Themes 2026 • Appendix 2: Summary of Key Governance Risks and Improvement Actions 2026 • Appendix 3: Updated Terms of Reference 18/05/2026 156
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Appendix 1 CLINICAL & CARE GOVERNANCE GROUP KEY ASSURANCE THEMES 2026 Purpose This appendix provides a summary of the key areas of assurance, oversight and improvement activity considered by the North Ayrshire HSCP Clinical & Care Governance Group during 2026. The group have met on 3 occasions since the beginning of 2026; • 30/03/2026 • 18/05/2026 • 27/07/2026 A copy of each note can be made available if required by the IJB. In general, the Key Themes identified during these meetings were as follows. 1. Clinical and Care Governance Framework The Group reviewed and updated its Terms of Reference to ensure alignment with the Healthcare Improvement Scotland (HIS) Clinical Governance Standards and agreed a programme of work to strengthen governance arrangements across health and social care services. Key developments included: • Review of governance reporting structures. • Governance mapping across North Ayrshire services. • Identification of decision-making and escalation pathways. • Establishment of quarterly governance review arrangements. 2. Healthcare Improvement Scotland Clinical Governance Standards The Group received detailed presentations and updates regarding implementation of the seven HIS Clinical Governance Standards. Areas reviewed included: • Leadership and staffing. • Quality management. • Clinical effectiveness. • Clinical safety. • Education and training. • Involvement and participation. • Data and information governance. A self-assessment and gap analysis process has commenced to identify areas requiring further development and improvement planning. 157
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3. Workforce Assurance The Group reviewed workforce sustainability risks and pressures affecting service delivery, including: Mental Health Services • Consultant Psychiatry vacancies. • Community Mental Health Team workforce pressures. • Community Eating Disorder Service workforce and funding challenges. • Development of Psychiatry Workforce Planning Arrangements. Nursing Workforce • Community nursing staffing levels and skill mix. • District nursing workforce resilience. • Demand and capacity within Adult Community Mental Health Services. Allied Health Professionals • Increasing complexity and demand. • Healthcare Staffing Act workforce review activity. • Professional assurance arrangements. Social Work and Social Care • Social work staffing sustainability. • Recruitment and retention challenges. • Service demand pressures. 4. Quality and Safety Assurance The Group received assurance reports relating to: • Falls prevention and management guidance. • Safe use of bed rails. • Adult dysphagia policy and training arrangements. • Infection Prevention and Control standards. • Provision and management of patient meals. • Chaperone policy implementation. The Group endorsed revised clinical guidance and policies where appropriate and identified areas requiring additional oversight and staff training. 158
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5. Public Protection The Group maintained oversight of Public Protection matters through updates relating to: • Adult Support and Protection. • MAPPA arrangements. • Management of Restricted Patient Cases. • Strategic Suicide Prevention Activity. • Drug Death Governance Arrangements. 6. Service Improvement and Clinical Effectiveness The Group received updates regarding: • Improving the Cancer Journey Programme. • Frailty Standards self-assessment. • Palliative and End of Life Care improvement work. • National clinical guidelines and standards implementation. 7. Learning Disability and Neurodevelopmental Services The Group considered several significant assurance issues including: • Demand and capacity challenges across specialist services. • Learning Disability patient safety considerations. • Ward 7A service redesign and options appraisal. • Lack of dedicated Learning Disability inpatient provision. • Adult Neurodevelopmental service demand. Overall Assurance Position The Clinical & Care Governance Group has established robust arrangements for Governance Oversight and Assurance. Positive progress has been demonstrated in strengthening governance structures, embedding national standards and improving risk oversight. The Group recognises that significant challenges remain in workforce sustainability, specialist service demand and delivery of improvement priorities, which continue to be actively monitored through established governance processes. 159
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Appendix 2 Summary of Key Governance Risks and Key Improvement Priorities for 2026/ 2027 Risk Area Current Position Key Mitigations/Actions Assurance Level Adult Neurodevelopmental Services (ORR65) Very High residual risk due to demand, access and treatment pressures. Review of service model, workforce planning and monitoring through governance structures. Moderate Children's Services Placements (ORR64) Very High risk relating to availability and sustainability of placements. Ongoing monitoring and escalation through senior management structures. Moderate NHS Staffing Levels and Skill Mix (ORR62) High residual workforce risk across services. Workforce review, recruitment activity and service redesign. Moderate Community Mental Health Services Workforce and capacity pressures affecting service delivery. Workforce planning, caseload review and medical leadership oversight. Moderate Learning Disability Inpatient Provision No dedicated inpatient resource for adults with learning disabilities. Ward 7A redesign, nursing competency review and escalation through governance structures. Moderate Arran Ferry Disruption Significant risk to access, transfers and patient safety. Ongoing monitoring and contingency planning. Moderate Complex Packages of Care High demand and resource pressures. Service redesign and operational oversight. Moderate Significant Adverse Event Reviews Historical backlog in completing reviews. Risk escalation and review of governance arrangements. Moderate Dysphagia Competency Assurance Inconsistent assurance across health and social care workforce. Training review, NES resources and monitoring arrangements. Developing Chaperone Policy Implementation New policy requiring awareness and workforce compliance. Communication, training and governance monitoring. Developing IPC Standards Compliance Predominantly compliant position with identified improvement actions. Quarterly performance monitoring and training assurance. Good 160
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HIS Clinical Governance Standards Implementation programme underway. Self-assessment, action planning and governance oversight. Developing Key Improvement Priorities for 2026/27 1. Complete HIS Clinical Governance Standards self-assessment and action planning. 2. Finalise governance mapping across health and social care services. 3. Strengthen workforce assurance arrangements across NHS and Social Care Services. 4. Improve oversight of high and very high risks through integrated governance reporting. 5. Strengthen assurance regarding Public Protection, MAPPA and restricted patient governance. 6. Enhance monitoring of staff training, competency and compliance requirements. 7. Maintain oversight of Learning Disability, Neurodevelopmental and Mental Health Service Pressures. 8. Develop integrated governance arrangements that better align health and social care standards and assurance frameworks. 161
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NORTH AYRSHIRE Health and Social Care Partnership In partnership with Appendix 3: Updated Terms of Reference 18/05/2026 Clinical and Care Governance Group Background The main purpose of integration is to improve the wellbeing of people who use our health and social care services, of families, our communities, and particularly those whose needs are complex and involve support from across health and social care at the same time. The North Ayrshire Health & Social Care Partnership (NAHSCP) Integration Scheme is intended to achieve the National Health and Wellbeing Outcomes prescribed by the Scottish Ministers in Regulations under section 5(1) of the Public Bodies (Joint Working) (Scotland) Act 2014 (hereinafter referred to as “the Act”). In Annex C of ‘Clinical and Care Governance of Integrated Health and Social Care Services’ (A Scottish Government publication) it contains the following description of clinical and care governance. 1. Clinical and care governance is the process by which accountability for the quality of health and social care is monitored and assured. It should create a culture where delivery of the highest quality of care and support is understood to be the responsibility of everyone working in the organisation - built upon partnership and collaboration within teams and between health and social care professionals and managers. 2. It is the way by which structures and processes assure Integration Joint Boards, Health Boards and Local Authorities that this is happening - whilst at the same time empowering clinical and care staff to contribute to the improvement of quality - making sure that there is a strong voice of the people and communities who use services. 3. Clinical and care governance should have a high profile, to ensure that quality of care is given the highest priority at every level within integrated services. Effective clinical and care governance will provide assurance to patients, service users, clinical and care staff and managers, Directors alike that: a. Quality of care, effectiveness and efficiency drives decision-making about the planning, provision, organisation and management of services; b. Unacceptable clinical and care practice will be detected and addressed 4. Effective clinical and care governance is not the sum of all these activities; rather it is the means by which these activities are brought together into this structured framework and linked to the corporate agenda of Integration Authorities, NHS Boards and Local Authorities. 5. A key purpose of clinical and care governance is to support staff in continuously improving the quality and safety of care. However, it will also ensure that wherever possible poor performance is identified and addressed. All health and social care professionals will remain accountable for their individual clinical and care decisions. 6. Many clinical and care governance issues will relate to the organisation and management of services rather than to individual clinical decisions. All aspects of the work of Integration Authorities, Health Boards and local authorities should be driven by and designed to support efforts to deliver the best possible quality of health and social care. Clinical and care governance, however, is principally concerned with those activities which directly affect the care, treatment and support people receive. 162
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NORTH AYRSHIRE Health and Social Care Partnership In partnership with Terms of Reference 1.0 Introduction The Clinical and Care Governance Group is identified as a subgroup of the North Ayrshire Health and Social Care Partnership, Integration Joint Board (IJB). The approved Terms of Reference and information on the composition and frequency of the group will be considered as an integral part of the standing orders of the Integrated Joint Board. The Group will be known as the Clinical and Care Governance Group of the Integration Joint Board and will be a subgroup of the Integration Joint Board. 2.0 Remit To provide assurance to the IJB as follows: • On the quality and safety of health and social care partnership services. • That staff across the Partnership are supported to provide quality services and are appropriately skilled and registered to discharge their professional responsibilities. • That proposed changes in practice, within one professional group, do not adversely impact upon another profession, and that there is a whole system approach to improvement. • That services are able to learn and develop from service user and carer experiences and that effective mechanisms are in place to do so. • That self-evaluation and quality assurance mechanisms are in place to inform improvement. • That a systematic and proportionate approach to the review of critical incidents, significant incidents and near misses is embedded in the Partnership; and pan- Ayrshire where this relates to mental health services. • That findings of critical incidents, significant events and near misses, locally and nationally, are considered and used to review and improve practice. • That services commissioned through registered, third and independent sector have appropriate contract monitoring arrangements in place and that those services are delivered to a high standard. • That medical devices (and where required - devices to support care), that are used, are sourced and maintained appropriately. • That appropriate links to Infection Control structures are in place. • That a learning culture is encouraged and that good practice and success is shared widely. • That current Partnership governance structures report into and through the Clinical & Care Governance Group. • That practice improvement plans are delivered, as appropriate. • That all Health and Care arrangements are developed with service users at the centre. 163
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NORTH AYRSHIRE Health and Social Care Partnership In partnership with 3.0 Group Membership The Clinical and Care Governance Group will be chaired by the Lead Nurse, on behalf of the Chief Officer. The Group will report to the Chief Officer and through the Chief Officer to the Integration Joint Board. The Vice Chair of the Group will be the Clinical Director (Primary Care) who will cover the meeting in the Chair’s absence. The group will comprise of the following members: • Lead Nurse • Clinical Director • Lead Allied Health Professional • Chief Social Work Officer • Associate Medical Director, Mental Health Services • Director of Public Health or representative • Head of Children, Families & Justice Services • Head of Health and Community Care • Head of Mental Health • Quality Improvement Lead • Director of Psychological Services • Risk Management Representative • Governance Representative (NHS) • Pharmacy Lead Service Users and Carers, Third and Independent sector representation will be sought via the IJB. The Chair and members will be appointed by the IJB. Group membership will be reviewed annually and the first meeting of the year. 4.0 Quorum Four members including two core members will constitute a quorum. Members will be asked to identify deputies to attend in their absence. 5.0 Attendance The group may co-opt additional advisors as required. 6.0 Frequency of Meetings The Group will meet quarterly. The Chair may, at any time, convene additional meetings of the group. 7.0 Authority The group is authorised to investigate any matters which fall within its terms of reference and obtain external professional advice. The group may form sub-groups to support its functions. The group is authorised to seek and obtain any information it requires from any employee whilst taking account of policy, legal rights and responsibilities. 164
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NORTH AYRSHIRE Health and Social Care Partnership In partnership with 8.0 Duties The Group shall be responsible for the oversight of clinical and care governance within North Ayrshire Health and Social Care Partnership and specifically it will: • Consider matters relating to; professional governance relevant to Strategic Plan development, service user feedback and complaints, standards, education, learning, continuous improvement and inspection activity. • Provide advice to the strategic planning group, audit and performance committee and locality groups within the Council area. The strategic planning group, audit and performance committee and locality groups may seek relevant advice directly from the Group. • Provide assurance to IJB on the operation of clinical and care governance within the Health and Social Care Partnership in compliance with relevant national standards, highlighting problems and action being taken where appropriate. • When clinical and care governance issues relating to Lead Partnership Services are being considered, the Clinical and Care Governance Group for the Lead Partner will obtain input from the Clinical and Care Governance Groups of the other Health and Social Care Partnerships. • When Clinical and Care Governance issues relating to Public Health are being considered, the Clinical and Care Governance Group will obtain input from the Public Health Governance Group. • The Integration Joint Board may seek advice on clinical and care governance directly from the Clinical and Care Governance Group. In addition, the Integration Joint Board may directly take into consideration the professional views of the professional leads as outlined previously. • Receive minutes and annual reports from the sub-groups established by the Clinical and Care Governance Group to provide assurance and accountability. • The group will monitor and review risks falling within its remit. 9.0 Conduct of Business Meetings of the group will be called by the Chair of the group. The agenda and supporting papers will be sent to members five working days prior to the date of the meeting. 10.0 Reporting Arrangements Minutes will be kept of the proceedings of the group and will be circulated in draft within five working days to the Chair of the meeting and within three working days thereafter to group members, prior to consideration at a subsequent meeting of the committee. The Chair of the group shall provide assurance on the work of the group, and the approved minutes will be submitted to the IJB for information. The group will conduct an annual review of its role, function and achievements. The group will hold a repository for annual reports from Stakeholder Groups. 165
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+ Integration Joint Board 20th August 2026 Subject: Strategic Risk Register Purpose: To present the updated IJB Strategic Risk Register for consideration and approval. Recommendation: To approve the updated IJB Strategic Risk Register 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 IJB Integration Joint Board NHS National Health Service PAC Performance Audit Committee PSMT Partnership Senior Management Team SRR Strategic Risk Register ORR Operational Risk Register 1. EXECUTIVE SUMMARY 1.1 This report presents the updated Strategic Risk Register and seeks approval of the revised register. It highlights the escalation of one new strategic risk from the Operational Risk Register and confirms that no existing risks have increased in score. The report supports the IJB in identifying, monitoring and managing risks to the successful delivery of the Strategic Plan. 2. BACKGROUND 2.1 A Strategic Risk Register (SRR) is a requirement of the Clinical and Care Governance Framework and as part of our Risk Management Strategy, which was last approved by the IJB in June 2025. 2.2 The Strategic Risk Register (SRR) was last reported to the IJB in April 2026 and the next review was planned for April 2027. This report is being presented earlier following a recent review of the Operational Risk Register (ORR), which recommended that one risk be escalated to the SRR. Agenda Item 11 167
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2.3 New Risks: One new Strategic Risk is proposed for inclusion following escalation from the ORR. This risk has been brought onto the Strategic Risk Register to reflect both the national and local pressures affecting the availability of placements. The principal impact is on service provision, with a potential indirect financial impact. This is shown in the table below: Ref Title Description Risk Rating Gross Risk Rating Residual ORR 64 (now SRR 17) Children’s Services Placements The availability of placements for children and young people locally and nationally is at a critical shortage. This risks provision not being available for children and young people who require to live away from home. 25 Very High 25 Very High 2.4 There are no risks with increased scores. 2.5 The narrative for SRR01 Financial Sustainability has been updated to reflect the 2025/26 outturn position. 2.6 The actions required to manage and control the risks have been identified and they will be subject to ongoing monitoring and review by the PSMT with an update to be reported to the Performance and Audit Committee. 2.7 There are now 13 risks noted on the Strategic Risk Register, with a number of these graded as very high or high risk. While there are a number of controls and mitigations in place there may be further actions required to reduce the risks further in line with the level of risk tolerance. The current Strategic Risk Register is included as Appendix A. The risks are summarised below: Ref Title Gross Risk (score pending further controls) April 2026 Residual Risk (score after further controls) April 2026 Gross Risk (score pending further controls) August 2026 Residual Risk (score after further controls) August 2026 SRR01 Financial Sustainability 25 Very High 25 Very High 25 Very High 25 Very High SRR02 Infrastructure (ICT Integration) 12 High 9 Moderate 12 High 9 Moderate SRR05 Transformational Change Programme 12 High 9 Moderate 12 High 9 Moderate SRR06 Governance 9 Moderate 3 Low 9 Moderate 3 Low SRR07 Demography and Inequality Pressures 16 High 12 High 16 High 12 High SRR08 Workforce 12 9 12 9 168
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High Moderate High Moderate SRR09 Local Impact of Scottish Government Policies 16 High 12 High 16 High 12 High SRR12 Clinical and Care Governance 9 Moderate 9 Moderate 9 Moderate 9 Moderate SRR13 Provider Failure (commissioned services) 16 High 16 High 16 High 16 High SRR14 Asylum Arrivals 12 High 12 High 12 High 12 High SRR15 Risk of Harm 16 High 16 High 16 High 16 High SRR16 Growth and expansion of specialist complex care developments 25 Very High 15 High 25 Very High 15 High SRR17 Children’s Services Placements n/a n/a 25 Very High 25 Very High 2.7 The scoring of the risks is based on the severity of the risk multiplied by the likelihood of it happening. Further detail is provided in the extract from the approved Risk Management Strategy in Appendix B. 2.8 The operational risks of the Partnership are regularly reviewed and considered at service management meetings. The Clinical and Care Governance Group is responsible for oversight of operational risks within the Partnership. The Group considers any high or very high risks, as defined by the approved Risk Management Strategy, and may, where appropriate, escalate these to the Partnership Senior Management Team (PSMT) for consideration for inclusion on the Strategic Risk Register. 3. PROPOSALS 3.1 It is proposed to approve the risk register detailed in Appendix A including the action required to manage, mitigate and control the risks. 3.2 Anticipated Outcomes Risk management is an integral part of governance, and it is essential that the IJB has assurance that risks are identified and managed appropriately to ensure the safe and sustainable delivery of services. 169
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3.3 Measuring Impact The risk register will be monitored, with individual risk owners responsible for keeping the register up to date under the oversight of the Principal Manager – Finance / Chief Finance Officer. It is recommended that risk assessments are reviewed at least annually. 4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic None 4.5 Risk The report falls in line with the agreed risk appetite statement which is low-risk appetite in respect to adherence to compliance duties. 4.6 Community Wealth Building None. 4.7 Key Priorities Appropriate and effective risk management practice will deliver better outcomes for the people of North Ayrshire, protecting the health, safety and wellbeing of everyone who engages with the IJB or for maximising opportunity, delivering innovation and best value, and increasing performance. 5. CONSULTATION 5.1 The strategic risks have been reviewed by the relevant risk owners. For more information please contact: Eleanor Currie, Chief Finance Officer – Finance at eleanorcurrie@north- ayrshire.gov.uk 170
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Appendix A Strategic Risk Register Glossary of Terms Term Definition Term Definition NAHSCP North Ayrshire Health and Social Care Partnership ARG Allocation of Resources Group SAHSCP South Ayrshire Health and Social Care Partnership ICT Information and Computer Technology EAHSCP East Ayrshire Health and Social Care Partnership MDTs Multi-Disciplinary Teams NHS/ NHS AAA NHS Ayrshire & Arran EKSF Electronic Knowledge and Skills Framework MTFP Medium Term Financial Plan TURAS Training Management System CRES Cash Releasing Efficiency Savings SPOG Strategic Planning Officers Group LD Learning Disability ICF Integrated Care Fund IJB Integrated Joint Board RMP Records Management Plan PSMT Partnership Senior Management Team CPAG Child Poverty Action Group NAC North Ayrshire Council 171
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Appendix B Extract from the Risk Strategy on Risk Scoring 172
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SEVERITY CONSEQUENCE MATRIX - Description and definition of the CONSEQUENCE / IMPACT of the risk should it occur (these are a guide) Severity “Domains” 1 Insignificant 2 Minor 3 Moderate 4 Major 5 Extreme Objectives and projects Barely noticeable reduction in scope / quality / schedule Minor reduction in scope / quality / schedule Reduction in scope or quality, project objectives or schedule. Significant reduction in ability to meet project objectives or schedule. Inability to meet project objectives, reputation of the organisation seriously damaged and failure to appropriately manage finances. Injury (physical and psychological) to patients/staff. Adverse event leading to minor injury not requiring first aid. Minor injury or illness, first-aid treatment needed. No staff absence required. Significant injury requiring medical treatment and/or counselling. Major injuries or long- term incapacity/ disability (loss of limb), requiring medical treatment and/or counselling. Incident leading to death or major permanent incapacity. Patient experience / outcome Reduced quality of patient experience / clinical outcome not directly related to delivery of clinical care. Unsatisfactory patient experience / clinical outcome directly related to care provision – readily resolvable Unsatisfactory patient experience / clinical outcome, short term effects – expect recovery < 1Wk Unsatisfactory patient experience / clinical outcome, long term effects - expect recovery > 1Wk Unsatisfactory patient experience / clinical outcome continued ongoing long-term effects. 173
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Complaints / claims Locally resolved complaint Justified complaint peripheral to clinical care Below excess claim. Justified complaint involving lack of appropriate care. Claim above excess level. Multiple justified complaints. Multiple claims or single major claims. Staffing and competence Short term low staffing level (< 1 day), where there is no disruption to patient care. Ongoing low staffing level results in minor reduction in quality of patient care Minor error due to ineffective training / implementation of training. Late delivery of key objective / service due to lack of staff. Moderate error due to ineffective training / implementation of training. Ongoing problems with staffing levels Uncertain delivery of key objective / service due to lack of staff. Major error due to ineffective training / implementation of training. Non delivery of key objective / service due to lack of staff. Loss of key staff. Critical error due to insufficient training / implementation of training. Service / business interruption Interruption in a service which does not impact on the delivery of patient care or the ability to continue to provide service Short term disruption to service with minor impact on patient care. Some disruption in service with unacceptable impact on patient care. Temporary loss of ability to provide service. Sustained loss of service which has serious impact on delivery of patient care resulting in major contingency plans being invoked. Permanent loss of core service or facility. Disruption to facility leading to significant “knock on” effect. Financial Negligible organisational financial loss (£< 1k). Minor organisational financial loss (£1- 10k). Significant organisational financial loss (£10-100k). Major organisational financial loss (£100k- 1m). Severe organisational financial loss (£>1m). Inspection / assessment / audit Small number of recommendations which focus on minor quality improvement issues. Minor recommendations made which can be addressed by low level of management action. Challenging recommendations but can be addressed with appropriate action plan. Enforcement Action. Low rating. Critical report. Prosecution. Zero Rating. Severely critical report. 174
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Adverse publicity / reputation No media coverage, little effect on staff morale. Local Media – short term. Minor effect on staff morale / public attitudes. Local Media – long term. Impact on staff morale and public perception of the organisation. National Media (< 3 days). Public confidence in the organisation undermined. Usage of services affected. National Media (> 3 days). MP / MSP Concern (Questions in Parliament). Organisational / Personal Security, and Equipment Damage, loss, theft (£< 1k). Damage, loss, theft (£1-10k). Damage, loss, theft (£10-100k). Damage, loss, theft (£100k-1m). Damage, loss, theft (£>1m). 1 Remote 2 Unlikely 3 Possible 4 Likely 5 Almost Certain Probability Will only occur in exceptional circumstances. Unlikely to occur but definite potential exists. Reasonable chance of occurring – has happened before on occasions. Likely to occur – strong possibility. The event will occur in most circumstances. 175
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Risk Rating LIKELIHOOD SEVERITY 1 Insignificant 2 Minor 3 Moderate 4 Major 5 Extreme 5 Almost Certain 5 10 15 20 25 4 Likely 4 8 12 16 20 3 Possible 3 6 9 12 15 2 Unlikely 2 4 6 8 10 1 Remote 1 2 3 4 5 176
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North Ayrshire Integration Joint Board Strategic Risk Register Risk Ref Description of Risk Risk Owner Mitigations/Control Measures Previous Severity Probability Score Rating Proposed New Control Measures Previous Severity Probability Score Rating Risk SRR01 Financial Sustainability of the Health and Social Care Partnership - Resources have not kept pace with the demand for and cost of health and social care services. The 2025/26 financial outturn was an overall year-end underspend of £2.501m on an IJB basis, reducing to £0.696m after new earmarked reserves of £1.805m. This improved position reflected the impact of financial recovery actions, strengthened controls and non-recurring benefits realised during the year; however, it does not remove the underlying recurring pressures across a number of service areas. Financial modelling continues to indicate significant medium-term challenges, with 2026/27 remaining particularly challenging due to cost and demand pressures, pay and inflation, demographic pressures and limited flexibility to absorb further in-year variation. The IJB approved a one-year balanced budget for 2026/27 on 13 March 2026. This included new budget pressures of £22.007m and approved savings of £8.644m. The funding increase assumed within the budget was £15.861m, comprising £11.147m from North Ayrshire Council and £4.714m from NHS Ayrshire and Arran. A remaining Health/NHS services gap of £0.494m will be monitored closely during 2026/27, with further recovery actions identified as required. Unearmarked reserves remain below the recommended level. At 31 March 2026, unallocated reserves were £0.696m, representing 0.2% of the 2025/26 budget, compared with the recommended reserve level of 2% to 4%. There is therefore limited scope to absorb in-year variances, with any material overspends requiring additional recovery action or support from partners. The wider system financial challenges and impact across the whole system, for example the financial position of NHS AA and the decisions taken to reduce the Board’s deficit may have impacts on other parts of the health and care system. The opening projected overspend for 2026/27 is £2.992m, predicated on maintaining Financial Recovery Plan controls and delivering agreed mitigations across key pressure areas including care at home, care packages, Brighter Pathways, supplementary staffing and high-cost placements. The main areas of continued financial risk include physical disability and learning disability care packages, integrated island services, inpatient ward staffing, UnPACs, psychiatry and ongoing demand and workforce pressures. Chief Finance Officer * The IJB has established financial governance arrangements in place to monitor, manage and report on the financial sustainability risk. This includes regular budget monitoring reports to the IJB, detailed financial reporting to the Partnership Senior Management Team, and ongoing oversight by the Finance Working Group, chaired by the IJB Vice Chair. Financial updates are also shared with the Directors of Finance of North Ayrshire Council and NHS Ayrshire and Arran, supporting whole-system oversight of the delegated resources. * The IJB continues to take an integrated approach to managing the totality of resources delegated by North Ayrshire Council and NHS Ayrshire and Arran. * The Integration Scheme requires recovery plans to be developed where overspends are forecast, and financial recovery actions have been approved and monitored throughout 2025/26. These actions contributed to a significant improvement in the projected financial position and supported delivery of financial balance by the end of 2025/26, although the position remains dependent on sustained grip, control and delivery of recurring savings. * Financial recovery controls remain in place, including vacancy scrutiny, recruitment delay arrangements, enhanced scrutiny of high-cost care packages, controls over supplementary staffing, and additional oversight of areas with material overspends. * The high-cost care package group has been expanded to include children with disability care packages and all UNPACS placement requests. All care packages, excluding in-house care at home and older people placements agreed through CARG, are subject to approval through this enhanced governance route. * Specific demand management controls are in place for key pressure areas, including care home placements, care at home, residential placements for children and young people, mental health inpatient services, learning disability services and community care packages. These controls are intended to ensure that expenditure decisions are based on assessed risk, need and affordability, while recognising that the measures may impact on waiting times, delayed discharges, unmet need and wider service performance. * The IJB approved a balanced budget for 2026/27, supported by additional partner funding, identification of unavoidable service pressures, and approved savings. The budget includes significant savings requirements, including implementation of revised adult social work and social care eligibility criteria, operational efficiencies, service redesign and transformation actions. 25 5 5 25 Very High * Recovery plan controls will be maintained into 2026/27, including vacancy controls, recruitment delay arrangements, high-cost care package scrutiny, supplementary staffing controls and targeted oversight of areas with recurring overspends. These controls will be reviewed regularly to ensure they remain proportionate, effective and aligned with safe service delivery. * The Finance Working Group will continue to provide enhanced scrutiny of the financial position, savings delivery, recovery actions, transformation progress and emerging risks. * The group will also support development of the 2027/28 budget and the next update of the Medium- Term Financial Outlook. * Focus will be given to the delivery of savings linked to revised eligibility criteria, care package reviews, operational efficiencies, transformation projects and areas of recurring overspend. * The Eligibility Criteria Programme Board will provide strategic oversight, assurance and direction for implementation of the revised Eligibility Policy for critical-only access to funded adult social work and social care services. This will include monitoring of financial delivery, operational impact, risk, governance, equality considerations, service user impact and any unintended consequences. * Financial monitoring arrangements will continue during 2026/27 to improve early identification of emerging cost pressures, demand trends, savings delivery risks and service areas requiring escalation. This will include continued focus on low-volume high-cost placements, commissioned services, provider sustainability, supplementary staffing, care at home, delayed discharges and children’s residential placements. * The Chief Officer and CFO will continue to engage with Scottish Government, national networks and partner organisations to highlight the scale of the financial challenge and the need for sustainable investment in community-based health and social care services. * A further update to the Medium-Term Financial Outlook will be developed to inform 2027/28 budget planning. 16 5 5 25 Very High Treat SRR01 (cont) * The Partnership undertook extensive community engagement, commencing in early December 2025, on the challenges of delivering social care services within budget. £5.828m of savings will be met through the review of eligibility criteria and three interlinked proposals developed to implement reductions to care packages:1) changing eligibility to support only people at critical risk; 2) introducing a Best Value Care Funding Framework; and 3) prioritising personal care. * The Medium-Term Financial Outlook is updated on a rolling basis and is used to identify future financial gaps, recurring pressures and the implications of demographic change, inflation, pay awards, policy commitments, workforce pressures and rising demand. This supports forward planning and informs budget development, transformation priorities and discussions with funding partners. * The Transformation Plan has been refreshed to ensure that remaining projects have clear objectives, defined benefits and alignment with the Strategic Plan and financial sustainability requirements. Oversight is provided through the Transformation Board, with updates reported to the IJB. Transformation activity is focused on redesigning services, shifting support closer to home, improving outcomes, reducing reliance on high-cost provision and supporting longer-term financial sustainability. * The IJB has a reserves policy and reports regularly on reserves as part of financial monitoring and annual accounts. Unearmarked reserves remain below the recommended level, which limits the IJB’s ability to absorb in-year financial shocks. This is recognised as a key element of the financial sustainability risk and is kept under review as part of financial planning. * The IJB continues to engage with North Ayrshire Council, NHS Ayrshire and Arran, the Scottish Government, Chief Officer networks, Chief Finance Officer networks and national IJB forums to highlight the local and national financial sustainability challenges facing health and social care partnerships. SRR02 Infrastructure - ICT System Integration and Property - lack of an integrated IT system to meet the needs of NAHSCP leading to non-robust and inefficient information recording and sharing resulting in inefficient business models, duplication of effort, inaccurate or lack of data on service demand and delivery and risk to service users, patients and staff. Principal Manager Transformation (usually updated by Neil McLaughlin) * Access to systems can be requested to allow NHS-Partnership staff access to NAC systems, and NAC-Partnership staff access of NHS systems. * Work has progressed to reduce the number of MH ancillary recording systems and consolidate data on centralised systems. * HSCP systems and performance team supporting work across the partnership and progressing developments and issues with systems * NHSAAA are undertaking a review of all MS Access databases in use for removal to centralised systems. - local review linked to MH reporting completed to plan removal * Implementation of Trakcare functionality within Adult Community Mental Health Services to manage patient clinics across all three Partnerships. * MH Digital Transformation board established * MH digital business case being developed to address future planning needs. * Digital pilot for CYP neurodevelopment transformation with Strata Health. 12 4 3 12 High * Two groups have recently been established to better coordinate ICT issues/concerns/developments: (i) HSCP Digital Leads with NAC, SAC, EAC and NHS IT and HSCP digital leads which is chaired by NHS (ii) NAHSCP Digital Working Group which includes representatives from each Service. A ToR was recently approved at Transformation Board in February. This group will have oversight of digital projects on the Transformation Board. * Network access issues at NHS/NAC sites being explored and supported by NAC IT 12 3 3 9 Moderate Tolerate SRR05 Transformational Change Programme - failure to deliver the transformational change required to meet current and future demands and ensure our long term financial sustainability. Principal Manager Transformation (Stuart MacMillan) * Senior Manager leading on the delivery of the Transformation Plan. * NAHSCP Transformation Board for oversight of programme development and delivery. * Reporting regularly to NAHSCP Integration Joint Board. * Development of Workforce Plan, and Digital and Data Plan, to ensure alignment with transformed products and services. * Programme risk register in place, with high rated risks escalated to the Board. * Alignment of service change/transformation plans to Strategic Plan priorities * Raise awareness of Programme within the three parent organisations (including elected members and board members) via established reporting arrangements. * Transformation Plan has been refreshed, updating project scopes and anticipated benefits * A benefits management approach has been introduced and all projects will have benefit trackers assigned * Transformation Board terms of reference has been approved 12 4 3 12 High * Regular meetings in place with planning managers and Finance colleagues to ensure coordinated approach to change and transformation * A new transformation strategy is in development which will articulate the partnership's strategic approach to delivering transformation * Diarised meetings between Principal Manager (Transformation) and each Head of Service aimed at better coordinating transformation activity at Service level * Discussions taking place with Senior managers to understand areas of challenge and opportunities for change underway. 12 3 3 9 Moderate Treat SRR06 Governance - IJB governance arrangements are not conducive to effective working and decision making, Leading to a lack of confidence in the IJB and reputational damage. Failure to comply with governance requirements such as Freedom of Information, Complaints and other regulations laid down within the Public Bodies (Scotland) Act. This could lead to a breach of specific regulations resulting in enforcement action from governing bodies, adverse public reaction and/or prosecution. Statutory Instrument to revise voting membership of IJBs to include lived experience, unpaid carer and third sector representatives will come into effect in September 2026. Revisions will be required to Integration Schemes, Standing Orders. Governance Officer (Karen Andrews) * Statutory governance arrangements defined by Integration Scheme are in place for representation at the IJB and sub- committees and reviewed within prescribed requirements. * Integration Scheme, Strategic Plan, Standing Orders and Code of Conduct in place. * Policies and procedures developed and in place for each function including Complaints, FOIs/Adverse Events for both HSCP and IJB. * Operational Governance / Delivery groups in place to ensure appropriate action planning and monitoring including Performance and Audit Committee, Clinical and Care Governance Group, Adverse Events Review Group, Health and Safety Groups and the Staff Partnership Forum. * IJB receives 6 monthly updates on Clinical and Care Governance activity including details of adverse events; significant case review; complaints. This update includes details of outcomes and lessons learned. The Adverse Event Review Group now includes a fortnightly update for all AERs across the North HSCP. *Approved a Risk Management Strategy, Strategic Risk Register and risk appetite statement. *Health and Care Governance Framework in place 9 3 3 9 Moderate *Strengthened induction programme and governance training including code of conduct to be delivered throughout 2026 following the changes to IJB voting rights. * IJB Carer Representative was appointed following a successful recruitment campaign. Additional stakeholder appointments still to be confirmed. *Statutory Instrument to extend IJB Voting Rights to include lived experience, unpaid carer and third sector representatives * HSCP reviewing resourcing and capacity for demand to undertake SAERs. Proposal to enhance process with training and reviewing capacity across the three HSCPs. *Ongoing Integration Scheme and Standing Orders review is underway to ensure fitness for purpose. *Refresh of induction programme for new IJB members and refresher of code of conduct and standing orders planned during 2026. *Regular PAC/Internal Audit review of governance processes. 3 3 1 3 Low Treat Gross Risk Residual Risk 177
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North Ayrshire Integration Joint Board Strategic Risk Register Risk Ref Description of Risk Risk Owner Mitigations/Control Measures Previous Severity Probability Score Rating Proposed New Control Measures Previous Severity Probability Score Rating Risk Gross Risk Residual Risk SRR07 Demography and Inequality Pressures - failure to adequately plan for and respond to changes in our population profile and in the levels of poverty in North Ayrshire will result in more people experiencing higher levels of physical and mental ill health, resulting in increasing demand on services, an inability of services to provide adequate care and negative impact on health and wellbeing. Chief Officer (usually updated by Seony Ross) • A full review of demographics was carried out throughout 2025. The Strategic Needs Assessment was published in August 2025 and reviews information regarding general health and wellbeing, mental health, hospital and community care, children and young people, economy and inequality. This has supported the review of the Strategic Plan as well as other internal service reviews and other pieces of work, and has been shared with partners to support their workstreams. •The HSCP reviewed and refreshed its Strategic Plan ‘Caring Together’ for the remainder of the plan period, which will be in place from 1st April 2026 to the 31st of March 2030. In addition to identifying Service Delivery Priorities which support the health and wellbeing of our communities, the Plan identified 3 Strategic Priorities which are and intended to reduce the pressures on the HSCP by anticipating future demand and aiming to improve outcomes at a population level. • Demography increases are factored into budget planning to ensure the resource requirements are understood and funding is identified to meet needs. The budget has also been considered in the development of the new Strategic Plan priorities. • The transformation programme is focused on reviewing services and ensuring transformation of services is focussed on meeting the needs of service users, including ensuring appropriate support is in place for complex and intensive support needs. • A new set of Equality Outcomes was published in April 2025 which considered inequality and demographic data, and the lived experience of equality groups within North Ayrshire. The new Equality Outcomes were published alongside a set of actions to be achieved between 2025 and 2029 to support mainstreaming equality activity and equality of opportunity for marginalised groups. • Equality and Children’s Rights Impact Assessments are carried out for new policies, proposed projects and service change proposals which are considered by IJB to inform decision making. These integrated assessments consider impacts for protected characteristics, socio-economic disadvantage, island consideration and impacts on consumers of services. • The HSCP has recently analysed all previous engagement carried out across the HSCP over the previous 3 years and developed a new Participation and Engagement Strategy for 2026-2030. This strategy outlines how communities, carers, and families will be able to share their views, and ensures the HSCP has the opportunity to hear people’s lived experience when developing services This will allow people’s own experiences of inequalities to be considered in our review and 16 4 4 16 High • The Strategic Plan outlines 3 Strategic Outcomes which aim to address future service requirements based on demographic changes and local inequalities and aim to better understand and assess how we may influence improved health and wellbeing. The Strategic Priorities are: Supporting the improvement of population health, Addressing the Changing needs of an ageing population, and tackling the root causes of health inequality. During 2026, the HSCP will begin a programme of work with Public Health Scotland Analysts to research anticipated future demographic changes, how services are currently responding to these issues and where improvements can be made. The 3 workstreams will inform the HSCPs transformation programme and complement participation in the CHES programme. • The CHES Programme will continue with extensive engagement activity to ensure lived experience influences the recommendations made through the programme. • The HSCP will develop locality plans which will consider the individual needs and circumstances of people living in smaller communities, and will outline how our services will meet the needs of those specific communities • the Strategic Planning group will continue to monitor the HSCPs Strategic plan and related strategies and respond to any demographic changes that may impact strategy delivery. 12 3 4 12 High Treat SRR07 (cont) * A new Learning Disability learning plan was published in 2025, which comprises of service information and engagement insights, and explores where there may be further need for development for this specific client group. • A new Strategy for unpaid carers: Together we care 2026-2029 was agreed by IJB in December 2025. It advises carers of their rights, sets out plans to identify carers, routes for assessment and support, and information about local and national services. The aim is that all North Ayrshire carers are identified, supported and valued and are afforded an opportunity to live, work, thrive and stay connected to their communities enjoying a life alongside caring, where they choose to continue to care. Care needs are becoming increasingly complex in North Ayrshire due to demographic changes, and the strategy will support the unpaid carers that provide care in the community. • North Ayrshire is participating in the Collaboration for Health Equity in Scotland Programme which will consist of intensive research and engagement in order to make recommendations for reducing health inequalities for North Ayrshire Residents. In North Ayrshire, the programme will focus on 3 principles in 3 specific areas: - Give every child the best start in life, in the Fullarton, Castlepark south, Bourtreehill area of Irvine - Create fair employment and good work for all, in the Ardrossan central, Saltcoats central and Stevenston Hayock areas of Three Towns - Strengthen the role and impact of ill health prevention, in the Garnock Valley. • In our Drug and Alcohol Services, we are implementing actions to reduce the number of local drug and alcohol related harms and deaths. This includes implementing the national MAT (Medicated Assisted Treatment) standards and increasing the number of ABIs (Alcohol Brief Interventions) delivered across North Ayrshire. * North Ayrshire is one of 3 areas in Scotland as part of the CHES programme (Collaboration for Health Equity Scotland) which launched in February 2025 - this programme is a partnership between NAC and the IJB and will involve all public sector partners to determine: - What are the most impactful areas for intervention for Scotland to make meaningful progress in closing the inequalities gap in healthy life expectancy? - What action can be taken to enable national and local organisations to work more effectively together to close the recognised implementation gap between policy intent and impact? SRR08 Workforce - failure to recruit and retain and plan workforce requirements effectively leading to an insufficient workforce (number of staff, key roles and competency levels), resulting in a reduction in capacity to safely and effectively care for local people and a negative impact on service user and patient's needs being met Chief Officer (usually updated by Seony Ross) • In March 2025 the HSCP submitted a workforce template to the Scottish Government which outlined workforce challenges for the HSCP including the agenda for change pay reform, demographic changes and increasingly complex needs, financial pressures, and recruitment challenges. No further guidance has yet been issued by the Government • To develop the refreshed strategic plan for 2026, service engagement was carried out which asked services for their challenges and opportunities which included staffing and resource challenges for specific teams • The learning and Development strategy for social work and social care 2023-2028 continues into its third year, continuing to offer training and succession planning. • HR and service leads will continue to meet quarterly to review, update and align workforce plans in line with evolving service demands and strategic planning requirements. Workforce Planning meetings incorporate a structured review of external factors using PESTLE to ensure workforce strategies remain responsive and proactive. • The Care at Home service has an ongoing recruitment review in place as part of budget savings plan, with regular establishment meetings taking place to review all vacancies and high-cost areas of spend to ensure all critical vacancies are being filled where applicable. This is done via regular recruitment events and advertising. The service has a robust recruitment strategy which includes a retention plan which is monitored via stay/exit questionnaire completion by senior members of the management team. • The iMatter staff experience survey continues, to ensure senior managers are able to get feedback from employees about what is important to them in the workplace. • In Arran, there are ongoing high costs of agency to support Montrose House Care Home to meet staffing legislation requirements for residents. A contract with the agency is in place to help reduce these costs and there is a rolling recruitment programme for vacant posts and a variety of recruitment opportunities have been explored including a recruitment campaign with assistance of an external agency. • Roles have been diversified to support challenges, e.g. Psychiatry has expanded MDT responsibilities to enable psychiatrists to focus on the most complex cases, and Health Care assistant roles have been developed in wards for long- term conditions. • Collaborative recruitment in A&A for areas including ICT, Primary Care Implementation plan, Mental Health and Clinical Leadership • Exit interviews with staff to understand reasons for leaving using this intelligence to inform plans to improve working 12 4 3 12 High • A new workforce plan for the HSCP which considers the above information, as well as projected demographic challenges, will be developed in 2027. • With the addition of a Workforce Data Analyst, a review of workforce information was undertaken and a phased release of new efficiently produced information developed. This information is being phased into use starting with the extension of core absence information to include - absence reason, absence cost, recruitment, vacancies - now as a core element included in the Partnership's quarterly performance report to the IJB Performance and Audit Committee. • A revised approach to jointly managing waiting lists has been implemented. Adult Providers have access to current waiting lists at all times and face to face meetings are also taking place to minimise waiting times for services users as much as possible and maximise providers staffing resources. • A review of provider forums is almost complete - the focus has been on consulting with providers to ensure a clear understanding of what the key issues are that the HSCP could support providers with at this time. • The HSCP continues to review the structure on an iterative basis with opportunities progressed as they arise to look at senior roles and to undertake gap analysis on roles and levels within the HSCP to better deliver on team and partnership outcomes. Examples of this being the recent review of the leadership structure in relation to finance and transformation and the review of disability services which introduced Senior Practitioner roles to the team. The review will continue on that basis, led by opportunity and service need • Increased focus on vacancy management and recruitment alongside service impact and for service areas with workforce shortage proactively looking to skill mix and different roles to address recruitment challenges - examples being SLT and OT. 9 3 3 9 Moderate Treat SRR09 Local Impact of Scottish Government Policies: risk of further legislative, policy developments or change which impacts on the IJBs ability to deliver on strategic objectives, examples include the NHS Agenda for Change in the Reduced Working Week, the Promise, the Living Wage, Free Personal Care and other future policy developments including the now amended National Care Service. The impact being the inability to deliver on these alongside strategic plan commitments and objectives and the impact of funding for new policy and legislative commitments. Chief Officer * Horizon scanning for policy developments through partners and professional networks, including links with Scottish Government policy teams. * Regular liaison with Scottish Government and COSLA senior officers. * Attendance and participation at the national Chief Officer network. * Responses to consultations on potential implementation of new policy areas. * Early local impact assessments for national policies, including operational and financial service impact. * Financial modelling to respond to requests for information and support full funding. * Fully brief IJB members and wider partners on policy implications for the IJB to gather support and awareness of any implementation issues or concerns. 16 4 4 16 High * Promote and develop pan-Ayrshire approaches to impact assessment of policy implementation * Reinforce the role of Elected Members and IJB members to influence Scottish Government decision making through political routes. 12 4 3 12 High Treat SRR12 Clinical and Care Governance: Failure to have an appropriate framework in place leading to an adverse impact on the culture resulting in a reduction in the quality of the delivery of the highest quality of care and support is understood. Chief Social Work Officer and Associate Nursing Director *continuous review of arrangements for Clinical and Care Governance are essential for the delivery of statutory, policy and professional requirements and the achievement of our quality ambitions. *ongoing review of established structures and processes to assure Integration Joint Boards, Health Boards and Local Authorities *empowering clinical and care staff to contribute to the improvement of quality *making sure that there is a strong voice of the people and communities who use our services. * ensure that professional leadership develops good governance for each of the following components: culture, systems, practices, performance, vision and leadership. * delivery of the highest quality of care and support is understood to be the responsibility of everyone working in the organisation - built upon partnership and collaboration within teams, and between health and social care professionals and managers. * Health and community Care have developed a governance Board to ensure feedback to the overarching Clinical and Care Governance arrangements. 9 3 3 9 Moderate * Continue to develop and monitor key performance indicators and report effectively through governance framework. * Ensuring we further develop clear and consistent reporting frameworks acknowledging the growing risks posed to service delivery due to financial and resource constraints. 9 3 3 9 Moderate Tolerate SRR13 Provider Failure (commissioned services) There is an ongoing risk of social care supplier failure due to staffing and recruitment challenges and the financial viability of care providers. Particularly across community based support and also in residential settings including care homes. Supplier failure leads to risk to service users, potential for withdrawal of care and disruption to care plans. Senior Managers - Lorraine Dyet. Louse Davidson, Julie Barrett * Reviewed and monitored via CAHOG and CHOG, where intelligence and early warning signs are shared across agencies, including the Care Inspectorate. * Enhanced contract management is in place, supported by monitoring tools. * Monthly or quarterly management meetings with companies are held where required. * Formal support measures are in place, including quality of care monitoring. 16 4 4 16 High * Continue with current governance, mitigation and control measures. * Ongoing engagement with current Community Support Providers. * Where possible, scope opportunities for additional providers to support capacity and contingency plans. * Promote an open-book approach with providers in relation to their financial position. 16 4 4 16 High Treat SRR14 Asylum Arrivals - there is a growing risk to health, primary care and social care sustainability, as the numbers of adult asylum seekers dispersed by the Home Office grows, the number of unaccompanied children and young people asylum seekers and trafficked young people grows. Head of Service - Elizabeth Stewart Senior Managers - Louise Henry * North Ayrshire Refugee taskforce led by NAC Housing, attended by Home Office and MEARs dispersal agents, * Agreed targets with COSLA for Mears and resettlement schemes - new MOD scheme has not yet set targets. * NHSAA Public Health continues to screen and treat TB and blood borne virus issues, * HSCP Refugee Support Team continues to screen all new arrivals including UASC linking with Public Health, social work, and other services as required 12 3 4 12 High *Continue governance approaches * Finance team continues to map impact on children's houses from unaccompanied asylum seekers and trafficked young people, * NHSAA Public Health continues to screen and treat TB and blood borne virus issues, *HSCP Refugee Support Team continues to screen all new arrivals including UASC linking with Public Health, social work, and other services as required * Impact statements provided to Home Office and MEARs about on-going stresses on primary care, HSCP Health and Social Care in specific towns and villages as agreed targets likely to be exceeded, 12 3 4 12 High Treat 178
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North Ayrshire Integration Joint Board Strategic Risk Register Risk Ref Description of Risk Risk Owner Mitigations/Control Measures Previous Severity Probability Score Rating Proposed New Control Measures Previous Severity Probability Score Rating Risk Gross Risk Residual Risk SRR15 Risk of Harm - A lack of resources combined with an increase in both demand and complexity is leading to increasing numbers of residents waiting for services, whether that be for referral, assessment or the provision of care and support. Resources will be directed at those with the greatest need, reducing capacity for early intervention and prevention supports. This results in a greater likelihood of residents experiencing harm as a result. The gross risk increased from 16 to 20 which reflects the current financial position and the move to critical eligibility criteria for access to social care services. Operational Heads of Service and CSWO * Children, Families and Justice Services: waiting list guidance has been produced and cascaded across teams, setting out arrangements for managing cases awaiting allocation, including escalation processes. A duty social work system is in place as the point of contact for cases not yet allocated. Monthly waiting list reports are produced to support Head of Service oversight of unallocated cases. Where appropriate, review meetings are convened to discuss cases where risk is escalating. * Community Care and Health: standard operating procedures are in place across Social Work and Service Delivery Teams for the management of risk. A social work duty system is in operation. The Health and Community Care Unmet Need Oversight Group meets weekly, supported by daily delayed discharge oversight, daily Care at Home waiting list review, weekly resource group meetings with senior managers, and monthly multi-disciplinary meetings with Health and Community Care teams and partners to identify people requiring support and escalation as early as possible. * Mental Health: weekly resource group meetings are held to consider new care packages and revisions to existing care packages. Waiting lists are reviewed regularly. Standard operating procedures are in place across Social Work and Service Delivery Teams for the management of risk, supported by the social work duty system. * Allied Health Professionals: referrals are prioritised at the point of referral, with higher-risk patients prioritised for support. Telephone support is offered to others where appropriate, alongside review of criteria and access routes for specialist, targeted and universal responses. 16 4 4 16 High * Ensure clear reporting of risks and trends in waiting lists through appropriate governance groups. * Maintain reporting and escalation to Scottish Government through regular unmet need returns and ongoing engagement and discussion regarding the level of resource required. * Review referral pathways and eligibility criteria to ensure available resources are directed to those with the greatest need. * Pursue opportunities across the wider system to support investment in early intervention supports, enabling residents to receive support at an earlier point where possible. 16 4 4 16 High Tolerate SRR16 Growth and expansion of specialist complex care developments - there has been a rapid increase across the independent sector in North and South Ayrshire since 2020 which lack alignment with local commissioning plans. This results in an exponential growth in un-forecasted referrals to community and inpatient Mental health and Learning disabilities services leading to an impact on capacity and demand on MDT's and inpatient occupancy levels when placements breakdown. The out of area demand lacks alignment with the principles enshrined in the Scottish Government 'Coming Home report', resulting in significant delayed discharge and high costs associated with inpatient stay and Scottish Government guidance regarding 'ordinary residence' and dual health board responsibility for NHS health care provision is exacerbating this position. Jan Thomson and Gillian Duffy * Engage with Housing and Planning Departments to be aware of new applications at an early planning stage. * Use provider forums to discuss emerging risks/concerns/developments and agree appropriate contingency plans. * Work with Scottish Government (HIS) to contribute and influence the national work on dynamic support registers to ensure these are being utilised appropriately. * collaborative working across Ayrshire HSCP’s to develop local complex care solutions * Share information through existing governance groups including Care Home and Care at Home Oversight Groups * Pro active escalation of our of area placement breakdown with placing authority to ensure consideration of social work intervention from responsible area and engagement with care provider. * Seek early legal advice from NAC and NHS Legal teams on accountabilities and position for NA 25 5 5 25 Very High * Develop a collaborative framework of communication to influence registration applications to the Care Inspectorate for specialist and highly specialist units. * Review service models, including learning disability acute assessment. * Continue to review and develop outreach support models as an alternative to admission. * Agree and deliver recommendations of the complex care business case in collaboration with housing and future Strategic Housing Investment Plans, where required for future years, to ensure we can meet the needs of our own local population. * Proactively work with incoming providers to develop referral pathways and ensure appropriate staffing and support are in place, including GP local enhanced services. * Escalate cross-boundary concerns to the Care Inspectorate, Scottish Government and Mental Welfare Commission to seek resolution and support. * Ensure that anyone placed in North Ayrshire by other authorities is on the placing authority’s Dynamic Support Register. Where there is risk of placement breakdown, ensure they are identified as red and that fortnightly action plan meetings are convened. Open and maintain dialogue with the allocated workers from the placing authority to determine actions being taken by them to assist in reviewing and/or stabilising the situation. * Where information is known about someone being at risk of placement breakdown and requests for admission to an in-patient setting are made, the General Manager for Woodland View and bed manager should be made aware at the earliest opportunity. Where the situation allows, a multi-disciplinary and cross-authority pre-admission discussion should be convened at the earliest opportunity 15 3 5 15 High Treat SRR17 (NEW) Children’s Services Placements - Critical shortage of appropriately matched local and national placements for babies, infants, children and young people leads to reduced ability to provide suitable care away from home when required, resulting in delayed or inappropriate placement decisions, increased use of higher-cost or out-of-area provision, reduced placement stability and potential impact on safety, wellbeing and outcomes. Elizabeth Stewart and Scott Hunter * Focus on Brighter Pathways programme of service transformation for care placements in North Ayrshire * Fortnightly residential placements review meetings * Fortnightly Resourcing Coordination Meeting - reviewing foster care and residential requests * Closer liaison with housing services via monthly Moving On Up Forum * Development of Boyle Street, Irvine, Supported Model of Accommodation as per Brighter Pathways work * Launch of new Fostering Scheme - Fostering Futures (1st April 2026) as per Brighter Pathways work * Ongoing Review of Intensive Support Services (to prevent family breakdown and requirement of placement). n/a 5 5 25 Very High The placement issue is being taken forward by SWS to COSLA and NSWA, concerns have been escalated nationally by all areas with further discussions happening at a national level. n/a 5 5 25 Very High Treat 179
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Integration Joint Board 20 August 2026 Subject : Annual Performance Report 2025-26 Purpose : This report is for: • Approval Recommendation : That the Integration Joint Board notes the key achievements during 2025-26 and retrospectively approves the publication of the Partnership’s Annual Performance Report. 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 HSCP Health and Social Care Partnership IJB Integration Joint Board PAC Performance and Audit Committee PSMT Partnership Senior Management Team APR Annual Performance Report 1. EXECUTIVE SUMMARY 1.1 The North Ayrshire Health and Social Care Partnership is required under the Public Bodies (Joint Working) (Scotland) Act 2014 to publish an Annual Performance Report setting out progress in delivering integration functions, strategic priorities and national health and wellbeing outcomes. The Annual Performance Report 2025-26 demonstrates continued progress across a broad range of integrated health and social care services. It highlights achievements in service quality, access, prevention, financial wellbeing, carer support, mental health improvement and digital transformation. The report also recognises significant and sustained pressures affecting the Partnership. The Performance and Audit Committee approved publication of the Annual Performance Report to meet the statutory deadline of 31 July 2026. The Integration Joint Board is now asked to note the achievements during 2025-26 and retrospectively approve the publication of the report. Agenda Item 12 181
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2. BACKGROUND 2.1 Section 42 of the Public Bodies (Joint Working) (Scotland) Act 2014 requires Partnerships to publish an annual performance report setting out an assessment of performance in planning and carrying out the integration functions for which they are responsible. 2.2 Guidance for Health and Social Care Integration Partnership Performance Reports (published by the Scottish Government, March 2016) was followed to ensure the content of the North Ayrshire HSCP performance report meets those requirements. 2.3 The Annual Performance Report 2025-26 demonstrates the ongoing progress made by the Partnership in delivering against its vision and strategic priorities, as well as the Scottish Government’s national health and wellbeing outcomes, children’s and justice service outcomes and a range of local measures. 2.4 The report uses case studies throughout to demonstrate service performance highlights balancing the quantitative with qualitative information. Notable highlights include: - High-quality care services: Care at Home services achieved predominantly ‘Very Good’ inspection ratings, with high user satisfaction and over 1,000 people supported, demonstrating strong service quality and workforce capability. - Strong performance in alcohol and drug treatment access: NADARS maintained high access performance, with at least 95.5% of alcohol referrals and 97% of drug referrals seen within three weeks across all quarters, and 100% seen within six weeks. - Dads Rock support expanded across North Ayrshire: The Dads Support Service, funded through the Whole Family Wellbeing Fund, expanded from the Three Towns into Irvine and Kilwinning, supporting fathers with parenting, confidence and wellbeing. In its first year it supported over 60 families, delivered 180+ one-to-one sessions, 36 group sessions and five family events. - Community-led and locality-based approaches are strengthening participation: The report highlights continued community partnership activity through Montrose House partnership with EcoSavvy, Cycling Without Age Scotland continued to offer free trishaw and wheelchair-accessible rides on Cumbrae and Arran CVS’ “Free for All” event, which brought together around 300 community members to connect with local groups, volunteering opportunities, health information and community activities. 182
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- Significant financial gains for residents through Money Smart and welfare rights support: Money Smart delivered around £20 million in financial gains for North Ayrshire residents in 2025-26, supporting 7,560 clients and helping reduce household debt by over £568,000. - Anam Cara Dementia Respite Unit supported carers and people living with dementia: The unit provided over 600 nights of respite in Quarter 1, offering safe, personalised support for people with dementia while helping carers sustain their caring role. - Mental health system improvements: the Unscheduled Care Hub reduced admissions, improved patient flow, and cut delays (e.g. 48% reduction in AWI delays), showing measurable system performance gains. The report also notes positive Mental Welfare Commission review visits to inpatient and community services.. - Digital and service transformation progress: The Partnership continued the shift from analogue to digital telecare, with around 3,700 alarm users supported and 92% already digital-ready, earning a Scottish Government Silver Award, showing measurable improvement in safety and reliability. - Approval of refreshed Strategic Plan 2026-30: The IJB approved the refreshed Strategic Plan 2026-30 in December 2025, setting a renewed vision and strategic direction for health and social care in North Ayrshire. The plan strengthens the Partnership’s focus on prevention, community-based support, fair and equal access, sustainability, and reducing health and care inequalities. The Annual Performance Report highlights continued progress across a wide range of integrated services yet also identifies significant and sustained challenges. The most pressing issues relate to delayed discharge, emergency admissions, financial sustainability, workforce capacity and health inequalities. These pressures are complex and system-wide, requiring continued transformation, strong partnership working and targeted use of performance intelligence to support improvement and inform future planning. 3. PROPOSALS 3.1 It is proposed that the IJB notes the achievements during 2025-26 and provides retrospective approval for publication of the Annual Performance Report on the Partnership’s website by the statutory deadline of 31 July 2026. 3.2 Anticipated Outcomes With the publication of the Annual Performance Report the Partnership is informing the people of North Ayrshire and wider stakeholders on the progress of health and social care integration, specifically relating to: 183
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• Outcomes for local people. • Locality health and social care needs. • Service provision (including lead partnership responsibilities and commissioned services). • Transformational change. • Budgetary and financial information. 3.3 Measuring Impact With the publication of the Annual Performance Report 2025-26 the Partnership has met its obligations under the Public Bodies (Joint Working) (Scotland) Act 2014. 4. IMPLICATIONS 4.1 Financial None. 4.2 Human Resources There are no direct human resources implications arising from approval of the report. However, the Annual Performance Report highlights workforce capacity and service sustainability as continuing pressures, and its findings will support ongoing workforce planning, service redesign and improvement activity across the Partnership. 4.3 Legal Publication of the Annual Performance Report supports compliance with the reporting requirements of the Public Bodies (Joint Working) (Scotland) Act 2014. There are no further direct legal implications arising from the recommendation. 4.4 Equality/Socio-Economic The report provides important evidence on the Partnership’s contribution to reducing inequalities and improving outcomes for people and communities across North Ayrshire. 4.5 Risk None 4.6 Community Wealth Building While there are no direct community wealth building implications, the report describes activity that contributes to community wellbeing and local resilience, including locality- based partnership working, community-led initiatives, welfare rights support and collaboration with third and independent sector partners. 184
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4.7 Key Priorities The Annual Performance Report supports delivery of the Partnership’s statutory reporting duties and provides evidence of progress against strategic priorities, including prevention, community-based support, fair access, sustainability, reducing inequalities and improving outcomes for people and communities across North Ayrshire. 5. CONSULTATION Consultation has taken place with Partnership staff, stakeholders, the Partnership Senior Management Team and the IJB Performance and Audit Committee as part of the development and approval process for publication of the final report. Director: Caroline Cameron Stuart MacMillan, Principle Manager, stuartmacmillan@north-ayrshire.gov.uk Appendices North Ayrshire Health and Social Care Partnership Annual Performance Report 2025-26 185
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PUBLIC INFORMATION PUBLIC INFORMATION North Ayrshire Health and Social Care Partnership Annual Performance Report 2025 to 2026 186
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PUBLIC INFORMATION PUBLIC INFORMATION Reflections from the Director Welcome to North Ayrshire Health and Social Care Partnership’s Annual Performance Report for 2025 to 2026. This report reflects on a year in which our services, staff and partners have continued to respond to significant and sustained pressures, while remaining focused on improving outcomes for the people and communities of North Ayrshire. The context in which we are operating remains extremely challenging. Demand for health and social care support continues to grow, with people presenting with increasingly complex needs. At the same time, the Partnership continues to work within a constrained financial environment, alongside wider workforce, demographic and system pressures being experienced across Scotland. In North Ayrshire, these challenges are particularly acute given the impact of poverty, deprivation, poorer healthy life expectancy and the needs of our island, remote and rural communities. Despite this, the report demonstrates the breadth of progress made across the Partnership during the year. Our services have continued to deliver high-quality care and support across health and community care, mental health and learning disability services, children, families and justice services, and our lead partnership responsibilities across Ayrshire and Arran. The achievements highlighted throughout this report reflect the professionalism, commitment and compassion of our staff and the strength of our relationships with partners across the Council, NHS Ayrshire and Arran, the third and independent sectors, communities, carers and people who use our services. This has also been a year of important strategic development. The Partnership has continued to deliver against the ambitions of Caring Together, while also preparing for the next phase of our strategic direction. The refreshed Strategic Plan for 2026 to 2030 sets out a renewed focus on empowerment, fair and equal access, sustainability and reducing inequalities. This is supported by our updated Strategic Needs Assessment, ongoing locality planning work, and our continued involvement in the Collaboration for Health Equity in Scotland, which provides an important opportunity to work with national and local partners to address the underlying causes of poor health and unequal outcomes. Transformation has remained central to our work. During the year, we have continued to modernise services, strengthen governance and improve how we use data, digital tools and evidence to support decision-making. Our transformation programme has focused on service redesign, sustainability and ensuring that people receive the right support, in the right place, at the right time. This includes work to improve hospital discharge pathways, develop community-based models of support, modernise telecare, strengthen early intervention, and support our workforce through new approaches to digital practice and service improvement. The report also highlights areas where further improvement is required. Delayed discharge, emergency admissions, financial sustainability, workforce pressures and inequalities remain significant challenges. These issues are complex and cannot be addressed by the Partnership alone. They require whole-system working, clear prioritisation and continued collaboration with communities and partners. We will continue to use performance information, lived experience and service intelligence to understand where change is most needed and to ensure that our resources are targeted where they can have the greatest impact. 187
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PUBLIC INFORMATION PUBLIC INFORMATION There is much to be proud of. Positive inspection outcomes across key services, strong examples of early intervention, increased digital readiness, improved support for unpaid carers, continued investment in children and families, and innovative community-led approaches all demonstrate the difference that integrated health and social care can make. These achievements show the value of working together and the importance of keeping people, families and communities at the centre of our planning and delivery. I want to take this opportunity to thank all staff across North Ayrshire Health and Social Care Partnership for their dedication, resilience and care throughout another demanding year. I also want to thank our partners, unpaid carers, volunteers, community organisations and people with lived experience who continue to support, challenge and shape our work. Your contribution is central to improving health and wellbeing across North Ayrshire. Looking ahead, we will continue to face difficult choices, but we will do so with a clear commitment to our values, our communities and our shared ambition to support people in North Ayrshire to live safe, healthy and active lives. By working together, focusing on prevention and early intervention, tackling inequalities and transforming services for the future, we can continue to make meaningful progress for the people we serve. 188
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4 PUBLIC INFORMATION PUBLIC INFORMATION Contents North Ayrshire Health and Social Care Partnership ............................................................................. 1 Annual Performance Report ................................................................................................................. 1 2025 to 2026 ........................................................................................................................................ 1 Reflections from the Director............................................................................................................. 2 Visions, Values and Priorities ............................................................................................................ 5 Local Priorities .................................................................................................................................. 6 Strategic Plan 2026-30 ..................................................................................................................... 7 Structure of this report ...................................................................................................................... 8 Provide Early and Effective Support ................................................................................................. 9 Tackle Inequalities .......................................................................................................................... 17 Enable Communities ....................................................................................................................... 24 Develop and Support Our Workforce .............................................................................................. 31 Improve Mental and Physical Health and Wellbeing ....................................................................... 37 National Health and Wellbeing Indicators ....................................................................................... 45 Performance in relation to the three Children’s Outcomes and three Justice Service Outcomes ... 48 Children’s Outcomes ................................................................................................................... 49 Justice Outcomes ........................................................................................................................ 56 Reporting on localities ..................................................................................................................... 63 Transformation Programme ............................................................................................................ 66 Reporting on lead partnership responsibility ................................................................................... 75 Mental Health Services ................................................................................................................ 76 Child Health Services .................................................................................................................. 81 Inspection of service ....................................................................................................................... 88 Financial performance and best value ............................................................................................ 93 Overall position ............................................................................................................................ 97 Appendix ....................................................................................................................................... 100 189
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5 PUBLIC INFORMATION PUBLIC INFORMATION Visions, Values and Priorities North Ayrshire Health and Social Care Partnership (NAHSCP/the Partnership) is working towards a vision where: “All people who live in North Ayrshire are able to have a safe, healthy and active life.” Our Partnership includes health and social care services within Health and Community Care Services (H&CC), Mental Health and Learning Disability Services, and Children, Families and Justice Services. In this Annual Performance Report, we look back on the progress made during the reporting year, highlight areas of strong performance, and reflect on areas where improvement continues to be required. This report aligns with the Partnership’s Caring Together Strategic Commissioning Plan 2022–2030. Following a formal review in December 2024, the Strategic Plan was updated to reflect the significantly changed context in which the Partnership is now operating, including demographic change, increasing demand, financial pressures, and updated evidence on population health and inequalities. Over the period of this strategic plan, the Health and Social Care Partnership will seek to: We see these priorities as interlinked, and we expect that where we see success against one priority, it’s effect will positively impact against others. People who use our services and North Ayrshire residents will experience our Partnership values in the way our staff and volunteers engage with you and how we behave. We will treat you with: 190
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6 PUBLIC INFORMATION PUBLIC INFORMATION Local Priorities The Strategic Plan sets out the overarching priorities for the Health and Social Care Partnership (HSCP) and how services will be planned and delivered to improve outcomes across North Ayrshire. While these priorities apply at a whole-system level, it is recognised that communities across North Ayrshire experience differing population needs, challenges and inequalities. To ensure planning is responsive to local circumstances, the HSCP undertakes Locality Planning across six defined geographical areas: • Arran • Garnock Valley • Irvine • Kilwinning • North Coast and Cumbrae • Three Towns Locality Planning enables the HSCP to understand and respond to variation in population health, wellbeing and access to services at a local level. It supports targeted action on health inequalities, informed by data, lived experience and community engagement. During the current reporting period, Locality Planning has continued to operate through a structured, evidence-led approach that combines population data, service intelligence and engagement with local communities and equalities groups. This approach supports the development of clear locality priorities aligned to the Strategic Plan and wider Community Planning Partnership priorities. Locality Plans will provide a clear statement of need, priorities and intended actions for each locality and will support ongoing performance monitoring, accountability and improvement at a local level. 191
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7 PUBLIC INFORMATION PUBLIC INFORMATION Strategic Plan 2026-2030 Our new Strategic Plan 2026-30 was approved by the Integrated Joint Board in December 2025. The new plan replaces the current priorities and outlines the strategic priorities for anticipating and improving future health and care needs, and Service Delivery Priorities, reflecting the current requirements for delivering services. As such the new vision going into the next 10 years, is: “To empower people in North Ayrshire to live safe, healthy and active lives with fair and equal access to sustainable health and care services”. The newly agreed Strategic Priorities are: 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 These aim to address future service requirements based on demographic changes and local inequalities and aim to better understand and assess how we may influence improved health and wellbeing. Strategies will be aligned to these goals and decision making will consider these priorities and impacts when implementing change The Service Delivery Priorities are: 1. Prevention 2. Community Based Services 3. Life Stages 4. Whole Person Approach 5. Accessibility and Communication 6. Evidence and Performance These reflect how services will be designed and delivered to address the health and care needs of the population. All future service planning will be aligned to these principles. All reporting within services and to the Integrated Joint Board and Performance and Audit Committee will be structured to meet these new priorities from Quarter 1 2026-27. 192
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8 PUBLIC INFORMATION PUBLIC INFORMATION Structure of this report We have measured and evaluated our performance in relation to: • Partnership Strategic Objectives • Scottish Government National Health and Well-being Outcomes • Children’s and Justice Services Outcomes • Local measures The North Ayrshire Health and Social Care Partnership continues to have lead partnership responsibilities across Ayrshire and Arran for Mental Health and Learning Disability Services as well as Child Health Services (including immunisation and infant feeding). We have reflected on some of the highlights and challenges of leading these services across Ayrshire. We will show that all our services (those provided by our Partnership staff and those provided by other organisations on our behalf) are providing high quality care and support to the people of North Ayrshire. Finally, the partnership continues to face financial challenges in delivering and improving services from within the available budget, during the year we have made significant progress towards achieving financial balance and overall service sustainability. We have detailed our financial position and reflected on how we continue to provide assurance that we are delivering Best Value in North Ayrshire for Health and Social Care services. 193
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9 PUBLIC INFORMATION PUBLIC INFORMATION Provide Early and Effective Support National Outcomes 1 People are able to look after and improve their own health and wellbeing and live in good health for longer. 2 People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. 3 Health and social care services contribute to reducing health inequalities. 194
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10 PUBLIC INFORMATION PUBLIC INFORMATION 1.1 Due to an increase in the number of adverse events relating to medication administration a review was conducted as part of the Pan Ayrshire Community Nursing Review (CNR).The review focussed on medication prescription charts (Kardex). Findings revealed that staff in the community were using multiple versions of Kardex at one time, including pre-printed sliding scales and COVID-specific templates issued by GP practices. A comparative review of prescribing practices across other health boards showed that institutions such as Hospices and Greater Glasgow and Clyde health board were using a palliative care booklet which more clearly separated PRN, as required, medications from the continuous infusions, helping to reduce administration errors. In response, a community nursing palliative prescribing Kardex was developed, based on the Greater Glasgow and Clyde model, which aligned with local policies and guidelines. The Safer Medicines Group reviewed the new Kardex and endorsed a test of change in North Ayrshire which has been underway. Initial testing the one community Nurse Independent Prescriber has yielded positive feedback, and next steps are to expand testing across community nursing in Ayrshire. 1.2 The North Ayrshire Drug and Alcohol Service (NADARS) has continued to demonstrate high levels of performance by meeting national and local standards and targets, such as access to treatment waiting times, provision of alcohol brief interventions (ABIs), the roll-out of Naloxone supplies and increasing patient choice regarding Opiate Substitution Therapy (OST) medications. Figures for those seen within 3 weeks for Alcohol were no lower than 95.5% during any quarter, while those seen within 3 weeks for Drugs were no lower than 97% during any quarter in 2025 to 2026. 100% of referrals for Alcohol and Drugs were seen within 6 weeks. 195
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11 PUBLIC INFORMATION PUBLIC INFORMATION The team continues to identify new ways of working to provide a more agile and streamlined service and further improve performance. This work has been evidenced by the delivery of early intervention services in the delivery of Alcohol Brief Interventions (ABI) in both priority (Primary Care, A&E and Antenatal) and wider settings. Indicator 2023- 2024 2024- 2025 2025- 2026 Target set by Scottish Government – Priority Settings 3,420 3,420 3,420 Total ABI delivery in Priority Settings (Ayrshire & Arran) 6,398 5,940 5,977 Indicator 2023- 2024 2024- 2025 2025- 2026 Target set by Scottish Government in Wider Settings 855 855 855 Total ABI delivery in Wider Settings (Ayrshire & Arran) 1,216 1,325 1,544 1.3 The implementation of a new telephony system in Arran War Memorial Hospital represents a successful example of service modernisation and operational improvement. Following staff training and infrastructure upgrades, the new system went live in August 2025. Communications were issued to stakeholders to support the transition, and additional monitors were procured to enhance usability. In the first six week from launch, the system handled 1,599 calls, with 43% routed directly to departments, freeing up reception staff to focus more effectively on front door services. The team will now monitor the system and capture any learning that can be shared with the wider Partnership, supporting continuous improvement and future service design. 1.4 The Partnership’s Care at Home service, across the Three Towns, North Coast, and Arran localities, was subject to a comprehensive, unannounced inspection by the Care Inspectorate 196
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12 PUBLIC INFORMATION PUBLIC INFORMATION in August 2025. This inspection involved engagement with over 180 individuals including service users, family members, staff, and visiting professionals and resulted in a ‘Very Good’ rating in three out of four categories, with the remaining category rated as ‘Good’. Inspectors highlighted the strength of relationships between staff and service users, noting high levels of satisfaction and a culture of respect and responsiveness. People using the service are actively encouraged to provide feedback and even participate in staff recruitment, reflecting a commitment to co-production and continuous improvement. Management oversight was recognised as a particular strength, with robust quality assurance processes in place. Staff were described as supportive and engaged, contributing to a positive working environment and consistent delivery of person-centred care. While support plans were found to be well-structured and tailored to individual needs, the inspection did note that review documentation requires updating, an area already being addressed. This inspection outcome is a significant endorsement of the service’s quality and impact, reflecting the professionalism and dedication of our teams and reinforces our commitment to delivering early, effective, and compassionate support to residents across North Ayrshire. 1.5 The Working Together Occupational Therapy Service, delivered in partnership with East and South HSCPs, has made a significant impact by embedding short-term, holistic support within GP practices. With 100% positive feedback from service users and an estimated cost avoidance of nearly £600,000, this model exemplifies the value of early intervention in both physical and mental health contexts. 1.6 North Ayrshire Health and Social Care Partnership has made significant progress in its transition from analogue to digital telecare, ahead of the UK-wide telecoms switchover in 2027. The successful completion of the first digital alarm connection marked a key milestone in this transformation, which now supports around 3,700 dispersed alarm users—92% of whom are already equipped with digital-ready alarms. In recognition of this achievement, the service was awarded the Silver Digital Telecare Implementation Award by the Scottish Government. This reflects the technical capability of the Telecare team and the strength of collaborative working across partners. The move to digital connectivity enhances safety, reliability, and responsiveness for vulnerable individuals across the region, positioning the service well for future advancements. 1.7 Our Family Centred Wellbeing Service (FCWS) situated in Meadowcroft, Irvine but available to all localities, has continued to strengthen its early intervention offer through the further embedding of the Building on Positive Relationships (BPR) parenting intervention. The team has benefited from weekly specialist input from SMcG, Educational Psychologist, whose coaching and developmental guidance have supported staff to deepen their confidence and skills in delivering BPR with families experiencing emerging emotional and behavioural challenges. A key innovation was the introduction of BPR-A, a tailored adaptation of the core programme designed to support parents in understanding and responding to childhood anxiety. The group explored how certain parental “accommodations”—well‑intentioned adjustments intended to ease distress—can inadvertently reinforce anxious behaviours, and how 197
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13 PUBLIC INFORMATION PUBLIC INFORMATION alternative approaches can promote children’s resilience. Parent feedback on BPR-A was highly positive, with participants particularly valuing the visual format of the sessions. The use of video examples and visual strategies helped parents contextualise learning and link theoretical concepts to everyday experiences with their children. Building on this successful use of visual tools, two of our FCWS practitioners, BM and NG, have led the development of a new ‘Understanding Anxiety’ video resource, co‑produced with children and young people who access the service. With creative support from SMcG, the team set out to design a resource that is relevant, relatable and grounded in the authentic voices of young people. Six young people have played an active role in shaping the content, contributing through a range of creative activities including drawing, digital illustration, sound recording, graphic tablet design, and clay modelling. Their artwork and ideas form the foundation of the video’s visual storytelling, featuring representations such as the brain and anxiety pathway, the iceberg analogy illustrating visible and hidden aspects of emotional experiences, and a series of personalised coping strategies that young people identified as useful when they feel anxious. By equipping parents with practical, psychologically informed tools at the earliest point of difficulty, FCWS is helping families to better understand and manage anxiety before issues escalate. The co‑produced video further enhances this preventative approach by offering children and young people accessible, relatable ways to understand their own emotional responses and develop confidence in using coping strategies. Together, these developments reinforce FCWS’s commitment to early intervention, strengthening family resilience and ensuring that children and young people receive the right support at the right time. 1.8 The Partnership’s Care at Home Service, across the Irvine, Kilwinning, Garnock Valley and Community Alarm Service, was subject to a comprehensive, unannounced inspection by the Care Inspectorate in September 2025. Key messages highlighted high user satisfaction and respectful, responsive care; active encouragement of feedback and involvement in recruitment (co‑production); good support planning with continued focus on timely reviews and strong, compassionate, and person-centred practice across a large and complex service. At the time of inspection, the service supported 1,023 people, with a further 4,500 individuals receiving support through the Community Alarm Service. Inspectors engaged with 119 staff and managers, undertook home visits, and reviewed a wide range of documentation and processes, providing a robust assessment of service quality. Feedback from people using the service and their families was overwhelmingly positive. Inspectors observed carers who were highly compassionate, attentive and skilled, often going “above and beyond” to ensure people felt comfortable, respected and valued. Families described staff as “exceptional” and “wonderful,” emphasising the dignity and kindness shown in day-to-day interactions. The inspection identified effective early intervention and strong collaboration with health professionals, with staff responding promptly to emerging health concerns. Workforce development was a particular strength, supported by a structured 12-week induction, mandatory 5-day training for new staff, ongoing specialist training and proactive approaches to staff wellbeing. The formal grading as a result of the inspection is detailed below: 198
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14 PUBLIC INFORMATION PUBLIC INFORMATION • How well do we support people’s wellbeing? 5 (Very Good) • How good is our staff team? 5 (Very Good) 1.9 As part of the ongoing Community Nursing Review, community nursing teams have collaborated with Tissue Viability, Pressure Ulcer Improvement, and Podiatry services to evaluate and enhance the current pressure ulcer risk assessment process. Historically, the Waterlow tool was used; however, it frequently yielded inaccurate scores and proved challenging to apply consistently within community settings due to impractical review timeframes. In response, a community-adapted version of the hospital-based Pressure Ulcer Daily Risk Assessment (PUDRA) has been developed, now referred to as the Community Pressure Ulcer Risk Assessment (CPURA). This new tool is designed to support robust clinical decision- making by facilitating comprehensive documentation, accurate grading, timely intervention, and appropriate escalation. The CPURA is currently undergoing pilot testing within North Ayrshire and the evaluation focuses on effectiveness, clarity, user experience of the assessment form and appropriate actions following pressure ulcer identification. Feedback from this pilot will inform future refinements to ensure the CPURA supports safe, consistent, and effective pressure ulcer management in community care settings. 1.10 Our Children and Families Health Team offers parents in North Ayrshire to source support for potty and toilet training. Families in need of some advice can speak to their Named Health Visitor or Family Nurse while more information is also available via the Ayrshire Bairns app. Over the past century, the average age that children are being potty trained in the UK has risen from between 12 and 18 months to an average of around three or even four years. Where children are not potty trained before starting school, this can have an impact on their health and wellbeing. Studies have also shown that school staff in the UK are diverting 2.5 hours a day, on average, away from teaching and towards supporting children who are not toilet trained, resulting in pupils losing around a third of learning time each day. 1.11 Compass is free online tool offering support to young people with additional support needs – and the adults in their lives – throughout the transition to adulthood. With separate versions for young people, parents/carers and professionals, this interactive digital platform contains up-to-date information and advice, all in one place, and is accessible whenever you need it. Compass is tailored to the individual, so it’s always relevant and specific, saving time and reducing stress. It helps young people explore what matters to them and allows them to share their thoughts, as well as giving parents and carers an individual transitions timeline and highlighting key actions at each stage. Additionally, it can guide professionals through the statutory duties that apply to transitions and supports a joined-up approach. 199
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15 PUBLIC INFORMATION PUBLIC INFORMATION 1.12 Break the Silence provides support to people affected by childhood sexual trauma in North and East Ayrshire. The charity has developed a range of online tools designed to support individuals who have experienced childhood sexual abuse, as well as their families, partners, and the professionals who care for them. Developed with guidance from the charity’s client-led advisory group - as well as experts in the field - these resources reflect the real experiences and needs of survivors. Support while waiting for therapy: Recognising the challenges faced while waiting for therapy, this set of online self-help tools is designed specifically for survivors of childhood sexual abuse. These tools offer a safe, accessible space to begin the healing journey, with resources focused on grounding techniques, managing trauma responses, and building emotional resilience. Resources for families and partners: Family members and partners play a crucial role in a survivor’s healing process. A dedicated self-help tool is now available to support those closest to the survivor. This resource helps build understanding of the impact of sexual trauma, offers guidance on providing informed and compassionate support, and highlights the importance of self-care for loved ones. Training for Perinatal and Postnatal Care Providers – Supporting Survivors: Pregnancy, Birth, and Beyond: In collaboration with partners, Break the Silence has developed an online training module for professionals supporting individuals through pregnancy, birth and beyond. This training equips practitioners with the knowledge and confidence to provide trauma-informed care to survivors of childhood sexual abuse. Participants will gain a deeper understanding of the lasting effects of trauma, how to navigate sensitive situations, and how to promote safety and healing in their practice. It is hoped that these tools will increase awareness, reduce isolation, and help create a more compassionate network of support for survivors and those around them. 200
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16 PUBLIC INFORMATION PUBLIC INFORMATION National Indicators Indicator NAHSCP Scotland Adults able to look after their health very well or quite well 89% 91% Adults supported at home who agreed that they are supported to live as independently as possible 72% 74% Adults supported at home who agreed that they had a say in how their help, care or support was provided 56% 64% Rate of Emergency Hospital Admissions for adults (Per 100,000 population) 14,594 11,470 Rate of emergency bed days for adults 147,915 108,988 Falls rate per 1,000 population aged 65+ 20 22 201
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17 PUBLIC INFORMATION PUBLIC INFORMATION Tackle Inequalities National Outcomes 3 People who use health and social care services have positive experiences of those services, and have their dignity respected. 4 Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. 5 Health and social care services contribute to reducing health inequalities. 6 People who provide unpaid care are supported to look after their own health and wellbeing. Including to reduce any negative impact of their caring role on their own health and wellbeing. 202
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18 PUBLIC INFORMATION PUBLIC INFORMATION 2.1 Following initial completion of modules and interviews, four Skills for Life applicants were identified by the Parent Employment team as suitable candidates for a placement within the Partnership’s Care at Home service. A further candidate was placed within the Partnership’s Community Equipment Store. Placements commenced in May 2025 within the 3 Towns, Kilwinning and Irvine localities. Candidates completed a full-service induction (5 days) and were allocated Care at Home Assistant buddies to support their placement, whilst also receiving ongoing support from Senior Carers and Care at Home Managers for each locality. Each Care at Home Manager submits a monthly report to the Parent Employment team, this report tracks each candidates’ progress throughout their placement. Within 5 weeks of placement one of the candidates felt confident enough to take the next step and apply for a permanent position within the service and has now been successful in receiving an interview date prior to completion of the programme. All candidates are offered an interview at end of the six-month programme. 2.2 The Learning Disability Service, in partnership with the Scottish Commission for people with Learning Disabilities, Scottish Care, and Glasgow School of Art, have successfully delivered the first phase of the Digital Inclusion project they had been collaborating on. This phase has resulted in the development of a variety of resources designed to support activity both at the individual and organisational level regarding digital inclusion. The resources, and the process behind them, were the subject of an exhibition at the Harbour Arts Centre during August. The remaining months of 2025 involved implementation and where necessary refining of the resources, enabled by the continuing presence on a part-time basis of the Care Connector. The Care Connector post is one with considerable potential to enhance the work of the Learning Disability Service, and the HSCP more broadly, in the promotion and implementation of care technology, and the role it can play in enhancing the independence of individuals. Opportunities are being explored in collaboration with partners to identify funding routes to allow for the maintenance of the post in North Ayrshire. 2.3 A group of service users from Trindlemoss Day Opportunities in Irvine has been working hard to achieve the Gold ‘Wild Challenge Award’. Dale Gilfillan, Sophie Burns, Russel Lee, David Charles and Grace Gallagher have been busy completing tasks in the ‘Experience Nature’ and ‘Help Nature’ categories, including building bat and bird boxes, wildlife detecting, creating a pond and mini-beast homes, taking part in a plant safari, and much more. The RSPB’s Wild Challenge is designed to encourage people to explore the great outdoors, discover local wildlife, appreciate nature and actively care for it. The group also previously achieved Bronze and Silver awards. 203
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19 PUBLIC INFORMATION PUBLIC INFORMATION 2.4 Through the Improving the Cancer Journey (ICJ) partnership, targeted welfare rights support has delivered over £760,000 in financial gains for people affected by cancer between January and August 2025. This support has included substantial awards through Scottish Adult Disability Payment, Attendance Allowance, and other benefits, helping to ease the financial burden associated with illness and care needs. In addition to financial relief, the service has provided practical assistance such as Blue Badges, fuel vouchers, and Macmillan Grants, ensuring that individuals receive holistic support during some of the most challenging periods of their lives. For example, one client supported under Special Rules successfully secured enhanced disability payments, a Macmillan Grant, and updated Universal Credit entitlements. Another individual received over £423 per month following a successful Work Capability Assessment, alongside increased mobility support and a £200 Macmillan Grant. These interventions exemplify the tangible impact of the ICJ partnership in addressing health-related inequalities and improving quality of life. 2.5 North Stevenston Community Association is dedicated to addressing issues within its local community, with a focus on tackling social isolation, debt, poverty, food insecurity and mental health inequalities, as well as suicide prevention. It aims to meet the needs of local groups and create opportunities for individuals to connect and build trusted relationships through initiatives at Hayocks Community Hall, including the Tap End community larder, the Hayocks Community Café, Money Matters sessions and support groups. The association also organises and fundraises for a range of free or subsidised community events for both children and adults, as well as regular activities such as a Youth Café and Youth Group, Over 50s Group, Toddlers Group, a knitting and crochet group. 2.6 Support for dads received a boost after the expansion of a successful venture between North Ayrshire Health and Social Care Partnership and Scottish charity Dads Rock. The Dads Support Service, led by Dads Worker RW, has been instrumental in empowering fathers and strengthening families throughout the Three Towns area. Thanks to funding secured through the Scottish Government’s Whole Family Wellbeing Fund, the service has recently welcomed an additional Dads Worker, JS, with support now being rolled out to dads in Irvine and Kilwinning. The service works with dads from a wide range of backgrounds who have been referred by their health visitor, family nurse, midwife or perinatal wellbeing team, providing one-to-one support that impacts on the whole family and improves outcomes for children, whether that be parenting advice, confidence building or support with general wellbeing. In its first year, the service connected with over 60 families in the Three Towns area, with over 180 personalised support sessions, 36 group sessions and five family events taking place. 204
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20 PUBLIC INFORMATION PUBLIC INFORMATION This partnership between NAHSCP and Dads Rock, which was the first of its type in Scotland, has earned recognition at local and national levels, with strong relationships forged with services including health visiting, early years support and social work. 2.7 The Community Brokerage Network provides free information and advice on Self Directed Support (SDS) for everyone in Ayrshire, regardless of their circumstances, age, and level of ability. A Community Broker is someone who helps people find their way through the social care system, with detailed local knowledge and strong connections that can help individuals access the services, community opportunities and resources that fit their unique needs and preferences. The service is fully funded by the Scottish Government and is free of charge to use. No formal assessment or social care budget is required in order to access the service, which is open to: • Those who are unsure if they qualify for social care and don’t know where to start. • Those who have been told they don't qualify for formal support and need help to explore other options. • Those waiting for a needs assessment after contacting social work. • Those who are struggling to get the right support with an allocated care package. • Those who need help reassessing their support due to changing needs. • Unpaid carers looking for support for themselves or a loved one. 2.8 North Ayrshire IJB agreed a new set of equality outcomes for NAHSCP for 2025 to 2029, which can be found on our website. Equality outcomes are required to be developed by public sector bodies at least every four years. The Equality Act 2010 identifies a set of protected characteristics for which people cannot be discriminated against. These are age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. Public sector bodies have a duty to eliminate discrimination, advance equality of opportunity, and promote understanding between those with protected characteristics and those without. Engagement was carried out in North Ayrshire with groups of people with shared characteristics, with national and local data and information helping to inform the new set of equality outcomes. Over the next four years, NAHSCP will aim to achieve the following: • Improved access to community mental health support and information. • Increased participation in leisure and healthy activity. 205
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21 PUBLIC INFORMATION PUBLIC INFORMATION • Improved access to support for those in a caring role. • Improved information and communication. 2.9 A fun day for North Ayrshire’s Ukrainian families was held at Eglinton Country Park. The venue provided a welcoming space for the families we support to take part in various adventures, both indoors and outdoors. The turnout was very good and included families attending this type of community event for the first time, allowing them to meet and socialise with other Ukrainians living in North Ayrshire. Indoors, the families enjoyed board games, a Ukrainian-themed picture quiz, arts and crafts, and activities including archery, bowling, hoopla and more - kindly facilitated by the Active Schools team. Outside, they took part in football and a treasure hunt, with the Family Wellbeing Team looking after a small campfire where everyone had a chance to roast marshmallows and make s’mores. One of the highlights of the day was a visit from our Police Liaison Officer - who allowed the children and adults to sit in the police car, try on the uniform, put the siren on and take photos. The feedback from the day was very positive, with one participant saying: “Thank you for such a wonderful day - this is the first event we have attended with the Ukrainian community, and it felt very special to bond with people.” This was a great day that we hope created one more bridge for integration for displaced people, who - during the ongoing war in their country - are as ever in need of a sense of safety, stability and home. 2.10 A thought-provoking play highlighting the risks involved in illegal substance use toured North Ayrshire secondary schools in October. S3 pupils watched a presentation of Mark Wheeler’s ‘I Love You Mum, I Promise I Won’t Die’ as part of Tie It Up Theatre's autumn schools tour. The play was developed in conjunction with drug education charity the DSM Foundation, which was set up in January 2014. The performance was followed by a drug education workshop, which shared key facts that will help pupils make informed decisions, as well as offering important strategies to help them put their decisions into practice in a pressured situation. Teachers also received a resource pack to assist them in further exploring the issues and themes from the play with pupils. 206
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22 PUBLIC INFORMATION PUBLIC INFORMATION Feedback about the event was extremely positive, with one pupil commenting: “The play makes you think about what you are doing and proves that you don’t know what you might be taking.” 2.11 Money Smart was established May 2025 incorporating the former Money Matters and Welfare Reform Advice teams. Based within Housing services, Criminal Justice, Children & Families, Macmillan, Foodbanks, 9 GP surgeries and Education. The service provides a range of support including delivery of specialist welfare rights advice, such as benefit checks, new benefit applications, mandatory reconsiderations, and appeals representation. As well as debt advice services, including budgeting support, financial capability guidance, and negotiation with creditors. 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. The team have achieved an incredible £20 million in financial gains for residents of North Ayrshire in 2025 to 26. Through supporting 7,560 clients by increasing household income through successful benefit claims and backdated awards, achieving an average £4,623 gain per client. The service continues to have a positive impact on individuals by reducing unmanaged or problem debt through structured repayment plans and debt solutions. In year 2025 to 2026 the total household debt reduction was £568,202.15. By relieving financial concerns this helps to improve mental health and wellbeing and prevent crisis situations like homelessness and fuel poverty and increases financial resilience and confidence in North Ayrshire residents. Money Smart is critical to North Ayrshire’s preventative approach, delivering significant financial gains for residents while reducing inequalities and demand on public services. Continued focus will ensure the service is able to meet increasing demand to maintain high- quality, specialist advice provision and continue to deliver strong outcomes for individuals and families as well as the wider community. * Figures for 2025 to 2026 relate to the new Money Smart team. All previous years relate to the Money Matters team only. 207
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23 PUBLIC INFORMATION PUBLIC INFORMATION National Indicators Indicators NAHSCP Scotland Carers who feel supported to continue in their caring role 27% 32% Adults who are supported at home who agreed they felt safe 74% 75% Premature mortality rate (Under 75s age-standardised death rates for all causes per 100,000 population 532 (2024) 426 (2024) 208
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24 PUBLIC INFORMATION PUBLIC INFORMATION Enable Communities National Outcomes 3 People who use health and social care services have positive experiences of those services, and have their dignity respected. 7 People who use health and social care services are safe from harm. 209
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25 PUBLIC INFORMATION PUBLIC INFORMATION 3.1 Anam Cara Dementia Respite Unit supports people living in North Ayrshire by providing short stay care in a residential, homely environment. Staff deliver personalised care addressing emotional, physical, and daily living needs and offer activities tailored to each guest. The unit accommodates 8 planned respite beds and 1 emergency respite bed and is accessed by service users throughout North Ayrshire. In Quarter 1 of 2025 to 2026, over 600 nights of respite were provided to North Ayrshire residents. Respite care benefits carers by protecting their health, relationships and resilience, ensuring their loved one with dementia is safe whilst also having a positive enriching experience. The value of this is described by family members in the comments below: “Thank you so much for the incredible work you do. Knowing my dad was safe and happy this last week has meant the world” “From the bottom of my heart, thank you for the truly extraordinary care you give with such compassion and kindness” “Thank you so much for all the care you give to Dad, I’m so grateful words can’t say enough” 3.2 During 2025 to 2026, 210 compliments were received by the Health and Social Care Partnership relating to the services provided and the professionalism demonstrated by partnership staff. Compliments “As a relative of a service user, I would like to highlight how impressed I am with the willingness & compassion every person has shown , when they have arrived to help , as everyone is aware these people only arrive when asked, so their helpfulness might go unnoticed!” “I just want to say how wonderful the district nurses are in North Ayrshire (particularly the nurses who work in West Kilbride) - they have cared for me after my recent accident. I can't thank them enough for the service they provided, showing their knowledge, attention to detail and exceptional kindness to me.” “After speaking to my GP I was unable to receive a diagnosis through NHS service. I was directed to private services and an appointment was made with the Community Links Practitioner in Barns Practice. She has been with me from the start making appointments, filling out paperwork and navigating the system which has been quite distressing for me. She has been so supportive and bent over backwards to help me, nothing has been a bother to her and I wouldn't have been able to do this on my own so I am forever grateful. It brings comfort to me knowing I have someone in my doctor surgery who will listen to me and help if she can. She is a star.” 210
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26 PUBLIC INFORMATION PUBLIC INFORMATION “My Aunt had a care package in place for past few years, and she recently became palliative and passed away. The carers she had were nothing short of amazing. The bond they had with her was so evident ,and we know she thought the world of her girls. Their support to her and to us in her last week was invaluable and we can’t thank them enough for all the love and support shown to her and us.” “I am writing this email, with a heart full of appreciation, for the outstanding support we received from [name], during a very stressful time. [name], was absolutely amazing. She was both professional and caring, yet understanding. Had it not been for [name], I'm not sure how I'd have coped with the situation I was in. I brought my husband back home from a carehome, where I truly felt they were not meeting his, physical, or emotional needs. We had a meeting with the management and [name]. I tried my best for it to work, but sadly, it didn't succeed. At no point , did [name] make me feel like a pain, or an overprotective wife.” “We're writing to let you know how grateful we are for the team of carers that our mum has. They take wonderful care of our mum, often going above and beyond basic care duties. They show a genuine affection in every interaction. We see this in the small things like combing my mum's hair so gently to get it just how she likes it, to always being very aware of any change in our mum's health so these can be addressed early. Just today, our mum took a 'funny turn' and the paramedics had to be called. [name] and [name] were so calm in dealing with the situation, even taking time to make sure I was ok! We all too often hear when things go wrong. However, we wanted to let you know that the team that are in place for our mum are truly outstanding. Knowing our mum is so well cared for is a great relief to the whole family, that makes such a difference.” 3.3 A total of 223 complaints were received during the year and were across all service areas, with 45 complaints being upheld. Complaint Topic Number Service provision/delivery 128 Staff behaviour (including alleged or perceived) 40 Other 12 Quality of care 12 Communication 9 Community OT 6 Blue Badge 5 Continuity of staff 3 Service Access 3 Missed/late appointment 2 Waiting times 2 System issues 1 211
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27 PUBLIC INFORMATION PUBLIC INFORMATION 3.4 Gowanlea Day Service in Kilbirnie received a full upgrade and refurbishment of its internal environment. Gowanlea is a community-based service that supports older adults to maintain independence, stay physically active, and enhance their health and wellbeing through social interaction. The much-needed improvements included new flooring, updated furniture, and refreshed décor throughout. This service plays a vital role in promoting the health and wellbeing of older adults in the Garnock Valley locality and provides essential support to carers. 3.5 On Arran, Montrose House continues to play a vital role in fostering community connections and promoting wellbeing through innovative local partnerships. One such initiative is the collaboration with EcoSavvy Community, a local organisation dedicated to environmental sustainability and zero waste living. Their café, now hosted at Montrose House on selected dates, offers homemade soup, locally grown bread, home baking, and refreshments, alongside a zero-waste shop section. Supported by the Council, the café also provides subsidised tinned goods to help address food affordability. This partnership not only supports sustainable living but also strengthens community ties by making healthy, seasonal produce more accessible. Intergenerational work has also flourished at Montrose House, with Brodick Primary pupils spending six months engaging with residents through activities such as baking, painting, and gardening. The feedback from both children and residents has been overwhelmingly positive, highlighting the mutual benefits of shared experiences across generations. Building on this success, plans are now being developed to collaborate with Arran High School to refresh work placement opportunities. This will support the skills group and promote closer working between sectors on the island, whilst reinforcing pathways into health and social care careers for young people. 3.6 Cycling Without Age Scotland is a charity aimed at getting people who are less able to pedal themselves out on a biking-type experience. The charity’s specially adapted ‘trishaws’ are piloted by trained volunteers, with the seat on the trishaw enabling anyone with limited access to outdoor activity or reduced mobility to enjoy the wind in their hair again. In North Ayrshire, the charity operates free of charge rides on Cumbrae, offering participants the chance to see the island in the open air at a cycling pace – perfect for someone who perhaps used to cycle but now can’t, or who wants to join the family on a bike ride. It can also offer free rides in a wheelchair transporter for those unable to transfer easily from their wheelchair onto the trishaw. The service is available all year round and is open to the elderly and those with mobility restrictions or in a wheelchair, whether they live on the island or are just visiting. 212
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28 PUBLIC INFORMATION PUBLIC INFORMATION 3.7 Arran Community and Voluntary Service (Arran CVS) hosted its third ‘Free for All’ community event in April, celebrating local services, community groups and public engagement through a vibrant and inclusive gathering. The event provided a showcase of free taster sessions, support services and activities available across Arran. This year’s event, which was opened by Depute Provost John Sweeney, held special significance, as it marked the 60th anniversary of Arran CVS. The celebration offered residents the opportunity to connect with a wide range of community groups, explore volunteering opportunities and learn more about the services available locally, with activities on the day including sports sessions, yoga/massage tasters and drumming workshops. Health and wellbeing was a major focus, with various health information stands, general health checks and displays from local emergency services. There were also arts and crafts activities, face painting and entertainment for children. Amongst others, the Arran Library bus, Community Council, North Ayrshire Active Schools, Heather Lodge, the National Trust and KA Leisure were all in attendance, providing lots of help throughout the day. Attendees also enjoyed musical entertainment from the Arran Allsorts Children’s Choir, the Arran Pipe Band, Taiko drummers, and the Arran Brass Band. A free buffet and refreshments were available to all, with a community food-sharing area - stocked with donations from local groups and organisations - further demonstrating the spirit of cooperation and mutual support. Approximately 300 community members attended, making the day a huge success in raising the profile of volunteering, gathering public feedback, and highlighting the vital contributions of community groups to the wellbeing of Arran’s residents. 3.8 To celebrate Scottish Breastfeeding Week - as well as the first anniversary of Largs Breastfeeding Support Group - an event was held in the creche room at Brooksby Medical Centre in Largs on Monday 9 June. Staff members, mums and expectant mums were all welcome to go along and join in. This weekly group provides support to mums in a welcoming environment, with 60 per cent of the women attending the group saying that they would have stopped breastfeeding without the additional support offered by the group. This year also marks the 20th anniversary of the Breastfeeding etc. (Scotland Act). This made it an offence to prevent a person in charge of a child from feeding milk to that child in public or private premises, enabling mums to feel safe and empowered, as well as giving them the confidence to feed their baby out with the home and challenge anyone who tries to prevent this. Support groups such as the Largs Breastfeeding Support Group help maintain increases in breastfeeding rates experienced in North Ayrshire in recent years. 213
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29 PUBLIC INFORMATION PUBLIC INFORMATION 3.9 Self-Directed Support (SDS): Awaiting Updated Data For the reporting year 2025 to 2026, the following information indicates how people have arranged and directed their support in North Ayrshire. Self-Directed Support offers four options. These are: • Option 1 – Direct Payment. • Option 2 – Individual Service Fund. • Option 3 – Council Arranged Services. • Option 4 – a mix of the above options. This continues to demonstrate that traditional support options are offered and accessed most with 84.8% of people receiving Option 3, where little choice and control is exercised and support is chosen, arranged and directed by the Health and Social Care Partnership. 3.10 On Wednesday 11 June, over 50 carers from all across North Ayrshire attended Carers Gateway North Ayrshire’s annual conference to celebrate Carers Week 2025. The theme this year was ‘Equality in Caring’, with Provost Anthea Dickson referencing this and the valuable work that unpaid carers provide. The newly formed Champions Board, a forum that brings carers and professionals together to design services for carers, announced the launch of the Carers Community Fund. This is available for groups, charities and communities to apply for up to £2,000 for activities, events or projects that benefit unpaid Carers across North Ayrshire. 214
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30 PUBLIC INFORMATION PUBLIC INFORMATION Carers also heard from Carers Trust Scotland, Ayrshire Independent Living Network, Social Security Scotland, Home Energy Scotland and North Ayrshire Health and Social Care Partnership about the work that they are doing to support unpaid carers. National Indicators Indicators NAHSCP Scotland Adults receiving any care or support who rated it as excellent or good 70% 72% People with positive experience of the care provided by their GP practice 63% 71% Proportion of care services graded ‘good’ (4) or better in Care Inspectorate Inspections 88% 83% 215
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31 PUBLIC INFORMATION PUBLIC INFORMATION Develop and Support Our Workforce National Outcomes 6 People who provide unpaid care are supported to look after their own health and wellbeing. Including to reduce any negative impact of their caring role on their own health and wellbeing. 8 People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. 9 Resources are used effectively and efficiently in the provision of health and social services. 216
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32 PUBLIC INFORMATION PUBLIC INFORMATION 4.1 Ward 1, Woodland View is a large 30 bedded adult rehabilitation and enablement ward, with single ensuite rooms. Alongside the ward nursing staff there is a dedicated Multi-Disciplinary Team, which includes Occupational Therapists and Physiotherapists, who support patients through many health conditions to become more independent to carry out daily activities. The ward had been experiencing a number of falls, including falls with harm. An audit found that all the appropriate paperwork, including risk assessments and behaviour charts, were being utilised to prevent falls. It was recognised that patients were trying to mobilise as if they were still at home, getting up unassisted for bathroom or personal care needs. Despite being introduced to the nurse call system some patients did not understand how to use the nurse call or know when they should use it. Staff had completed falls prevention training and were able to prevent many falls by being vigilant with safety walk rounds and quick to respond to patient needs. Led by Senior Charge Nurse SH, the ward staff worked alongside Quality Improvement colleagues to develop a laminated poster which was placed on the bathroom door in every bedroom across from where the patient’s seat was arranged. The poster states "Call, don’t fall" with a picture of the nurse call pendent, matching colour of the actual pendant used by patients in the ward. Due to the fall improvement work the number of falls has continued to decrease, from 7 in April to only 2 in July. A falls improvement board was placed in the ward area to celebrate the improvement work. 4.2 In September 2025, six staff members from North Ayrshire Justice fieldwork teams and the Pan Ayrshire Partnership Delivery Team attended the National Organisation for the Treatment of Abuse (NOTA) Scotland Annual Conference at the Stirling Management Centre. This flagship event brought together practitioners, academics, and policy makers from across Scotland to share research, practice developments, and innovative approaches to managing harmful sexual behaviour and supporting victims. This year’s theme centred on adult support and services, offering an engaging mix of keynote presentations exploring the neurobiological basis of sexual offending and evidence-based treatment approaches, alongside interactive workshops designed to deepen understanding of risk assessment and intervention strategies. Expert panel discussions on leadership and multi- agency collaboration in managing sexual harm also featured heavily on the day. Our teams gained valuable insights into the role of trauma and neurobiology in harmful sexual behaviour, alongside best practice in risk management and rehabilitation. Our staff were able to take practical learning from the workshops that took place, allowing them to apply advanced intervention strategies in real life cases upon their return to work. The training event also served as a key facilitator in terms of strengthening partnership working across services to enhance public protection. 217
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33 PUBLIC INFORMATION PUBLIC INFORMATION Our workforce advises that attendance at the NOTA Scotland Annual conference has enhanced their professional confidence, promoted innovative thinking and reinforced collaborative approaches essential for public protection. 4.3 Douglas Grant Rehabilitation Ward is a specialist neurological rehabilitation unit providing care for individuals with a broad spectrum of neurological conditions. Historically, the ward primarily supported patients with long-term conditions such as Multiple Sclerosis. However, in recent years, the patient profile has evolved significantly following the integration of a Major Trauma Unit. This has led to an increase in referrals for individuals requiring rehabilitation following acute neurological events, including traumatic brain injuries. In response to this shift, the Senior Charge Nurse and Deputy Charge Nurses introduced a structured programme of professional development in 2024. This included a series of study days held at the hospital’s training centre, designed to enhance the knowledge and skills of the nursing team. The programme consisted of two identical sessions delivered one month apart, ensuring all staff could participate without compromising safe staffing levels on the ward. The initiative was met with overwhelmingly positive feedback from staff, who reported increased confidence and competence in managing complex neurological cases. Importantly, this education programme has been recognised as having a direct and positive impact on the quality of care delivered to patients, supporting safer, more informed clinical decision-making and improved patient outcomes. Building on this success, the Deputy Charge Nurses under the leadership of Senior Charge Nurse SC, committed to making the study days an annual event each autumn. Staff were actively involved in shaping the content of future sessions by identifying their own learning needs. For the 2025 programme, feedback highlighted a strong interest in further education around head trauma. In response, the team curated a focused agenda that included expert contributions from Psychology and Allied Health Professional teams, as well as guest speakers from Queen Elizabeth University Hospital and the charity Headway. This collaborative and responsive approach to staff development continues to foster a culture of learning and excellence within the ward, ensuring the team remains equipped to meet the evolving needs of their patient population. 4.4 As part of the long-term work being undertaken within the Assessment Hub, a training framework is being produced to create development pathways for all staff grades working within the clinical environment. To ensure the provision of training across services, unscheduled care have created a training lead post, allowing experienced clinical staff to focus on continued development of and training in BRITE risk management and formulation training. • Multidisciplinary team: PMHS includes a psychiatrist, mental health nurses, CBT Nurse. • Therapist, and a psychologist, fostering collaborative practice. 218
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34 PUBLIC INFORMATION PUBLIC INFORMATION • Training and development: Staff are equipped to deliver evidence-based, person- centred care, and participate in MDT meetings, including at the Mother and Baby Unit. The service provides training and awareness sessions for professionals across health, social care, and third-sector organisations. The service has adapted an e-learning module on infant mental health accessible health and non-health colleagues. This builds capacity and confidence in identifying and responding to infant mental health needs. Quarterly IMH steering groups ensure partners influence service development and can identify how the team can best support them. In order to support staff wellbeing, improved attendance, and engagement with service development activity, additional support has been sought for the nursing staff group via the Senior Nurse to deliver reflective practice sessions. 4.5 Nine Health Care Support Workers successfully completed their studies via Ayrshire College becoming Band 4 Assistant Practitioners and a graduation event was held in August 2025 to celebrate this with certificates presented by the Associate Nurse Director (Mental Health). This was an excellent example of learn as you earn with staff who had already undertaken Scotvec Level III studies being supported to further develop their knowledge/skills and gain a promoted post by being released a day a week to undertake these studies. 4.6 A free, digital mental health and wellbeing resource is available to all staff. The National Wellbeing Hub provides access to high quality, evidence-informed online mental health and wellbeing resources to support everyone working in health and social care in Scotland. On the hub you can find a range of resources including free apps, articles, videos, tip sheets, podcasts and e-modules, designed to promote self-care and enhance individual and team wellbeing, as well as signposting to a number of regional and national services available to support staff members. 4.7 In October 2025, North Ayrshire Council introduced a new mandatory Prevent Awareness training module through iLearn, reinforcing our commitment to ensuring that all staff understand their responsibilities under the Prevent duty. The module provides a clear introduction to the statutory framework, outlines the key forms of extremism and terrorism currently presenting the greatest threat to the UK, and supports staff to develop confidence in recognising the indicators of radicalisation and pathways into appropriate safeguarding processes. Roseanne Burns, Senior Manager in Justice Services was instrumental in the development and roll out of this Module. Engagement with the new training has been strong. By the end of December 2025, over 600 staff members, council wide had successfully completed the module, reflecting a high level of organisational commitment to strengthening our collective safeguarding responsibilities. This uptake also demonstrates the value of clear messaging, coordinated communication across services, and the accessibility of the online learning platform. 219
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35 PUBLIC INFORMATION PUBLIC INFORMATION Interest in North Ayrshire’s module has grown across the region. Several West of Scotland local authorities have expressed a desire to emulate our training approach, recognising the clarity, accessibility and quality of the iLearn module and how it contributes to developing the workforce. This positions North Ayrshire as a sector leader in Prevent learning design and delivery, contributing positively to shared regional practice and supporting the wider objective of ensuring consistent standards in safeguarding across local authority areas. 4.8 Congratulations to Care at Home Assistant Marita Higgins, who reached the final in the Care and Compassion category at NHS A&A’s Ayrshire Achieves Awards 2025. Ayrshire Achieves is about recognising exceptional staff and volunteers who provide health and care services in Ayrshire and Arran. Awards are open to all members of staff employed by NHS Ayrshire & Arran or one of the three Health and Social Care Partnerships, as well as volunteers. Nominees - Care and Compassion Category 4.9 The Care at Home service and the Ayrshire Hospice undertook a Palliative and End of Life Care Project which concluded in late 2025. The joint initiative included shared learning opportunities, with placements in the Ayrshire Hospice and bespoke training for a group of care staff receiving highly positive feedback. Staff described the work as both professionally valuable and personally meaningful, gaining increased confidence, greater insight into holistic care, and a strengthened sense of purpose. Families highlighted dignity, kindness, and empathy as defining features of the support they received. The project shows strong alignment with strategic objectives by improving early intervention, enhancing staff capability, and supporting wellbeing at a particularly vulnerable stage of life. 4.10 Congratulations to Dads Worker Ryan Warren, who was shortlisted for the ‘Unsung Hero – Reader’s Choice Award’ category at this year’s Scotland’s Health Awards. The awards, hosted by The Scotsman in partnership with NHS Scotland and the Scottish Government, offer an opportunity to recognise and celebrate the extraordinary individuals and teams who go above and beyond to deliver compassionate, high-quality health and social care across Scotland. Ryan, who works for charity Dads Rock and sits within our Children and Families Health team, was nominated for his work in providing support to dads in North Ayrshire, helping them to be the best dads they can be and supporting them to give their children the best possible start in life. 220
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36 PUBLIC INFORMATION PUBLIC INFORMATION National Indicators Indicators NAHSCP Scotland Readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 103 104 Percentage of adults with intensive needs receiving Care at Home (all levels of CAH) 77% 65% Number of days people aged 75+ spend in hospital when they are ready to be discharged per 1,000 population 1,738 873 221
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37 PUBLIC INFORMATION PUBLIC INFORMATION Improve Mental and Physical Health and Wellbeing National Outcomes 1 People are able to look after and improve their own health and wellbeing and live in good health for longer. 5 Health and social care services contribute to reducing health inequalities. 9 Resources are used effectively and efficiently in the provision of health and social services. 222
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38 PUBLIC INFORMATION PUBLIC INFORMATION 5.1 A new specialist facility at West Road for Neuro CAMHS (N-CAMHS) and Community Eating Disorder Service (CEDS) opened this year with the first patients seen in April 2025. The Official Opening was 22 May 2025 with the Leader of the Council and the Provost carrying out these duties. The facility will result in an improved environment to carry out physical examinations and improve the wellbeing for patients and staff in the facility. Previously physical examinations were being carried out in environments which were much less suitable. The newly refurbished facility will enable a much safer and hygienic environment which the workforce has been involved in designing. Open seven days per week, specialist CAMHS Neuro, ADHD, play Therapy and other Clinical Interventions will be delivered from this re-fitted facility. Hosting flexible working space for staff with five clinic rooms and two large meeting rooms, it is envisaged that the facility will become a centre of excellence in the care and treatment of child and adolescent mental ill-health and eating disorders. 5.2 The launch of the Improving the Cancer Journey (ICJ) service across Ayrshire & Arran represents a major step forward in supporting individuals affected by cancer. Delivered in partnership with NHS Ayrshire & Arran and Macmillan Cancer Support, the service provides personalised, non-clinical support addressing emotional, financial, and practical needs. This initiative reflects our commitment to holistic, compassionate care and has already begun to make a meaningful difference in people’s lives. Support is available to anyone 16 years and over, living in Ayrshire and Arran that has been affected by cancer and everyone who accesses the service will be offered a Holistic Needs Assessment (HNA). As of September 2025, the service had set up 832 assessments across Ayrshire, with 37% of these for North Ayrshire residents. 5.3 The Partnership’s Dementia Support Service received formal recognition in an inspection report from the Care Inspectorate in July 2025 with upgraded ratings to ‘Very Good’ across all key areas, marking a significant milestone in our commitment to delivering high-quality, person-centred care. Previously rated as ‘Good’, the service has now achieved a ‘Very Good’ rating across all key areas—an outcome that reflects the dedication, professionalism, and compassion of staff. Inspectors commended the respectful and skilled relationships between staff and service users, noting that families consistently shared positive feedback about the difference the service has made to their loved ones’ lives. The inspection also recognised the strength of quality assurance systems, which include regular wellbeing calls, audits, supervisions and reflective practice. These mechanisms have fostered a culture of continuous improvement and accountability. Staffing arrangements were highlighted as a particular strength, with flexible rota management, daily handovers, and regular team meetings contributing to a stable and supportive working environment. Care planning was praised for being detailed, personalised, and outcome-focused, ensuring that individual preferences and 223
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39 PUBLIC INFORMATION PUBLIC INFORMATION goals are central to the support provided. This outcome is not only a formal endorsement of the service’s quality but also a reflection of the values that underpin the Partnership’s approach to dementia care. It demonstrates an unwavering commitment to improving the mental and physical wellbeing of individuals and families across North Ayrshire. 5.4 Peace of Mind is an innovative programme aimed at reducing social exclusion and isolation as a result of a disability, impairment or long-term health condition, with a particular emphasis on people who do not receive statutory services but still need support. With a focus on providing our users with fun experiences and building new friendships whether that’s attending a local football match, going to the gym, visiting different places or developing new skills, we offer it all. The Peace of Mind programme aims to cultivate communities and nurture natural networks. This means that we seek to support and assist disabled people, people with long-term illness or other life limiting health conditions to think about what they would like to do and how this would make them happier and better connected with their local community. Then we go about helping you to make it happen. 5.5 Mental Health Unscheduled Care has moved under the inpatient management structure. This move brings exciting opportunities for reviewing points of interaction between inpatient and community care to ensure patients are receiving the most appropriate care to meet their needs. The team behind the Unscheduled Care Assessment Hub have been recognised for their positive impact, being named among the finalists at this year’s Royal College of Nursing (RCN) Scotland Nurse of the Year Awards in the Mental Health category. The service provides 24-hour access to mental health assessment and interventions and can accommodate up to five patients within a therapeutic environment for up to 72 hours. Since being established in 2024, the service has successfully: • Reduced the number of unscheduled admissions to acute adult inpatient mental health beds. • Brought community and inpatient services closer together to help create a smoother patient journey. • Reduced the waiting time for planned adult acute admissions. • Reduced the number of initial assessments being carried out in acute wards – releasing resource for treatment. In addition, Unscheduled care staff have been invited to present at a Mental Health Distress Collaboration event being held in the Royal Society of Edinburgh – this follows a Quality Assurance Survey within Police Scotland which saw Ayrshire and Arran score highest in usage and staff satisfaction in relation to community triage. 224
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40 PUBLIC INFORMATION PUBLIC INFORMATION 5.6 Case Study: Community Link Worker Service The following case highlights the importance of person-centred care, showing that with understanding and empathy we deliver practical solutions that uphold dignity and promote wellbeing. One individual, a neurodiverse adult experiencing significant mental health challenges, was facing multiple barriers including homelessness, unemployment, and poor physical health. At the time of contact, they were sleeping rough and had limited access to basic necessities, including food and hygiene. Their appearance reflected the hardship they were enduring, and they openly shared struggles with self-care. A deeply important source of comfort and stability for this person was their pet dog, whom they described as their “safety blanket.” The emotional bond was so strong that they expressed thoughts of suicide if separated from their companion. Unfortunately, this created a barrier to accessing temporary accommodation and support services, as many facilities were unable to accommodate pets. Despite these challenges, our community link workers responded with compassion and creativity. They arranged emergency food support through the local foodbank and liaised with Housing Services to advocate for a more flexible approach. Permission was secured for the individual to attend a housing appointment with their dog, ensuring their emotional needs were respected whilst giving them access to support around accommodation. A referral to social work was also made to explore longer-term support options. 5.7 The Ayrshire Out of Hours Social Work Service has been operational for 14 years. During 2025 to 2026, despite some challenges relating to staff absences and an average of 18% staff vacancies, the service continued to provide uninterrupted cover. During this period, the team manged a total of 9,973 referrals, this included an increase of 518 referrals compared to 2024 to 2025. Referrals to North Ayrshire were 4,122 or 41.3% of all referrals across Ayrshire. Of the 4,122 referrals to North Ayrshire, 742 were requests for Child Protection Register checks. Of these 706 were from the Police, with 24 from Social Work and 10 from Health. 225
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41 PUBLIC INFORMATION PUBLIC INFORMATION There were 1,466 referrals in relation to Child Concerns/Child Welfare and 578 in relation to Adult Concern/Welfare. There were 94 referrals in relation to Child Protection and 34 referrals in relation to Adult Protection. There were 261 referrals relating to young people missing from home, 87 relating to Care at Home, 140 in relation to Mental Health and 54 in relation to financial destitution. Referrals to North Ayrshire have been consistently around 4,000 in five of the past six years with a dip in numbers experienced in 2022 to 2023. 5.8 Finding Your Feet is Scotland’s only charity dedicated exclusively to amputees. It provides a comprehensive wellbeing program for amputees in North Ayrshire, focusing on social support, mental resilience and physical health, with many staff and volunteers being amputees themselves. The charity collaborates with hospitals, physiotherapists and community organisations to ensure amputees receive the best possible support, and services are available to both new and long-term amputees, ensuring ongoing support at every stage of their journey. It can also provide transport assistance to ensure accessibility - particularly for amputees facing mobility challenges or financial barriers. Fortnightly Ampu-Teas sessions are held in Irvine, offering a friendly and supportive space for amputees to meet others in the community facing similar experiences. In addition, weekly indoor bowls sessions are held at the Galleon in Kilmarnock on Fridays from 12.30pm to 2.30pm. 5.9 As part of the North Operational Improvement Plan utilising NHS Renewal Funding, North Ayrshire HSCP secured ring fenced funding from the Ayrshire and Arran allocation for enhanced Mental Health Officer (MHO) capacity. 226
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42 PUBLIC INFORMATION PUBLIC INFORMATION Hospital based MHO capacity was increased immediately on confirmation of ring-fenced funding to expand critical MHO capacity within the hospital team. In addition to the recruitment of posts to expand the North HSCP’s dedicated hospital-based MHO support for discharge planning, other improvement activity has included the implementation of guardianship activity trackers, anticipatory care planning protocols and enhanced collaboration with legal and advocacy services to streamline processes. The impact has been immediate and measurable, with reduced waits for hospital MHO allocation and a reduction in Adults with Incapacity (AWI) delays by 48% throughout Quarter 3. 5.10 Staff and service users of the Dirrans Centre took part in a sponsored walk for the Ayrshire Hospice on Friday 18 July, raising over £850 for the charity through their Just Giving page and cash donations. The centre runs twice-weekly Health Walks for service users undergoing periods of rehabilitation, with a walk of 1km to 3km on Tuesdays, and a longer walk of 4km to 5km on Fridays. These not only help to improve physical and mental wellbeing but also offer an important opportunity for social connection. The group members expressed an interest in doing a sponsored walk again this year for the Ayrshire Hospice, with the charity being close to the hearts of many. A total of 17 service users took part in the event, joined by volunteers and rehab staff. 5.11 A new way to access mental health support via text message launched as part of Suicide Prevention Month. In partnership with Education, North Ayrshire Health and Social Care Partnership and Shout, residents will be able to access in-the-moment mental health support by texting ‘SUPPORTNA’ to 85258. This text-based service offers tailored support to people of all ages in North Ayrshire whenever they need it. The service can provide confidential support with: • Anxiety and stress. • Depression and sadness. • Suicidal thoughts and self-harm. • Panic attacks. • Loneliness and isolation. • Bullying and abuse. 227
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43 PUBLIC INFORMATION PUBLIC INFORMATION Shout volunteers are on hand to help 24 hours a day, seven days a week, when things get tough or if you are feeling overwhelmed or need support. 5.12 Delayed Discharge rates per 1,000 population have continued to increase in North Ayrshire with the rate for 2025 to 2026 being 29.3 per 1,000 population compared to 13.2 per 1,000 population across Scotland. Across January to March 2026, North Ayrshire HSCP progressed the implementation of a new acute based Discharge to Assess social work team, fully staffed and implemented by February 2026. The establishment of this dedicated team strengthens the Partnership’s contribution to Discharge without Delay (DwD) by embedding earlier, proportionate decision making and reinforcing a “home first” approach within discharge pathways. Supporting people to leave hospital as soon as it is clinically and functionally appropriate and return home at the earliest safe opportunity. This aligns with the national DwD focus on improving the patient journey through early and effective planning and stronger, more seamless links between acute services, hospital-based social care and community teams. 16.2 17.0 16.3 26.1 29.3 12.2 12.1 13.0 13.3 13.2 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 2021-22 2022-23 2023-24 2024-25 2025-26 Delayed Discharge Bed Days (All Reasons) Rate per 1,000 population 18+ North Ayrshire Scotland 228
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44 PUBLIC INFORMATION PUBLIC INFORMATION National Indicators Indicators NAHSCP Scotland Adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life 67% 72% Proportion of last 6 months of life spent at home or in community setting 88% 89% MSG Indicators Indicators Value Emergency admissions to acute hospitals* 18,232 Emergency admissions to acute hospitals (Rate per 1,000) 136.0 Admissions from emergency department 8,545 Admissions from emergency department (Rate per 1,000) 63.8 Percentage of people at emergency department who go onto ward stay (conversion rate) 24.2% Unscheduled ‘hospital bed days’ in acute hospital* 140,530 Unscheduled ‘hospital bed days’ in acute hospital (Rate per 1,000) 1,048.7 Unscheduled ‘hospital bed days’ in long stay mental health hospital* 24,760 Unscheduled ‘hospital bed days’ in long stay mental health hospital (Rate per 1,000) 184.8 Unscheduled ‘hospital bed days’ in geriatric long stay* 7,349 Unscheduled ‘hospital bed days’ in geriatric long stay (Rate per 1,000) 66.8 Emergency department attendances 35,323 Emergency department attendances (Rate per 1,000) 263.6 Percentage of people seen within 4hrs at emergency department 64.8% MSG Indicators – Delayed Discharges Indicators Value Delayed discharges bed days (all reasons) 36,882 Delayed discharges bed days (all reasons) (rate per 1,000) 335.1 Delayed discharges bed days (code 9) 8,787 Delayed discharges bed days (code 9) (rate per 1,000) 79.8 Delayed discharges H&SC Reasons 27,951 Delayed discharges H&SC Reasons Rates 254.0 * Calendar year 2025 used as a proxy for financial year 2025 to 2026 due to data completeness, following advice from Public Health Scotland. 229
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45 PUBLIC INFORMATION PUBLIC INFORMATION National Health and Wellbeing Indicators The Scottish Government identified 23 (4 remain in development) indicators that were felt evidenced the 9 National Health and Wellbeing Outcomes. Nine indicators come from the biennial Health and Care Experience Survey (see below) and the additional indicators (also below), which evidence the operation of NAHSCP, come from the NHS Information Services Division (ISD) survey. This survey represents a sample of the community and asks about the collective services received whether it be from Social Services, NHS, the collective HSCP, Private or Voluntary organisations. The survey responses do not separate each organisation’s service provision. The information below represents the most up-to-date information with further updates accessible from – Public Health Scotland This information along with other HSCP information can be found via – the Audit Scotland - Integrated Authority Tool Health and Social Care Experience Indicators 2017- 2019 2019- 2020 2021- 2022 2023- 2024 2025- 2026 Scottish Average % Rank against Family Group Adults able to look after their health very well or quite well 91% 92% 89% 89% 89% 91% 5 Adults supported at home who agreed that they are supported to live as independently as possible 84% 84% 81% 67% 72% 74% 6 Adults supported at home who agreed that they had a say in how their help, care, or support was provided 70% 75% 73% 51% 56% 64% 7 Adults supported at home who agreed that their health and social care services seemed to be well co-ordinated 74% 76% 64% 55% 64% 65% 4 Adults receiving any care or support who rated it as excellent or good 78% 77% 76% 68% 70% 72% 5 People with positive experience of the care provided by their GP practice 80% 73% 61% 60% 63% 71% 6 Adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life 82% 79% 78% 68% 67% 72% 6 230
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46 PUBLIC INFORMATION PUBLIC INFORMATION Health and Social Care Experience Indicators 2017- 2019 2019- 2020 2021- 2022 2023- 2024 2025- 2026 Scottish Average % Rank against Family Group Carers who feel supported to continue in their caring role 39% 31% 31% 32% 27% 32% 8 Adults supported at home who agreed they felt safe 80% 85% 83% 67% 74% 75% 5 To support service improvement, the Scottish Government has identified local authority / Partnership benchmarking families. These family groups are made up of eight local authorities that share similar social, demographic and economic characteristics. Comparing our performance information with our family group should provide a more meaningful comparison with similar areas and allow for greater opportunities for shared learning and best practice. Rankings are on a scale of 1–8, where 1= best performing, 8=worst performing. North Ayrshire is partnered in its family group with: East Ayrshire, Dundee, Western Isles, Glasgow, Inverclyde, North Lanarkshire, and West Dunbartonshire. Survey fieldwork was carried out between October and December in the financial year presented and respondents were asked about their experiences over the previous 12 months. Please note results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 and 2025/26 are not comparable to previous years due to changes in survey wording. Also results for 2019/20 and 2021/22 for indicators 2, 3, 4, 5, 7 and 9 are comparable to each other, but not directly comparable to figures in previous years due to changes in survey wording and methodology. 231
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47 PUBLIC INFORMATION PUBLIC INFORMATION Indicators based on administrative data 2021- 2022* 2022- 2023* 2023- 2024* 2024- 2025* 2025- 2026* Scottish Average Rank against Family Group Premature mortality rate. (Under 75s age-standardised death rates for all causes per 100,000 population). 568 527 507 509 532 426 6 Rate of Emergency Hospital Admissions for adults (per 100,000 population) 14,269 13,449 14,009 15,142 14,594 11,470 6 Rate of emergency bed days for adults. 155,206 151,553 142,222 155,896 147,915 108,988 7 Readmissions to hospital within 28 days of discharge. 113 100 101 106 103 104 5 Proportion of last 6 months of life spent at home or in community setting. 89% 88% 88% 88% 88% 89% 6 Falls rate per 1,000 population aged 65+ 20 20 22 23 20 22 1 Proportion of care services graded ‘good’ (4) or better in Care Inspectorate Inspections. 79% 78% 83% 87% 88% 83% 2 Percentage of adults with intensive needs receiving Care at Home. (All levels of CAH) 77% 77% 78% 77% 77% 65% 1 Number of days people aged 75+ spend in hospital when they are ready to be discharged per 1000 population) 805 1,038 1,087 1,266 1,738 873 7 *Column contents are the most up to date data information received from Scottish Government statisticians. As well as the National Health and Wellbeing indicators, we regularly report on local measures to help us to evidence performance against the nine National Health and Wellbeing Outcomes and our Strategic Priorities. The list of local indicators can be found in Appendix 1. 232
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48 PUBLIC INFORMATION PUBLIC INFORMATION Performance in relation to the three Children’s Outcomes and three Justice Service Outcomes 233
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49 PUBLIC INFORMATION PUBLIC INFORMATION Children’s Outcomes Outcome 1: Our Children have the best start in life and are ready to succeed. Outcome 2: Our young people are successful learners, confident individuals, effective contributors, and responsible citizens. Outcome 3: We have improved the life chances for children, young people and families at risk. 1.1 To support children and young people affected by parental substance use, JC, Senior Manager within our Children and Families service successfully applied to the Alcohol and Drug Partnership (ADP) for funding to launch a social prescription initiative across all Children and Families localities. The service was awarded £10,000, which was equitably distributed amongst all locality teams. This funding enables access to social prescriptions for children and young people who have experienced the trauma and disruption associated with parental drug or alcohol use. These experiences often limit opportunities for leisure, personal development, and quality family time. Social prescriptions offer vital reparative benefits, including enhanced confidence and self-esteem, reduced stigma and shame, the promotion of prosocial lifestyle choices, and the discovery of individual strengths and talents. They also help strengthen social connections and improve physical and mental health through regular activity. Collectively, these short and medium-term benefits contribute to long-term aspirations of reducing trauma, tackling inequalities, and improving life outcomes and future opportunities for affected children and young people. 1.2 Our Children and Adolescent Specialist Support Team (CASST) Modern Apprenticeship (MA) scheme has proven to be a significant success. One young person successfully completed their placement and has since secured permanent employment within North Ayrshire Council’s care sector. The second apprentice is on track to complete their programme and is aspiring to pursue further education in nursing. Building on this success, we intend to submit a further funding application to CORRA to continue the MA scheme moving forward. What makes this initiative particularly impactful is its focus on addressing inequalities experienced by young people affected by parental substance use. A key eligibility criterion for the scheme is that apprentices must have grown up in households impacted by a parent or carer’s drug or alcohol use. Both MAs within the team are care-experienced from within North Ayrshire—one through kinship care and the other through foster care. This initiative not only supports individual development and employment opportunities but also contributes to breaking intergenerational cycles of adversity. By turning lived experience into resilience and purpose, the scheme empowers young people to build sustainable 234
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50 PUBLIC INFORMATION PUBLIC INFORMATION futures, while strengthening community wellbeing and reducing the long-term impact of substance-related harm. 1.3 In 2025 to 2026 there were 185 Child Protection registrations and 130 De-registrations. The greatest number of registrations were found in July, when there were 26 registrations within the month. The lowest number of registrations occurred in May, when there were 8 registrations within the month. The median number of registrations per month across the year was 15. 1.4 Within the HSCP, we have sadly experienced adoption breakdowns that have had a profound impact, leaving families devastated and staff feeling disheartened. These experiences have underscored the critical importance of proactive, ongoing support to prevent crisis and sustain successful placements. In response, our Families for Children (FFC) Team has introduced Post-Approval Training, designed to empower adopters beyond their initial approval at Adoption Panels in North Ayrshire. Feedback from adoptive families highlighted a strong willingness to engage in further learning, and the FFC team has responded with practical, home-based sessions delivered by experienced practitioners. The aim is to build resilience within families and reduce the risk of adoption disruptions, which can leave a legacy of trauma and poor wellbeing. The training consists of: • Theraplay – Two sessions to strengthen attachment and emotional connection, reducing anxiety and promoting emotional security for both children and parents. • Life Story Work – A session to support identity and understanding, helping children process their experiences and build resilience. 235
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51 PUBLIC INFORMATION PUBLIC INFORMATION • Crisis Intervention and De-escalation Techniques – Practical strategies to manage challenging situations confidently, reducing stress and preventing escalation that can impact family wellbeing. • Social Media Awareness – Guidance to help families navigate online safety and digital boundaries, reducing risks that can cause emotional distress. Adoption is a lifelong journey, and families often encounter unique challenges that require support at different times. By introducing this enhanced training approach, we recognise that accessing the right help at the right time can prevent crisis and adoption breakdown, strengthen family relationships, and promote stability for children. Our Post-Adoption Support Team is committed to supporting adoptive families every step of the way. This proactive approach reduces stress, builds resilience, and improves mental health by creating a sense of security and belonging for both children and parents. Physical wellbeing is supported through calmer home environments, improved routines, and reduced conflict, which contribute to healthier family dynamics. Ultimately, this initiative empowers families, sustains successful placements, and ensures children grow up loved, safe, and respected which fully aligns with The Promise. 1.5 P7 and S1 pupils from across North Ayrshire schools attended a young person’s engagement event held by North Ayrshire Child Protection Committee at Greenwood Academy in May. Around 100 young people, along with staff from their schools, came along to the event, which was organised by the CPC’s Public Information and Engagement Group. The aim was for the CPC to learn more about what young people know with regards to accessing support on a range of child protection issues, find out where there are gaps in knowledge or sources of information, and discuss with young people the best ways to share this information with them – and in what format – so they have all of the resources they need to keep them safe and well. Information gathered on the day will help the CPC to shape how child protection messaging is best delivered to young people in the future to ensure their needs are met. 1.6 The North Ayrshire Children’s Services Plan Performance Update Report 2024 to 2025 outlines the work that has taken place to date around the priorities outlined in the North Ayrshire Children’s Services Plan, which runs from 2023 to 2026. This three-year plan set out how the Children’s Services Strategic Partnership will safeguard, support and promote the wellbeing of all children in North Ayrshire, with a focus on the following key areas: • The rights of children and young people are promoted and protected. • Ensuring early intervention to improve what happens next. 236
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52 PUBLIC INFORMATION PUBLIC INFORMATION • Making things fairer. • Promoting good mental health and wellbeing. • Inspiring children and young people to be active. Some key highlights include that 97% of North Ayrshire education establishments are now engaged in UNICEF’s Rights Respecting Schools accreditation process, which supports schools to embed the UN Convention on the Rights of the Child into their practice to improve wellbeing and help all children and young people to realise their potential. This number is significantly higher than the Scottish average of 78%. North Ayrshire secondary schools are also championing equality as they work to maintain their LGBT Youth Scotland Charter of Education status, ensuring that LGBTQ+ pupils, staff and parents can be safe, supported and included. Extra-curricular provision has been delivered across all primary, secondary and ASN establishments. Over 9,200 young people have attended a variety of sport and physical activity sessions led by Active Schools, which focus on getting ‘More Kids, More Active, More Often’. In the past year, the Young Carers Fund has been accessed by 115 children and young people, boosting physical and mental wellbeing, reducing social isolation and improving attainment. Each school has now nominated a Young Carers Champion, and an information pack was launched to give education staff an overall understanding of the duties and approach in North Ayrshire to identifying, working with, and supporting young carers. Welfare Rights Officers in schools have continued to provide support to families, with financial gains for those using the service in the 2024 to 2025 school year reaching £818,000 - and over £1.8 million in total since the project began. 1.7 The Whole Family Wellbeing Fund (WFWF) aims to transform the way family support is delivered by ensuring families can access seamless and holistic support that is wrapped around their individual needs. In the reporting period of 2024 to 2025 a total of 831 children and young people across North Ayrshire accessed WFWF funded services or programmes. 237
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53 PUBLIC INFORMATION PUBLIC INFORMATION In terms of the geographical spread of the WFWF proposals, the majority are operating in the Three Towns locality and on a North Ayrshire wide basis. Although Arran does not have any specific services delivered on the island, Arran is covered by the North Ayrshire wide services. By the end of the five years funding, it is envisioned that: • Parents/carers are more able to access employability and other support to improve their finances. • Services are more accessible – children, young people and their families know where to go and receive help when needed. • Better collective awareness of available support among children, young people, and their families. • Reduced ‘missing middle’ between universal and statutory services. • Collaborative, multi-agency approach to the funding, commissioning, and delivery of family support. • Cross-sectoral commitment to collaboration and innovation which empowers and supports the workforce to provide family-centred holistic support. 1.8 Plans for new supported living accommodation for care experienced young people were approved by members of North Ayrshire Integration Joint Board (IJB) on Thursday 13 November. The IJB supported these proposals, alongside receiving an update on a range of work and actions being taken forward following a system-wide programme with all Corporate Parents in North Ayrshire to improve outcomes for care experienced young people - the Brighter Pathways programme. The programme focusses on a rights-based approach to create a sustainable, responsive, and nurturing care system for our children and young people. Through engagement with care-experienced young people, NAHSCP identified a gap in provision for those who do not require full residential care but still need additional support - or are ready to step down from residential care as they move into adulthood. The go- ahead has been given to develop supported living accommodation that will open in Spring 2026, which as well as equipping young people with the skills, confidence and stability they need for a successful future, will also free up capacity in its Children’s Houses. Located in Irvine, the accommodation will offer a safe and supportive environment for young people aged 16 to 21 years, bridging the gap between residential care and independent living. The service will provide individual ensuite rooms, shared living spaces, and 24/7 dedicated staff support, with practical help around issues such as budgeting, cooking, and tenancy management. Proactive in-reach support will also be available from a range of services and agencies, including housing, employability, and Money Smart. 238
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54 PUBLIC INFORMATION PUBLIC INFORMATION 1.9 Foster Care Fortnight took place in May with a dedicated social media campaign on the NAHSCP Facebook channel highlighting some of the myths and facts around foster caring and signposting the public to our dedicated foster care website. Figures above reflect a decline in foster care provision due to a national shortage of carers, often resulting in children being accommodated in expensive external placements, away from their schools, friends and support networks. Currently, it is especially difficult to recruit full time foster carers and given the high cost of living, most families require to have two parents/carers, at work. In addition, the complexity of the young people is also a factor. An enhanced package of support for foster carers was approved by members of North Ayrshire Integration Joint Board (IJB) on Thursday 13 November. A new Fostering Scheme has been approved, offering greater support for those providing foster care for NAHSCP, with the aim of boosting the recruitment of new carers and retaining current carers. This was developed after engaging and consulting with approved foster carers, whose feedback was invaluable. As well as an increased weekly payment, the new scheme will also see the introduction of a retainer payment, providing financial stability for carers who may be without a placement until a suitable match is made; a loyalty payment for new foster carers who join NAHSCP and remain with the organisation, and an additional payment for those who care for children with enhanced needs. We also now utilise Can Digital for all our fostering advertising, via social media, to raise our digital profile and this has resulted in a rise in enquiries. 1.10 On Wednesday 26 November 2025, North Ayrshire’s annual Joint Champions Board Conference brought together 59 care experienced young people from nine secondary schools across the authority. The event, held at Saltcoats Town Hall, aimed to unite all 239
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55 PUBLIC INFORMATION PUBLIC INFORMATION school-based Champions Boards for a full day of connection, learning, creativity, and influence. The Joint Champions Board Conference 2025 was a powerful demonstration of young people’s leadership, creativity, and influence. The day strengthened relationships, amplified youth voice, and generated meaningful insights that will shape North Ayrshire’s corporate parenting work in 2026 and beyond. Four workshops were delivered across the day and all feedback (digital, written, and verbal) was collated into the “What Matters To Us” poster, summarising the six priorities care experienced young people want their corporate parents to understand: Feeling Safe and Secure • Trust and Relationships. • Having a Voice and Being Listened To. • Friendships and Social Connections. • Opportunities and Aspirations. • Understanding and Respect. 240
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56 PUBLIC INFORMATION PUBLIC INFORMATION Justice Outcomes Outcome 1: Community Safety and Public Protection. Outcome 2: The Reduction of re-offending. Outcome 3: Social inclusion to support desistance from offending. 2.1 Collaborative efforts have continued between Justice Services and the Alcohol and Drug Partnership to enhance access to recovery activities and support diversionary recovery projects for individuals subject to Community Payback Orders. This partnership has led to the creation of a Recovery Development Worker role within Justice Services, based at the New Street office. The Recovery Development Worker has been instrumental in embedding a public health approach within community justice, offering tailored support to individuals experiencing addiction. Their work promotes equality, encourages recovery, and empowers service users to take control of their lives and recovery journeys. Operating in line with core recovery principles—such as personal responsibility, education, self-advocacy, and self-management—the Recovery Development Worker provides opportunities for improved health and wellbeing through both individual and group interventions. They also serve as a positive role model, inspiring hope and demonstrating that recovery is achievable. Referrals to the Recovery Development Worker have increased, encompassing individuals subject to various court orders and requirements, including Community Payback Orders, Supervision Requirements, Unpaid Work Requirements, and Alcohol and Drug Treatment Requirements. Support provided includes psychosocial interventions aimed at helping service users develop long-term coping strategies. This work covers areas such as alcohol and drug awareness, problem-solving, and consequential thinking. Additionally, the Recovery Development Worker facilitates access to local recovery groups, including Alcoholics Anonymous, Cocaine Anonymous, the Justice and MINDS Recovery Group, NADARS Recovery Groups, and Café Solace. They also actively participate in the Community Recovery Forum and the Recovery Workers Forum. 2.2 Diversion from Prosecution (Diversion) has been available since 1997, within this past year we have experienced a further increase across Ayrshire in assessment referrals from the Procurator Fiscal. Referrals have increased at a significant rate from 2018. Although this disposal is early intervention and low-level offending, the presenting need of service users is extremely high, thus resulting in more staff time being allocated and closer partnership working with other agencies to provide identified services. The number of assessment reports submitted are relatively lower than the number requested due to limited resources, which has resulted in waiting lists within each local authority area. 241
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57 PUBLIC INFORMATION PUBLIC INFORMATION In comparison with last year, 2025 to 2026 notes a decrease in the number of Diversion cases imposed. This is due to delays from the time that the offence was committed until the individual is referred to and assessed by the Diversion team. In this time many positive changes could have taken place and individuals are actively seeking and engaging with services to address any issues which they may have, thus reducing their risk of further offending. In these instances, no interventions are required due to positive reasons. 2.3 During the last year, the Rosemount service has run six eight-week blocks of the Building on Positive Relationships (BPR) parenting programme across North Ayrshire. This programme supports parents and carers who are finding family life stressful or struggling with their relationship with their children. Many of these families face extra challenges such as neurodevelopmental needs, trauma, or complex social issues. BPR is based on Non-Violent Resistance (NVR). It helps parents be more present and connected with their children, reduce conflict and stop situations from escalating alongside building trust and positive routines with their children. Parents who took part said they felt more confident in their parenting role, better able to stay calm and avoid power struggles, and importantly they felt less isolated, thanks to meeting other parents, sharing experiences and making links with other parents from their local community. They learned practical techniques like self-regulation, de-escalation, and using planned announcements - ways to keep boundaries firm while showing care and commitment. Many families reported improvements, including better school attendance, fewer crises, and a calmer home life. The programme also focused on self-care and resilience, encouraging parents to look after their own wellbeing and use support networks that they identified throughout the duration of the programme. By giving families access to this parenting programme, BPR helps prevent crisis, improves outcomes for children and helps to reduce isolation and strengthens community connections - helping parents support each other and share experiences. This approach tackles inequalities by making sure families have the tools and confidence they need to thrive. 242
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58 PUBLIC INFORMATION PUBLIC INFORMATION 2.4 Case Study: MAPPA Amongst other local authorities in Scotland, our MAPPA team continue to be recognised as an example of best practice. Based at Irvine Police Station, the team not only manage local arrangements but also host MAPPA on behalf of the entire South West Scotland region. This includes North, East, and South Ayrshire, as well as Dumfries and Galloway, ensuring a consistent and collaborative approach to public protection. Recently, the Fife MAPPA Coordinator and administrative staff visited the team to learn more about our processes, video resources, and innovative MAPPA Dashboard. This dashboard has become a cornerstone of our approach, providing a real-time, data-driven management tool that captures key statistical information with clarity and transparency. It supports evidence-based decision-making, enables live monitoring of cases, and ensures performance data is readily available for strategic oversight and reporting. The MAPPA Coordinator for North Strathclyde also visited, as did Lanarkshire, reflecting growing interest in our systems and methods. These visits highlighted the strength of our processes and the increasing recognition of how we deliver effective multi-agency risk management. In addition, the MAPPA team developed a short video resource explaining what MAPPA is and how it operates, designed for internal training purposes. No other MAPPA region in Scotland had produced such a resource, underlining how advanced and forward-thinking our approach is as a South West Scotland entity. This video helps staff understand the framework, processes, and responsibilities, ensuring consistency and confidence in practice. The dashboard and video resource demonstrate our commitment to continuous improvement and innovation. By making data and training accessible, we have strengthened multi-agency collaboration, improved risk management, and reinforced confidence in public protection. In July 2025, Community Justice Ayrshire held a training event at Fullerton ConneXions in Irvine on the subject of “What is MAPPA?”. Our MAPPA Strategic Oversight Group Chair opened the event and introduced AW, MAPPA Coordinator, who delivered the input. The event was attended by 77 members of staff from a variety of agencies. Feedback received suggested the input was well received, and this is an event that is likely to be repeated due to high demand. 2.5 Under the Community Justice (Scotland) Act 2016, local authorities are required to report annually to Community Justice Scotland (CJS) on the operation of Community Payback Orders (CPOs). These statutory reports promote transparency, strengthen accountability, and provide an important measure of how unpaid work and supervision requirements support rehabilitation and contribute to safer communities. They also allow us to highlight the wider community benefits delivered through CPO activity, including improvements to local environments, support for community organisations, and the development of skills and confidence among individuals subject to orders. CJS collates all local authority returns and produces a national summary report which is then laid before the Scottish Parliament, ensuring clear oversight of how CPOs are being used 243
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59 PUBLIC INFORMATION PUBLIC INFORMATION across Scotland. North Ayrshire submitted its 2024 to 2025 CPO annual return at the end of October 2025. This work directly supports our strategic priority in terms of Enabling Communities, as CPOs provide a meaningful mechanism for individuals to make positive contributions to the places in which they live. Unpaid work projects enhance local facilities, support community groups, and improve shared spaces, CPOs help strengthen community resilience and foster stronger connections between people and their neighbourhoods. At the same time, the support and supervision components of CPOs help people develop new skills, build confidence, and reduce harmful behaviours—benefits that ripple back into communities and contribute to longer‑term safety and wellbeing. 2.6 There was a marked decrease in Drug Treatment and Testing Order (DTTO) Assessment and Impositions in 2025 to 2026. There had been a slight decline in the previous year 2024 to 2025. There have been some staffing pressures in the past year which are being resolved. With increased staffing, the team will have more capacity to have a presence within fieldwork teams to advocate for more DTTO screenings/referrals. Of the 44 assessments completed in 2025 to 2026, 36 new DTTO’s were imposed across Ayrshire. This incorporates Orders from both Kilmarnock and Ayr Sheriff Courts. DTTO is an intense Order which involves monthly Court reviews, twice weekly contact for the first month and weekly oral drug screens. There are three distinct roles within the team delivering the service and interventions. The Supervising Officer oversees the Order, monitors compliance and compiles the assessment and review reports. The Additions Worker delivers the therapeutic interventions and is primarily responsible for administering the oral drug screens. There are then Recovery Development Workers who provide practical supports, assistance with welfare needs and also build links and connections within the recovery community to help build the persons own recovery capital. A Recovery Care Plan is created with each individual. There are ten domains, including substance use, relationships and offending, which are scored from 1 to 10. These plans are updated at three monthly intervals and allows areas for support/intervention to be identified and progress to be monitored. 2.7 A comprehensive review of the Multi‑Agency Risk Assessment Conference (MARAC) arrangements in North Ayrshire was undertaken by the Senior Manager and Local Authority lead during summer and early autumn 2025, with the final report completed in November 244
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60 PUBLIC INFORMATION PUBLIC INFORMATION 2025. The review examined current practice, governance structures, partner engagement and the overall effectiveness of MARAC in responding to high‑risk domestic abuse. The resulting report sets out a series of recommendations aimed at strengthening consistency, improving information‑sharing, and ensuring that safety planning is robust, timely and responsive to the complex needs of victims and their families. These recommendations have now been shared with both the Violence Against Women Partnership and the MARAC Governance Group for consideration and implementation. This work directly supports the strategic priority to Improve Mental and Physical Health and Wellbeing, recognising that domestic abuse has profound and enduring impacts on survivors’ emotional, psychological and physical health. By enhancing the MARAC process, North Ayrshire is working to ensure that individuals experiencing the highest levels of risk receive coordinated, trauma‑informed and holistic support. Strengthening MARAC practice also contributes to earlier identification of harm, clearer pathways to recovery, and improved access to health, wellbeing and specialist services. Ultimately, the review aims to ensure that our multi‑agency response promotes safety, reduces re‑traumatisation, and supports survivors and their families to rebuild stability and wellbeing. 2.8 The latest Government statistics on Community Payback Orders (CPOs) 2024 to 2025 show that figures for North Ayrshire were identical (478) to that of the year before and occupied median positioning of the Ayrshires in this regard. The population per 10,000 was the lowest of the Ayrshires at 52.2. In comparison, East Ayrshire had 509 CPOs and was 60.8 per 10,000 population while South Ayrshire had 429 CPOs and was 57.3 per 10,000 population. The Scottish average was 42.2 per 10,000 population. 2025 to 2026 has seen a significant increase in CPOs exceeding 500 impositions. There has been a reduction in the number of Criminal Justice Social Work Reports (CJSW) since 2020 to 2021 largely thought to be due to the result of COVID-19. 2025 to 2026 sees the highest number of report submissions since this downward turn, albeit not yet at pre-covid numbers. The latest Government statistics on CJSWs for 2024 to 2025 reveal North Ayrshire to have submitted the highest number of reports of the Ayrshires however continue to be the lowest of the Ayrshires at 77.2 per 10,000 population. In comparison, East Ayrshire sits at 79.2 and South Ayrshire sits at 77.6. The Scottish average is 75.9 per 10,000 population. Our Justice Services continue to have a positive impact on the local community through the Community Payback Order (CPO) unpaid work scheme. For thirteen years we have continuously over-achieved against targets for CPO level 1 and level 2. 2025 to 2026 saw 82 out of 85 level 1 CPO’s completing within timescales and 136 out of 138 level 2 CPO’s completing within timescales. The targets set for unpaid work are pan-Ayrshire targets. 245
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61 PUBLIC INFORMATION PUBLIC INFORMATION 2.9 Case Study: Unpaid Work Income Regeneration Programme Unpaid Work provides individuals subject to community justice disposals with the opportunity to make meaningful reparation, develop new skills, and contribute positively to their local area. The income generated reflects the commitment, effort, and productivity of those undertaking unpaid work, supported by Officers and Supervisors who ensure that work activities are purposeful, safe, and community-facing. The Unpaid Work Income Generation Programme continues to demonstrate the positive contribution that unpaid work can make to local communities across North Ayrshire. Between April 2025 and March 2026, income generated through supervised unpaid work activity allowed a total donation of £2,285.46 to be made, split evenly between two local charities: Café Solace and Andy’s Man Shed in Dreghorn. Each organisation received £1,142.73, supporting their ongoing work within the community. 246
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62 PUBLIC INFORMATION PUBLIC INFORMATION The donations were warmly received by both charities, who highlighted the importance of this funding in supporting local wellbeing and mental health initiatives. Due to the sensitive nature of mental health support within Andy’s Man Shed, the organisation was unable to have a representative participate in a photograph. Café Solace were able to take part in a group photograph, with Supervisor Peter Donohue pictured alongside staff and volunteers, as seen below. This programme not only delivers tangible financial benefits to third-sector partners but also reinforces the rehabilitative purpose of unpaid work, supporting individuals to build responsibility, confidence, and a stronger connection to their community, while delivering visible social value across North Ayrshire. 247
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63 PUBLIC INFORMATION PUBLIC INFORMATION Reporting on localities North Ayrshire is home to approximately 134,010 people, all living in its many towns, villages, and islands. These places are home to many different communities, each with their own characteristics and needs. We recognise that a one – size all approach to services delivery is not appropriate. A blanket service may be of great benefit to one community and of little value to another. That is why we are now designing local services based on local need, identifying the health and social care priorities in communities and developing services that help people access the right services at the right time. 248
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64 PUBLIC INFORMATION PUBLIC INFORMATION Locality Planning Locality Planning remains the local mechanism for strategic planning through which local priorities are developed for smaller geographical areas across North Ayrshire. During 2025 to 2026, work to develop HSCP locality plans was paused to allow focus on the development of the refreshed Strategic Plan 2026–2030, and in response to ongoing capacity and resource pressures associated with maintaining the Locality Planning Review Groups. The Integration Joint Board approved revised Locality Planning Arrangements which align HSCP locality planning with existing Community Planning Partnership (CPP) Locality Partnership structures. This revised approach is intended to streamline governance, reduce duplication, and strengthen joint ownership of place-based priorities, while ensuring the HSCP continues to meet its statutory locality planning duties. Under the revised model: • HSCP locality planning activity will be integrated within CPP Locality Partnership meetings, removing the need for separate HSCP locality planning forums, with the exception of Arran, where established integrated arrangements will continue. • HSCP Locality Leads (Heads of Service) will attend two CPP Locality Partnership meetings per year, with written HSCP locality planning updates provided for remaining meetings to support ongoing visibility and accountability without additional meeting attendance. • Locality Plans will continue to be developed by the Strategic Planning and Equalities Team, drawing on locality data, engagement activity, service input and feedback from CPP Locality Partnerships, with oversight through the Strategic Planning Group. This revised approach supports a more sustainable locality planning model, strengthens alignment between health and social care priorities and wider community planning outcomes, and maintains statutory locality leadership and assurance within HSCP governance. Progress 2025 to 2026 During 2025 to 2026, locality planning activity focused on consolidating existing evidence and completing key engagement activity to inform future locality plan development, while preparing for the implementation of the revised Locality Planning Arrangements. Between March and May 2025, targeted engagement was undertaken with children and young people across all six localities in North Ayrshire as part of the Locality Planning biannual engagement cycle. This engagement was designed to ensure that younger people’s views and experiences were captured as part of the locality evidence base and to support alignment with the Children’s Services Plan and wider strategic planning. Engagement activity included: • Facilitated sessions with youth groups across each locality. • An online survey promoted through a range of internal and external networks; and • a joint Health and Social Care Conversation Café with the Youth Cabinet. 249
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65 PUBLIC INFORMATION PUBLIC INFORMATION The purpose of this engagement was to understand the issues that matter most to young people in their local areas, explore where they seek support, identify barriers to accessing health and social care services, and gather suggestions for service improvement. Findings from this work have been collated at locality level and form part of the wider evidence base that will inform the development of HSCP Locality Plans. Alongside this engagement activity, the Strategic Planning and Equalities Team continued to maintain and consolidate existing locality evidence gathered between April 2023 and April 2025, including data profiles, service mapping and previous engagement findings. This ensured that, despite pauses to formal locality planning structures due to capacity pressures, a comprehensive and up-to-date evidence base has been retained to support future locality planning activity. In 2026, the Integration Joint Board approved revised Locality Planning Arrangements, aligning HSCP locality planning with Community Planning Partnership Locality Partnership structures. This provides a clear governance framework and implementation approach for the next phase of locality plan development, with delivery scheduled to commence from June 2026. 250
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66 PUBLIC INFORMATION PUBLIC INFORMATION Transformation Programme North Ayrshire HSCP’s Transformation Team support Partnership teams to identify, develop and deliver system wide change to local services and improve outcomes for the people of North Ayrshire 251
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67 PUBLIC INFORMATION PUBLIC INFORMATION Transformation 2025 to 2026 The North Ayrshire HSCP Transformation Plan 2024 to 2027 continues to be an important programme of change across the Partnership, designed to improve service quality and support long-term sustainability. The plan was approved by the Integration Joint Board in March 2024 and has remained under regular review through the Transformation Board. During 2025 to 2026, the Health and Social Care Partnership (HSCP) undertook a refresh of its Transformation Plan to strengthen delivery, improve financial sustainability and respond to external audit recommendations. This followed feedback from Audit Scotland and the Council’s Best Value Review, which highlighted the need for clearer alignment between transformation activity, financial planning and demonstrable benefits. A comprehensive internal review was completed to ensure the Transformation Plan is focused, deliverable and aligned with strategic priorities. As a result: • The programme has been streamlined, reducing the number of projects and removing activity better classified as business as usual. • Governance arrangements have been refreshed and strengthened, including updated Terms of Reference for the Transformation Board. • A key development has been the introduction of a formal Benefits Realisation Framework to improve transparency and accountability. • All projects with approved business cases now include benefits trackers, covering financial (cashable), quantitative and qualitative outcomes. To date, the Partnership’s Transformation Plan has delivered savings of £2.1 million against a profiled target of £2.3 million. In order to support Services as they look to redesign, reshape or transform how they work, Planning Managers undertook training in Service Design by the Scottish Service Design Academy. The training provided learning on new tools and techniques to support Service Design, which is now an important element of the Partnership’s transformation approach. 252
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68 PUBLIC INFORMATION PUBLIC INFORMATION Children, Families and Justice During 2025 to 2026, transformation activity within Children, Families and Justice has focused on progressing key service redesign proposals and strengthening the overall approach to delivery and sustainability. A key achievement has been the development and implementation of Brighter Pathways, a strategic approach with a focus on redesigning services to better meet the needs of children, young people and families. This has included development of the strategic proposal and consideration through governance processes to support approval and implementation. A number of projects were progressed over this period, delivering a wide range of service improvements: • Brighter Pathways – Strategic Vision and Programme Development – a wide- ranging strategic overview of Children’s Services which provides a clearer overall framework for redesign activity. The strategic priorities established through the Brighter Pathways programme will continue to provide a clear framework for ongoing service improvement and transformation. These priorities underpin a coherent and consistent approach to enhancing outcomes, ensuring that developments remain aligned with agreed objectives and organisational ambitions. • Internal Residential Capacity and Placement Oversight – work was undertaken to strengthen oversight of placements, including the establishment of the Placement Assurance Forum and the progression of a supported accommodation service (Boyle Street). Focus was on improving planning, reducing pressure on internal capacity, and supporting more stable transitions. • Fostering and Care Capacity – review of foster carer recruitment, including identifying more targeted approaches linked to demand. This supports the wider aim of increasing family-based care and reducing reliance on residential placements. A new platform has been introduced to increase engagement with potential foster carers, while raising the online profile of fostering overall. A new fostering scheme was also introduced to encourage new foster carer applications and help retention of current foster carers. • Intensive Support Review – the first phase of this work was completed, whereby the rationale for reviewing intensive support services was developed. This work recognised the increasing complexity of need and the requirement for more coordinated approaches across the system. • Moving On / Throughcare and Housing Transitions – the introduction of the Moving On Forum, bringing together Children’s Services, Housing and Throughcare to support earlier planning and more coordinated transitions for young people moving into adulthood. • Justice / Court Review Work - Kilmarnock Sheriff Court review, including analysis of resource requirements and development of recommendations, with formal project closure. This resulted in a reduction of costs and a realignment of responsibility in a pan Ayrshire context. 253
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69 PUBLIC INFORMATION PUBLIC INFORMATION Looking ahead, these strategic aims will also play a central role in shaping future service design. This includes supporting the development of responsive, person-centred models of care that are sustainable, evidence-informed, and adaptable to changing population needs. Continued focus will be placed on integrating learning from current delivery, engaging stakeholders, and leveraging innovation to design services that improve accessibility, efficiency, and overall quality. 254
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70 PUBLIC INFORMATION PUBLIC INFORMATION Health and Community Care During 2025 to 2026, transformation work has delivered a wide range of improvements across Health and Community Care, with a focus on performance, access and sustainability. A number of projects were completed, delivering tangible improvements in service performance and access: • Aids and Adaptations Review reduced waiting times and simplified processes, with stronger joint working and more consistent decision making. • Arran Single Point of Contact improved public access and reduced pressure on front door services through a consistent telephony model. • Care Packages (Complex Care Service Review) reviewed the model for delivering complex care, supporting more sustainable and cost-effective provision while maintaining quality and continuity of support. • Community Rehabilitation Review defined a more integrated model to improve pathway clarity and service effectiveness, with longer-term recommendations identified. • Delayed Discharge and Winter Planning established a single improvement plan and embedded performance monitoring, strengthening system resilience and oversight. • Discharge Performance Planning increased assessment capacity, improved tracking and strengthened governance arrangements. • eICT Service Review clarified roles, standardised pathways and supported a more sustainable, integrated rehabilitation model. • Podiatry Service Review delivered a significant reduction in waiting times and improved access through clearer triage and referral processes. Alongside this, a substantial programme of work is underway to redesign services, manage increasing demand and improve sustainability. This work is expected to deliver the following benefits: • Analogue to Digital Telecare Switchover is delivering a transition to a fully digital service, ensuring safe and reliable alarm provision while establishing a more resilient platform for future technology-enabled care. • Care Package Reviews are streamlining Care at Home rotas, assessing levels of provision and introducing more consistent, better planned services to maximise available resources. • Community Wards programme is developing options to ensure beds are used for their intended rehabilitation purpose, improve patient flow and support delivery within available resources. • Dementia Support and Respite is redesigning pathways to improve access, integration and support for people and carers. 255
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71 PUBLIC INFORMATION PUBLIC INFORMATION • Fleet Transformation is considering options to ensure the fleet remains efficient, sustainable and better aligned to frontline service delivery. • Montrose House Transformation is reviewing the allocation process, reintroducing outreach provision and reviewing use of the building to ensure capacity is used effectively and services are aligned to need. • Palliative and End of Life Care Strategy is establishing a pan-Ayrshire, whole-system model, bringing partners together to deliver more consistent, coordinated and person-centred care, supporting earlier planning and greater individual choice. • Post Diagnostic Support review is developing a more consistent and sustainable service model, better integrated with wider mental health pathways. • Speech and Language Service Review is redesigning pathways and service delivery to reduce waiting times, improve access and ensure resources are used more effectively in response to increasing demand and complexity. • TEC First (Castleview Hub) is introducing a technology-enabled care model to support people to remain safely at home, improve staff efficiency and reduce reliance on traditional care provision, with the hub acting as a central space to demonstrate solutions, support learning and enable wider adoption of technology. • Telecare Transformation is reviewing the service to better manage demand, improve response and support more effective use of technology. Across the programme, there has been a consistent emphasis on strengthening data, governance and performance monitoring to support robust, evidence-based decision making. This is enabling Health and Community Care services to respond to rising demand and ongoing resource pressures, while supporting new ways of working and innovation to deliver sustainable services aligned to national and local priorities. 256
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72 PUBLIC INFORMATION PUBLIC INFORMATION Mental Health and Learning Disabilities Learning Disabilities Assessment and Treatment Services, Pan Ayrshire A Programme Board was set up to oversee a review of current provision of Inpatient Assessment and Treatment for Learning Disabilities. For a number of years, the Service has experienced significant challenges associated primarily with staffing and delayed discharges. These factors affect the Service’s ability to consistently ensure the provision of effective assessment, implementation of therapeutic interventions and delivery of appropriate care. The review explored a number of alternative delivery options and feasibility of implementing such options in the current financial climate as well as taking account of workforce availability in both NHS and Third sector services. An Options Appraisal process was subsequently initiated, with a view to identifying a preferred route for future development. This involved extensive engagement with staff, clients and families who were later invited to take part in the scoring exercise. This part of the programme is now concluded with a view to initiating a new programme of work to take the recommendations forward. Other pieces of work concluding this year include; • The HSCP worked with Local Authority Housing colleagues to find solutions for people with complex care needs. Members of the Learning Disability Service have been involved in work related to the national programme for implementation of the recommendations of the Coming Home Report. The work related to the assessment and treatment services in particular, has contributed to national learning in this area. • Trindlemoss House, staffing model changing from primarily a medical focused delivery to a social care model. Some aspects of the training etc are still to be completed. The new service model has received very positive reviews from the Care Inspectorate following a recent visit and has been delivering positive outcomes for the residents. • The first phase of work has been concluded in bringing together two teams to provide an all- age disability service. This includes bringing the Children with Disabilities service under the management of the learning disabilities service and the addition of a senior practitioner role to support team managers and provide development opportunities for staff. • The next phase of this work will focus on eligibility and assessment of need. This work will utilise new tools, such as Magic Notes, to bring efficiencies in the assessment process and provide consistency across the teams. 257
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73 PUBLIC INFORMATION PUBLIC INFORMATION Mental Health Over the period from April 2025 to the end of March 2026, Mental Health services continued to improve access, strengthen community-based support, make better use of resources and build more sustainable ways of delivering care. The main outcomes from this work have been a stronger response for people in crisis, clearer options for future service redesign, improved digital infrastructure and reporting, and progress in aligning local services with national expectations. • A more appropriate response for people experiencing mental health crisis has been established through the Adult Mental Health Assessment Hub at Woodland View, a short-stay assessment service for adults who may otherwise have been admitted directly to an inpatient ward. During the year the Hub became operational at full capacity, and early evidence indicated that around 75% of people admitted were supported back to the community without onward admission to inpatient psychiatry. This has improved patient flow and helped reduce pressure on hospital services. • Access to treatment and the consistency of care for people affected by alcohol and drug use has continued to improve through implementation of the Medication Assisted Treatment (MAT) Standards. During the year this included further work to embed the standards within local service delivery, strengthen referral pathways and improve performance monitoring, helping to support a more timely and person-centred response across Mental Health and related services. • Work on the Early Intervention in Psychosis service is laying the groundwork for earlier specialist support for people experiencing a first episode of psychosis, with the intended outcome of quicker access to assessment and treatment and improved long-term outcomes. With short-term funding provided by the Scottish Government, the service launched in September 2025. • Recording and reporting arrangements have improved through the programme of digital transformation in Mental Health, which is replacing older systems and improving how information is stored, shared and used. During the year this included implementing TrakCare across additional services, closing legacy databases and progressing a wider digital strategy. The result has been more consistent recording and a stronger basis for service planning, performance monitoring and decision making. • Savings were delivered through the Adult Community Wellbeing project, which reviewed how lower-level wellbeing and recovery support could be provided in future for adults with mental health needs. During the year the project achieved savings through the reduction of some commissioned services and a vacancy that was never filled. It also set out a possible future model for how wellbeing, peer support and recovery services could be organised on a more integrated and sustainable basis should resources allow. • A stronger evidence base for future redesign has been developed through the Adult Community Mental Health Service review, which is examining how community mental health services are organised and delivered. Although the main review was paused for part of the year while decisions were taken on wellbeing services, preparatory work continued. This included engagement with staff and service users, further data analysis and work on the development of a performance dashboard to provide better oversight of activity, demand and outcomes and to support future service planning. 258
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74 PUBLIC INFORMATION PUBLIC INFORMATION • Clearer options for the future of the Community Eating Disorders Service (CEDS) have been developed through work on a business case setting out how a safe and effective local service could be sustained for people living with an eating disorder in North Ayrshire. The business case outlines a range of options and the level of investment required under each, providing a basis for future decision making on how best to deliver this support. • Clearer options for a future neurodevelopmental service for children and young people have been developed through completion of work on a business case, setting out how a diagnostic and support service could be delivered more safely and effectively. The work included development and appraisal of options covering pathways and referrals, service model, workforce, digital solutions and the level of investment required, providing a basis for future decision making across Ayrshire. • Administrative time has been reduced and the quality of recording improved through the Magic Notes trial in social work, which tested digital note-writing technology to support staff in recording assessments and casework. The trial involved Mental Health and Learning Disabilities teams and began in March 2026, with the final evaluation completed shortly afterwards. The pilot and evaluation showed benefits including faster completion of write-ups, improved consistency of recording, better quality interactions with service users and a positive impact on practitioner wellbeing. The final evaluation supported wider rollout across social work services as a practical way to improve capacity, quality and workforce sustainability. Taken together, this work shows a service area that is actively redesigning how support is delivered, managing difficult financial choices while still progressing innovation, and building stronger community, digital and performance foundations for the future. 259
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75 PUBLIC INFORMATION PUBLIC INFORMATION Reporting on lead partnership responsibility North Ayrshire Health and Social Care Partnership has lead responsibility for: Mental health services (including psychology, CAMHS, learning disability assessment and treatment) Child health services (including child immunisation and infant feeding) East Ayrshire Health and Social Care Partnership has lead responsibility for primary care and urgent care services. Primary care refers to the four independent contractors who provide the first point of contact for the Ayrshire and Arran population. These contractors are General Practitioners (GPs), Community Pharmacists, Optometrists, and General Dental Practitioners. South Ayrshire Health and Social Care Partnership is the lead partnership for the Integrated Continence Service, Community Equipment Store, and the Family Nurse Partnership (FNP). This lead responsibility relates to the delivery of continence care and education across Ayrshire, provision of equipment to people living in the community and supporting first-time mothers aged 19 and under through an intensive preventative home visiting programme delivered by FNP. 260
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76 PUBLIC INFORMATION PUBLIC INFORMATION Mental Health Services 1.1 The Emergency Services Mental Health Pathway (ESMHP) continues to receive positive feedback from all partners related to service access, response and outcome with continued evidence of reduction in avoidable mental health presentations to the area Emergency Departments and significantly reducing the time from referral to contact with specialty. During the first year of full operation, the Assessment Hub has reduced incidence of unscheduled or crisis admissions to the three acute inpatient psychiatric wards. Currently, 76% of patients admitted to the Assessment Hub are supported back to the community without the requirement for acute ward admission. Pre-conception advice: Women at high risk of severe mental illness are supported even before pregnancy. • Rapid response: Initial routine assessments are conducted within 15 working days whilst urgent assessments can be provided within 24-48 hours, care plans are tailored to individual needs. • Continuity of care: Support is maintained throughout pregnancy, postnatal period, and during any hospital admissions to MBU and Woodland View. Mini Minds Matter intervenes during pregnancy and up to the third birthday, focusing on early relationships and emotional wellbeing. The team offers professionals consultations and advice lines to ensure timely support and maximum impact from a small team. The pan-Ayrshire Early Intervention Psychosis Service launched on 1st September 2025 and is now at full staffing complement. This new service has been developed to provide timely, specialist assessment and intervention for individuals aged 16-35 who are experiencing a first episode of psychosis, offering support for up to two years. Delivered as a test of change and supported by Healthcare Improvement Scotland, the service aims to improve outcomes by promoting early recognition, recovery-focused care and evidence-based practice in line with national clinical guidelines. The service takes a multidisciplinary approach, with a strong emphasis on joint working and collaborative formulation to ensure care is tailored to each individual needs. Psychology input is an integral part of the service, offering specialist assessment, formulation and therapy. In addition, low-intensity psychosocial support is provided to help individuals develop coping strategies, build resilience and work toward their recovery goals. A key feature of the service is its assertive outreach approach, providing tailored support not only to individuals, but also to their families. By intervening early, the service seeks to reduce relapse, prevent hospital admissions, and help people remain connected with relationships, education and employment during a crucial stage in life. Ongoing review of the service provided by North Ayrshire Mental Health Practitioners (MHP), incorporating relevant stakeholder feedback, has supported the restructure of the daily template utilised by MHP staff. This in turn has promoted the sustainability of the service and significantly improved sickness absence rates have been observed since the implementation of the new template. Revised data collection relating to the activity of this service will inform further development, support early identification of mental health problems and referral or signposting to most appropriate treatment where appropriate. 261
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77 PUBLIC INFORMATION PUBLIC INFORMATION 1.2 The Pan-Ayrshire Early Intervention Psychosis Service was launched on 1st September 2025 and is now operating at full staffing capacity, compromising one Consultant Clinical Psychologist, one Team Leader and two Keyworkers. The service has been developed to provide timely, specialist assessment and intervention for individuals aged 14-35 years experiencing a first episode of psychosis, with support offered for up to two years. Delivered as a test of change and supported by Healthcare Improvement Scotland, the service aims to improve outcomes through the early recognition of psychosis, recovery-focused care and evidence-based practice in line with national clinical guidelines. The service adopts a multidisciplinary approach, with a strong emphasis on joint working and collaborative formulation to ensure care is tailored to individual needs. A key feature of the service is its assertive outreach model, which provides tailored support not only for individuals but also to their families. Psychology input is an integral component of the service, providing specialist assessment, formulation and therapeutic interventions. In addition, low intensity psychological interventions are offered to assist individuals in developing coping strategies, building resilience and progressing towards their personal recovery goals. All staff members are now trained in delivering Psychosocial Interventions for Psychosis and are undergoing training in Behavioural Family Therapy. 1.3 Throughout 2025, the North Ayrshire Learning Disability Service participated in a Scottish Government funded project, led by the Scottish Commission for People with Learning Disabilities in partnership with Scottish Care. The work was focused around exploring new approaches to enhancing digital inclusion for people with learning disabilities, but with a view to generating resources/learning which could also benefit others. A broad range of stakeholders were involved in shaping the work, including Third Sector representatives. Key to the delivery of the work was a new role termed a Care Connector, one of a family of tech-related roles developed by Scottish Care in partnership with the Glasgow School of Art (GSA). The early work of the Care Connector, in mapping existing digital inclusion activity across North Ayrshire, informed subsequent activity by a group of interns from the School of Innovation and Technology at GSA, supported by a Design Consultant from Opencast. Together, this design team collaborated with the Care Connector, people with learning disabilities, and others, in the development of a suite of resources. Central to this was the development of a game (‘Let’s Link’), which could be used to structure conversations with people with learning disabilities around digital and tech use. Accompanying this were 3 resources aimed at the level of organisations, describing an overarching framework for digital inclusion, international case studies, and a best practice guide. All of these resources were promoted via a launch event and exhibition held at the Harbour Arts Centre, as well as being showcased at Scottish Care’s Care Home conference (November 2025) and Digifest (December 2025). Learning regarding the early implementation of the Let’s Link game continues to be gathered from North Ayrshire and elsewhere, with a view to informing further iteration. 262
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78 PUBLIC INFORMATION PUBLIC INFORMATION 1.4 In 2025 to 2026, 100% of all accepted referrals to the Intensive Community Psychiatric Nurse team from non-mental health refers received contact with 4 hours. This is an increase of 13% from figures in 2021 to 2022 and an increase of 6% on figures for the previous year. The target of 95% has been met in three of the previous five years. There were 1,749 referrals in 2025 to 2026 and all received contact within 4 hours. 1.5 Launched in 2025, our Adult Mental Health Services Engagement and Participation Framework sets out how we will build and maintain vital connections. This will help to create opportunities for people to influence decisions, share their experiences, and be active partners in the ongoing development of mental health services across Ayrshire. North Ayrshire Health and Social Care Partnership has lead responsibility for mental health services across Ayrshire. We are committed to working in partnership with people who have lived experience of mental health challenges, and those who support them, to improve the services we provide. Engagement means building meaningful relationships with service users, families, carers and supporters. By listening and learning together, we aim to shape services that reflect the real needs and strengths of our communities. Within adult mental health services, we take a human rights-based approach to engagement, respecting each person’s dignity, voice and choices. Engagement can take many forms, offering flexible ways for people to share their views, experiences and ideas. Some of the ways we connect with individuals and communities include: • Surveys and feedback cards – quick ways to share your thoughts. • 1:1 interviews – personal conversations to hear your story. • Listening events (Conversation Cafés) – informal spaces to talk and be heard. • Workshops – collaborative sessions to explore ideas and solutions. • Lived Experience Forums – regular group discussions, in person or online. 263
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79 PUBLIC INFORMATION PUBLIC INFORMATION • Communication networks – stay connected through mailing lists and updates. • Newsletters – sharing news, opportunities, and ways to get involved. • Mental Health and Wellbeing Connects – public events, market stalls, workshops and guest speakers. • Lived Experience Panels – topic-specific groups that help shape services. 1.6 CAMHS or Child and Adolescent Mental Health Services, exists to support young people and their families who are finding it hard to cope with everyday life due to difficult feelings, emotional wellbeing, or behavioural problems. CAMHS assess and treat children and young people (usually up to age 18) who are experiencing moderate to severe mental health difficulties. The CAMHS service has a referral to treatment target of 90% seen within 18 weeks and as can be seen below 100% of young people seen by the service in 2025 to 2026 were seen within the 18-week target. Over 1,000 young people (1,044) were seen within the 18-week target. The service has met its target in four of the previous five years with the only exception being 2022 to 2023. 1.7 Congratulations to the nursing team at Woodland View’s Ward 7A, who were shortlisted for the Learning Disability Nursing Award at this year’s Royal College of Nursing (RCN) Scotland Nurse of the Year event. This category aims to recognise 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. Although unsuccessful at the ceremony, the Ward 7A team were described as demonstrating ‘exceptional flexibility, creativity, and person-centred care’. 1.8 In 2025 to 2026, Psychological Therapies referral to treatment, seen within 18 weeks figure was 91%. This is an increase of 4% from figures in 2023 to 2024 and an increase of 1% on 264
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80 PUBLIC INFORMATION PUBLIC INFORMATION figures for the previous year. The target of 90% has been met in two of the previous five years. There were 4,075 referrals in 2025 to 2026 and 3,696 (91%) were actioned within 4 hours. 1.9 The team behind the NHS Ayrshire & Arran Mental Health Unscheduled Care Assessment Hub have been recognised for their positive impact, being named among the finalists at this year’s Royal College of Nursing (RCN) Scotland Nurse of the Year Awards in the Mental Health category. The nurse-led hub was established in September 2024 following a pilot and is the first of its kind in Scotland. Based at Woodland View in Irvine, it hosts a patient-focused therapeutic space to support the delivery of compassionate care to patients with acute mental illness. The Mental Health Unscheduled Care service provides 24-hour access to mental health assessment and interventions and can accommodate up to five patients within a therapeutic environment for up to 72 hours. Since being established 18 months ago, the service has successfully: • Reduced the number of unscheduled admissions to acute adult inpatient mental health beds. • Brought community and inpatient services closer together to help create a smoother patient journey. • Reduced the waiting time for planned adult acute admissions, and • Reduced the number of initial assessments being carried out in acute wards – releasing resource for treatment. 265
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81 PUBLIC INFORMATION PUBLIC INFORMATION Child Health Services 2.1 Our Children and Families Health Team (CFHT) is a multi-disciplinary service providing early and preventative support to children and their families—from the ante-natal stage through to the transition into adult services or leaving education. The team comprises a range of specialist services, each with a distinct remit, function, and target population. These include Health Visiting, School Nursing, Children’s Immunisations*, Perinatal Wellbeing Team, Infant Feeding* and Early Years Support Team. *Some services are delivered across Ayrshire. The Senior Manager, supported by her service managers, has worked hard to develop a five- year Workforce Plan covering 2025-2030. The plan outlines our vision for the CFHT workforce and how we will continue to deliver high-quality support to children and families, aligned with strategic, operational, and financial priorities. It provides a detailed overview of the current workforce, assesses present and future service demands, and identifies future workforce requirements. Through this plan the service aims to: • Recruit individuals who embody the values and behaviours of NHS Ayrshire and Arran. • Anticipate and plan for future skill requirements. • Build a resilient, adaptable, and versatile workforce. • Enhance staff development and upskilling opportunities. • Implement robust talent management and succession planning. The plan is aligned with the five pillars of Scotland’s National Workforce Strategy for Health and Social Care: • Plan. • Attract. • Train. • Employ. • Nurture. 2.2 The Health Visiting service in North Ayrshire continues to fully implement the national Universal Health Visiting Pathway, with all children under 5 and their families offered a minimum of 11 visits from the ante-natal period through to the child starting school. Developmental assessments are undertaken at 13-15 months; 27-30 months and 4-5 years. Since 2020, the percentage of children with one or more developmental concern at these assessments has increased as shown in the table below: 266
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82 PUBLIC INFORMATION PUBLIC INFORMATION Over the last ten years, the Children and Families Health Team (CFHT) has continued to enhance its approach to early years through the introduction of different roles to support early and preventative help. The early years part of CFHT consists of: • Health Visitors. • Health Visiting Support Workers. • Family Nurtures. • Perinatal Mental Health Nurses. • Community Infant Feeding Nurse (pan-Ayrshire). • Community Infant Feeding Support Nurse (North Ayrshire only). The service has also been working in partnership with national charity Dads Rock and have commissioned, through North Ayrshire’s Whole Family Wellbeing Fund, two dads’ workers to support dads of children under 5 to promote confidence and improved interaction and attachment. As well as all children under 5 in North Ayrshire being supported by the health visiting team as part of the Universal Health Visiting Pathway (UVHP), during 2025 to 2026, 841 children and families were supported by the various roles described above, evidencing our approach to early help and support where concerns are identified. The Collaboration for Health Equity in Scotland (CHES) programme – a partnership between North Ayrshire, Public Health Scotland and the Institute of Health Equity (IHE) seeks to look at our approach to early years support with the aim of improving outcomes for children, including data around developmental concerns. 267
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83 PUBLIC INFORMATION PUBLIC INFORMATION 2.3 Breastfeeding remains a priority for Scotland and, correspondingly, for local partners involved in the promotion of breastfeeding within community and hospital settings. The benefits of breastfeeding on the short and long-term health of mothers and babies has been well documented. It promotes optimum nutrition, growth and development for babies, as well as providing comfort and protection from infections. As such, breastfeeding is actively promoted and supported in a wide range of settings across North Ayrshire and Arran. The health visiting and infant feeding team in North Ayrshire, along with counterparts in South and East continue to work towards maintaining UNICEF Baby Friendly Gold standards following re-accreditation in 2024. This remains a significant and prestigious achievement, with only a small number of areas re-accredited to this standard. Published data for 2024 to 2025 has shown that despite slight decreases in two of the indicators, improvements from 2022 to 2023 have been maintained in the most recent year from an NHS Ayrshire and Arran perspective: Indicator 2022 to 2023 2023 to 2024 2024 to 2025 % breastfeeding at initiation 54.6% 57.6% 55.9% % exclusive breastfeeding at first HV contact (10-14 days) 27.4% 30.5% 30.2% % exclusive breastfeeding at 6–8-week HV assessment 22.8% 25.6% 25.9% Similarly, the published data for 2024 to 2025 has shown the following changes in breastfeeding indicators from a North Ayrshire perspective: Indicator 2022 to 2023 2023 to 2024 2024 to 2025 % breastfeeding at initiation 53.0% 59.6% 56.0% % exclusive breastfeeding at first HV contact (10-14 days) 23.2% 30.5% 29.0% % exclusive breastfeeding at 6–8-week HV assessment 20.3% 25.0% 25.5% Data has also shown that the number of babies receiving any breastmilk (mixed feeding with breastmilk and infant formula) in North Ayrshire has increased: Indicator 2022 to 2023 2023 to 2024 2024 to 2025 % overall breastfeeding at first HV contact (10-14 days) 41.0% 44.9% 46.0% % overall breastfeeding at 6–8-week HV assessment 31.7% 35.2% 38.7% In two years, we have seen an increase in overall breastfeeding of 5% at the first health visiting contact and 7% at the 6–8-week health visitor assessment. 2.4 Child healthy weight is a public health priority. Over the last three decades, obesity levels in children and, indeed, the wider population have increased, with inequalities observed across our communities. Maintaining a healthy weight throughout childhood is associated with many health benefits both in the short-term and the medium term. 268
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84 PUBLIC INFORMATION PUBLIC INFORMATION Child healthy weight is monitored throughout the universal Health Visiting pathway but also when a child moves into Primary 1. The most recent data for 2024 to 2025 was released in December 2025. For North Ayrshire: • 70.9% of P1 children were of a healthy weight. • 13.6% of P1 children were at risk of overweight. • 15.1% of P1 children were at risk of obesity. 2.5 Dads Rock North Ayrshire was showcased on BBC’s The One Show in June 2025, highlighting the charity’s inspiring work in supporting fathers and families across Scotland. The feature explored how Dads Rock empowers dads to build confidence, strengthen bonds with their children, and access essential support services. In North Ayrshire, Dads Rock works in partnership with the North Ayrshire Health and Social Care Partnership, with funding from the Scottish Government’s Whole Family Wellbeing Fund. Through this collaboration, a dedicated Dads Rock worker is embedded within the Children and Family Health Team, providing tailored one-to-one support to fathers in communities including Irvine, Kilwinning, Saltcoats, Stevenston, and Ardrossan. The initiative works closely with health visitors, midwives, and social workers to ensure fathers are equipped to give their children the best possible start in life. The One Show segment celebrated this innovative approach and the wider mission of Dads Rock to promote fatherhood as a positive and supported experience. The programme featured RW, Dads Rock worker in North Ayrshire, alongside MW, a local Health Visitor, and a North Ayrshire father who shared his personal experience of the support he received. 2.6 In July 2025, our Children’s health team in conjunction with NHS Ayrshire and Arran and colleagues in Education, launched a targeted campaign to help families support their young children with toilet training. 269
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85 PUBLIC INFORMATION PUBLIC INFORMATION This initiative was driven by a growing concern that over the past century, the average age for potty training in the UK has shifted significantly - from around 12–18 months to approximately three to four years. While every child develops at their own pace, delayed toilet training can have implications for health, wellbeing, and school readiness. Later potty training can mean that bladder and bowel conditions go undetected, potentially leading to long-term issues that require specialist treatment. Additionally, not being toilet trained can reduce children’s independence, making them feel different from their peers and impacting their social confidence, which may lead to social isolation. When children start school without being toilet trained, it often places additional strain on educational settings. Studies indicate that school staff in the UK spend an average of 2.5 hours per day assisting children who are not toilet trained. This diverts time away from teaching and results in pupils losing up to one-third of their learning time each day. Beyond the educational impact, this can affect children’s confidence, independence, and social development. To address these challenges, a comprehensive communications strategy was introduced. The campaign aimed to raise awareness among parents about the importance of early toilet training and its impact on learning. It provided clear signposting to support services, encouraging families to speak with their named Health Visitor, consult their GP, or access resources via the Ayrshire Bairns App. In addition, the campaign offered practical guidance and a range of informative links for parents seeking further advice. This proactive approach reflects a commitment to improving outcomes for children and reducing pressures on schools. By equipping families with knowledge and support, the campaign seeks to foster positive habits early, ensuring children are ready for the transition to school and able to thrive in the classroom. 2.7 North Ayrshire continues to play an active and influential role in the Collaboration for Health Equity in Scotland (CHES), with our Children, Families and Health Team Senior Manager continuing to co‑chair the Good Start (Principle 1) Workstream. This workstream focuses on ensuring that all children—particularly those living in socio‑economically disadvantaged circumstances—experience the best start in life, recognising the profound impact early childhood conditions have on long‑term outcomes. In late 2025, the programme delivered a well‑attended professional stakeholder workshop centred on identified Irvine communities. The session facilitated detailed asset‑mapping, considering the strengths, existing community resources, and informal supports available to families, alongside the persistent challenges faced by households with young children. Themes emerging from the workshop included inequalities in access to high‑quality early years provision, affordability and availability of childcare, transport barriers, and varying levels of confidence among parents in navigating support systems. This local intelligence will directly inform the next phase of the workstream. The CHES work has also strengthened relationships with Public Health Scotland, particularly through discussions with Dr ES, and with the Scottish Government around the use, interpretation, and implications of developmental concern data. This data provides crucial insight into the early developmental disparities experienced by children in deprived communities and offers opportunities for more targeted intervention and resource allocation. 270
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86 PUBLIC INFORMATION PUBLIC INFORMATION 2.8 Immunisation Uptake in North Ayrshire has been historically lower than in South and East Ayrshire, closely correlated with deprivation levels. With 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 A&A and in particular North Ayrshire to lessen the gap in uptake across Local Authorities. All Secondary age pupils are called for Teenage Boosters (Td/IPV – Tetanus, Diphtheria and Polio) and HPV (Human Papillomavirus). All Schools are visited between January and April each year to complete the Td/IPV, Meningococcal ACWY and HPV. There is an additional offer at absentee dates in August- September each year for those who missed the first session. In Ayrshire and Arran all S1 pupils are eligible for HPV vaccine and are offered this from S1 every year until the course is complete. This is a one dose schedule for most pupils unless Immunocompromised. S3 pupils are eligible for Td/IPV and Meningococcal ACWY and are offered this from S3 every year until the course is complete. This is a one dose schedule for both vaccines. MMR (Measles, Mumps and Rubella) are offered to all Secondary pupils without a complete course of 2 doses of MMR. These pupils will not have had their Primary immunisation of MMR at 12 months and 3 years 4 months. All Primary and Secondary pupils are offered the Annual Flu Vaccine which is mainly the LAIV (Live attenuated Influenza vaccine) unless clinically not appropriate where the Inactive vaccine would be offered. HPV Immunisation in 2024 to 2025 showed 75.2% of those in S1 were immunised in Ayrshire and Arran, compared to a Scottish uptake of 72.6%. HPV uptake in Ayrshire & Arran has seen a rise of 8% overall and 10.1% in North Ayrshire. HPV immunisation uptake at S1 by the end of the school year 2022 - 2025, by local authority of residence, NHS Ayrshire and Arran and Scotland Source: PHS – HPV immunisation 2024 to 2025 - Statistics Scotland – 25 November 2025 271
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87 PUBLIC INFORMATION PUBLIC INFORMATION In 2024 to 2025, 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% and Ayrshire & Arran as a whole an increase of 2.5%. Td/IPV and MenACWY immunisation uptake by S3/S4 by the end of the school year 2022 to 2025, by local authority of residence, NHS Ayrshire and Arran and Scotland. Source: PHS – Teenage Td/IPV and MenACWY 2024 to 2025 immunisation - Statistics Scotland – 25 November 2025 272
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88 PUBLIC INFORMATION PUBLIC INFORMATION Inspection of service The Partnership works closely with independent care providers to ensure that the care and support provided is being delivered in line with peoples’ outcomes, offers best value, meets regulatory requirements, and keeps people healthy and well. Care services provided by Partnership teams also undergo external inspections and are subject to rigorous review and inspection. Working together, we ensure that all required standards of quality and safety are met. 273
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89 PUBLIC INFORMATION PUBLIC INFORMATION Independent Care Providers who provide care services on our behalf Where we commission care and support from independent and 3rd sector Providers services based within the North Ayrshire area, we monitor these services via the Contract Management Framework. The Framework focusses on ensuring a joint approach to evaluating the quality of care and where appropriate provides an approach to supporting Providers to progress improvements. We use a range of methods to monitor performance, including: • Formal Contract Management meetings on a 6 monthly basis and an Annual Joint Evaluation of Contract to ensure that services are safe, effective and most of all, that they meet people’s needs. • Review of compliments, complaints and feedback from staff, carers and people who use services. • Information that we collect, before visits, from the provider or from our records. • Local and national information, for example, Care Inspectorate reports. • Visits to providers, including observing care and support and looking at records and documents. The information below represents how those services which are registered with Care Inspectorate and are based in North Ayrshire are currently performing. Registered Services – Minimum Grades across all themes Care Service Subtype 2 Weak 3 Adequate 4 Good 5 Very Good 6 Excellent Grand Total Care Home Service Older People 0 3 6 2 0 11 Care Home Service Children & Young People 0 1 3 7 0 11 Care Home Service Alcohol & Drug Misuse 0 0 0 1 0 1 Care Home Service Learning Disabilities 0 1 2 0 0 3 274
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90 PUBLIC INFORMATION PUBLIC INFORMATION Care Service Subtype 2 Weak 3 Adequate 4 Good 5 Very Good 6 Excellent Grand Total Care Home Service Mental Health Problems 0 0 1 0 0 1 Care Home Service Respite Care & Short Breaks 0 0 0 1 0 1 Child Minding Not applicable 0 5 5 11 0 21 Day Care of Children Not applicable 1 2 11 2 0 16 Fostering Service Not applicable 0 1 0 0 0 1 Housing Support Service Not applicable 0 1 7 3 0 11 Support Service Care at Home 0 2 8 5 0 15 Grand Total Not applicable 1 16 43 32 0 92 275
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91 PUBLIC INFORMATION PUBLIC INFORMATION Inspection of Local Services Throughout 2025 to 2026, a total of ten inspections took place by the Care Inspectorate, all ten were unannounced. • Health & Community Care - 5 inspections. • Children & Families & Justice Services - 4 inspections. • Adult Services - 1 inspection. The Care Inspectorate use a six-point scale to grade inspections: 1 Unsatisfactory Major weaknesses – urgent remedial action required 2 Weak Important weaknesses – priority action required 3 Adequate Strengths just outweigh weaknesses 4 Good Important strengths, with some areas for improvement 5 Very Good Major strengths 6 Excellent Outstanding or sector leading Gradings for inspections can be found below. Inspection reports can be found on the Care Inspectorate website - Inspection Reports. 276
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92 PUBLIC INFORMATION PUBLIC INFORMATION Inspection Date Service/Unit Wellbeing Leadership Staffing Environment Care & Support 03 - July – 2025 Dementia Support Services 5 5 5 5 5 15 - August – 2025 Three Towns, North Coast & Arran 5 5 5 0 4 26 - August – 2025 Canmore Children’s House 4 0 0 0 0 24 - September – 2025 Irvine, Garnock Valley & Community Alarm 5 0 5 0 0 03 - November – 2025 Abbeycroft Children’s House 4 0 0 0 0 09 - December – 2025 The Meadows 4 4 0 0 5 09 - January – 2026 Anam Cara 5 0 5 5 5 15 - January – 2026 Achnamara 3 0 0 0 0 17 - March – 2026 Montrose House 4 4 4 4 4 23 - March – 2026 Trindlemoss House 5 5 5 4 5 277
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93 PUBLIC INFORMATION PUBLIC INFORMATION Financial performance and best value Financial information is part of our performance management framework with regular reporting of financial performance to the IJB. This section summarises the main elements of our financial performance for 2025 to 2026. 278
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94 PUBLIC INFORMATION PUBLIC INFORMATION Partnership Revenue Expenditure 2025 to 2026 Strong financial planning and management is essential to ensure limited resources are targeted to maximise contribution to our objectives. Delivering services in the same way is not financially sustainable. The refreshed Strategic Plan 2026 to 2030 reflects the significantly changed context in which the Partnership is operating, including increasing financial pressures, demographic change and rising demand for services. The financial plan therefore focuses on prioritisation, service redesign and investment decisions that support the Strategic Plan’s vision and priorities while maintaining financial sustainability and delivering best value. The ability to plan across the totality of resources within the health and care system to meet the needs of local people is one of the hallmarks of integrated care. Medium-term financial planning supports delivery of the Strategic Plan 2026 to 2030 by aligning resources to strategic and service delivery priorities, enabling planned shifts in investment towards prevention, early intervention and community-based support where this improves outcomes and sustainability, and ensuring that the Transformation Plan and other enabling plans are affordable and deliverable within anticipated resources. This approach is supported by the Medium-Term Financial Outlook (MTFO) and ongoing financial governance arrangements, which help identify emerging pressures and risks early, track delivery of savings and transformation activity, and ensure that investment decisions remain aligned to the Strategic Plan 2026 to 2030. The IJB set a balanced budget for 2025 to 2026 on 20 March 2025. This did not require any draw on reserves but did include approval of £4.019 million of savings to achieve financial balance. Financial information forms part of the performance management framework, with regular reporting to the IJB. This includes an integrated approach to financial monitoring, covering progress with savings delivery, key financial risks, recovery actions and any variations or changes to the delegated budget. Significant financial challenges emerged during the year, with the main pressures arising from children’s residential placements, supplementary staffing in wards and Unplanned Activities (UnPACs) within the mental health lead partnership. At month 3, an overspend was projected in the budget monitoring reports. The Integration Scheme requires the preparation of a recovery plan where an overspend is forecast, in order to bring overall service delivery back into line with available resources. Following finalisation of the 2024 to 2025 outturn position, the IJB agreed initial recovery actions at its June meeting. Further financial recovery actions were then developed and approved by the IJB during 2025 to 2026. These actions were in addition to those approved in 2024 to 2025. Recovery actions implemented during 2025 to 2026 included: • Recruitment delay (“recruitment drag”): vacancy-scrutiny-approved vacancies were held for four weeks before advertising to create additional payroll turnover, except for clinical or registered service vacancies, or where cover costs would otherwise be incurred. 279
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95 PUBLIC INFORMATION PUBLIC INFORMATION • High-cost care package group: the remit was expanded to include care packages for children with a disability and all UnPACs placement requests. • Oversight group for looked after and accommodated children in residential care: the group meets fortnightly to actively review all placements. • SBAR reporting: senior managers in the main overspend areas were required to prepare SBAR reports for the Partnership Senior Management Team (PSMT), setting out current and planned actions to reduce overspends. • One-to-one budget holder meetings: the Director and Chief Finance Officer introduced a rolling programme of meetings with budget holders to identify opportunities for cost reduction, service change and spend-to-save proposals to support 2026 to 2027 budget development and additional in-year reductions. • Care home placements: a move was made to one admission for every two discharges, as approved by PSMT on 20 November 2025, and care placements at CARG were approved on the basis of risk and need rather than current care setting, except where risk was too great. • Care at home: a recruitment freeze was applied to reduce the overspend position gradually, with an acknowledged impact on wait times and service performance. • Approval of care packages: all care packages out with in-house care at home and older people placements agreed via CARG were considered for approval by the high- cost care package group. • Additional actions at month 9: these included improving sickness absence through the Promoting Attendance Policy, pursuing cross-charge for persons admitted from out of area following failed placements in Ayrshire and Arran, and continuing implementation of the Flexible Intervention Guideline to minimise the duration of 1:1 or higher levels of support. Since the initial recovery plan was agreed in June 2025, costs have reduced by £3.498 million. Although the full benefit was not reflected in the in-year bottom-line outturn, these actions helped mitigate a further deterioration arising from £1.006 million of additional in-year financial pressures. This represents a net recovery benefit of £2.492 million. To support greater scrutiny of the financial position and delivery of the financial recovery plan, the IJB agreed in June 2024 to establish a Finance Working Group (FWG), chaired by the IJB Vice Chair. The Director and Heads of Service are members of the group. The FWG meets regularly to provide enhanced oversight of the financial position and transformation programme, as well as detailed budget planning for future financial years. The table below summarises financial performance for 2024 to 2025 and 2025 to 2026. It presents the budget outturn on a managed basis, including the full allocation for North HSCP lead partnership services, and then adjusts for the net effect of lead partnership allocations across North, South and East Ayrshire and for new earmarked balances. The table includes the financial performance of services managed by the IJB during the year and therefore excludes the hospital Set Aside Budget of £41.833 million, which was allocated 280
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96 PUBLIC INFORMATION PUBLIC INFORMATION to the IJB at the end of the period. The set aside budget is included within the financial statements. 2024-25 Budget £000 2024-25 Actual £000 Variance (Fav) / Adv £000 Service 2025-26 Budget £000 2025-26 Actual £000 Variance (Fav) / Adv £000 92,549 98,181 5,632 Health and Community Care 101,333 102,239 906 108,721 107,823 (898) Mental Health 119,856 119,590 (266) 43,717 44,294 577 Children, Families and Justice 41,437 41,790 353 53,575 53,662 87 Primary Care 52,996 53,035 39 10,748 10,749 1 Allied Health Professionals 11,480 11,480 0 13,970 10,186 (3,784) Management and Support Costs 13,995 10,814 (3,181) 1,635 1,725 90 Chief Social Work Officer 1,910 1,763 (147) 1,710 1,773 63 Financial Inclusion 1,160 1,221 61 4 4 0 National Commissioned Service 0 0 0 326,629 328,397 1,768 Total expenditure 344,167 341,932 (2,235) (326,629) (326,629) 0 Total income (344,167) (344,167) 0 0 1,768 1,768 Outturn on a managed basis 0 Blank Blank 0 (556) (556) Lead Partnership Allocations 0 (266) (266) 0 1,212 1,212 Outturn on an IJB basis 0 (2,501) (2,501) 0 2,381 2,381 New Earmarking 0 1,805 1,805 0 3,593 3,593 Outturn position prior to additional funding contributions 0 (696) (696) 3,593 0 (3,593) Additional funding contributions 0 0 0 3,593 3,593 0 Final outturn position 0 (696) (696) The main areas of variance during 2025 to 2026 are noted below: Health and Community Care – overspend of £0.906 million mainly relates to overspends in care home placements, integrated Island Services, specialist rehabilitation wards and Wards 1 and 2, partly offset by underspends in care at home, Telecare, adaptations, physical disability services and Unscheduled Care. Mental Health – underspend of £0.266 million which relates to underspends in community mental health, Hospital Based Complex Continuing Care, Enhanced Mental Health Outcome Framework, Action 15 and mental health pharmacy, partly offset by overspends in learning disabilities, Adult Inpatients, UNPACS, Learning Disability Services within the Lead Partnership, elderly inpatients and psychiatry. Vacancy savings across the Lead Partnership also contributed to the favourable position. 281
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97 PUBLIC INFORMATION PUBLIC INFORMATION Children, Families and Justice – overspend of £0.353 million which is mainly related to overspends in care experienced children and young people, including children’s residential placements, residential respite, employee costs and Section 29 payments. These were partially offset by an underspend in looked after and accommodated children, grant funding in relation to Unaccompanied Asylum-Seeking Children, and the Whole Family Wellbeing Fund which is earmarked for use in 2026 to 2027. Management and Support Costs – underspend of £3.181 million mainly relates to slippage in transition funding, additional funding received in-year, over-achievement of payroll turnover across social care and health services, and other centrally held budget variances, partly offset by contractual inflation and NHS savings shortfall held centrally. Overall position It is essential that the IJB operates within its delegated budget and commissions services from the Council and NHS Ayrshire and Arran on that basis. For 2025 to 2026, the year-end position is an overall underspend of £2.501 million on an IJB basis, reducing to £0.696 million after the creation of new earmarked reserves of £1.805 million. This is a significantly improved position compared with the in-year overspend projections and reflects the impact of recovery actions, strengthened financial controls and non-recurring benefits realised during the year. However, underlying recurring pressures remain across a number of service areas, and without sustained service redesign, delivery of approved savings and ongoing cost control, there remains a risk that future years will again require reliance on one-off measures or support from partner organisations. Medium Term Financial Outlook The Medium-Term Financial Outlook (MTFO) is a key part of the strategic planning process. It helps ensure that the IJB’s strategic ambitions are considered alongside the financial resources likely to be available in what remains a very challenging public sector financial context. The MTFO provides an indication of the IJB’s possible financial position over future years, identifies the key challenges likely to be faced, and helps the IJB understand the medium-term impact of current and future decisions on financial sustainability. It is also used to identify pressure points and inform the decisions required to ensure the Partnership remains financially sustainable. There are a range of factors which influence the financial planning of the IJB. These are considered through the MTFO and include the following: • Demographic changes. • Local priorities. • Workforce challenges. • The UK and Scottish Economy. • Policy and Legislation. 282
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98 PUBLIC INFORMATION PUBLIC INFORMATION • Cost and demand pressures. • Available funding. As in previous years, a Medium-Term Financial Outlook has been prepared to identify the potential financial position over the period 2026 to 2027 to 2028 to 2029. This was presented to the December 2025 IJB. Reporting on Localities The Partnership has arrangements to consult and involve localities via their Locality Forums. The IJB has established six Locality Planning Forums, reflecting the previously agreed local planning areas. These provide Board Members with the opportunity to be involved in considering the priorities for each area and outline the role for each Community Planning Partner in meeting these priorities in conjunction with the local communities. This spend has been split into localities by initially allocating spend which could be directly identified to a locality, and the remainder which was not locality specific was allocated on a population basis. 73.8% (68.1% in 2024 to 2025) of spend was allocated based on population, which means at this stage the spend per locality can only be used as a guide and will not fully reflect actual locality usage of services. The population information used can be seen in the following table and was taken from the 2024 mid-year population statistics (sourced from National Records of Scotland). Allocation Method % Total allocated on population basis 73.8% By Locality 26.2% Total 100% Age Group Irvine Kilwinning Three Towns Garnock Valley North Coast Arran Total % of spend allocated Children aged 0 to 15 31.4% 13.0% 24.5% 14.5% 13.9% 2.6% 100% 12.3% Adults aged 16 to 64 30.0% 12.1% 24.1% 15.3% 15.5% 3.1% 100% 26.5% Older People aged 65+ 25.6% 10.1% 21.4% 13.6% 24.3% 5.0% 100% 17.0% Share of total population 29.2% 11.8% 23.5% 14.8% 17.3% 3.5% 100% 17.9% 283
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99 PUBLIC INFORMATION PUBLIC INFORMATION This resulted in the following spend per locality - Expenditure Irvine £000’s Kilwinning £000’s Three Towns £000’s Garnock Valley £000’s North Coast £000’s Arran £000’s Total £000’s 2025-26 Expenditure 104,641 36,527 78,203 49,426 57,438 15,697 341,932 % share of spend 30.6% 10.7% 22.9% 14.4% 16.8% 4.6% 100% % of total population 29.2% 11.7% 23.5% 14.6% 17.5% 3.5% 100% 284
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100 PUBLIC INFORMATION PUBLIC INFORMATION Appendix 285
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101 PUBLIC INFORMATION PUBLIC INFORMATION Local Indicators – 2025 to 2026 These local indicators are those related to our strategic plan outcomes for 2022 to 2030 Performance Indicator 2025 to 2026 Target Status Number of service users referred to employability service 109 36 Employability mentors - No of service users being supported into employment, training, education. 68 28 Number of PRI sessions which have taken place 1 8 Support 4 formerly cared for young people to move into independent living each year. 25 4 Support 45 children and young people into kinship care placements each year. 42 45 Recruit 6 new foster carers each year. 1 6 People attending the emergency department will be seen within 4 hours from arrival at hospital (Arran) 98.1% 95% Increase the number of Naloxone Kits distributed per annum (387 per year) 846 387 Deliver 4,275 ABIs each year (pan Ayrshire) 7,597 4,275 CAMHS – Seen within 18 weeks (RTT) 100% 90% Psychological Therapies – Seen within 18 weeks (RTT) 90.7% 90% Reduce out of hours admissions for people aged 65 and over (MH) 20 32 No under 18 should be admitted onto the Adult Intensive Psychiatric Care Unit (Ward 8) 1 0 All accepted referrals to the Intensive CPN team from non-mental health referrers will receive contact within 4 hours 99.9% 90% People subject to level 1 Community Payback Order (CPO) Unpaid Work completed within three months 96.5% 57% Individuals subject to level 2 Community Payback Order (CPO) Unpaid Work completed within six months 98.6% 67% 286
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102 PUBLIC INFORMATION PUBLIC INFORMATION MSG Indicators Performance Indicator 2022-23 2023-24 2024-25 2025-26 Target Status Emergency admissions to acute hospitals 1,562 1,645 1,528 1,619 1,836 Emergency admissions to acute hospitals (rate per 1000) 11.70 12.30 11.40 12.08 13.6 Admissions from emergency department 699 820 732 798 1,173 Admissions from emergency department (rate per 1000) 5.24 6.13 5.46 5.95 8.7 % people at emergency department who go onto ward stay (conversion rate) 26.70% 27.60% 24.50% 25.25% 33 Unscheduled ‘hospital bed days’ in acute hospital 11,689 13,209 12,487 6,837 12,320 Unscheduled ‘hospital bed days’ in acute hospital (rate per 1000) 87.56 98.78 93.18 51.02 91 Unscheduled ‘hospital bed days’ in long stay mental health hospital 2,117 2,191 2,167 2,109 6,782 Unscheduled ‘hospital bed days’ in long stay mental health hospital (rate per 1000) 15.86 16.38 16.17 15.74 50.1 Unscheduled ‘hospital bed days’ in geriatric long stay 715 702 670 190 1,772 Unscheduled ‘hospital bed days’ in geriatric long stay (rate per 1000) 6.55 6.42 6.09 1.73 13 Emergency department attendances 2,620 2,972 2,988 3,160 3,292 Emergency department attendances (rate per 1000) 19.63 22.23 22.30 23.58 24.4 % people seen within 4 hrs at emergency department 65.50% 59.80% 64.19% 66.20% 95% Delayed Discharges bed days (all reasons) 1,852 1,785 2,876 3,229 1,515 Delayed Discharges bed days (all reasons) (rate per 1000) 16.96 16.30 26.13 29.34 13.9 Delayed Discharges bed days (code 9) 893 548 864 858 770 Delayed Discharges bed days (Code 9) (rate per 1000) 8.18 5.00 7.85 7.80 7 287
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103 PUBLIC INFORMATION PUBLIC INFORMATION Where to find more information If you would like more information on IJB strategies, plans and policies and our performance and spending, please refer to the following websites. • North Ayrshire Health and Social Care Partnership • North Ayrshire & Arran - About Us • North Ayrshire - Strategies, Plans and Publications • North Ayrshire Council - Performance and spending Additional financial information for Ayrshire wide services can be found in: • East Ayrshire HSCP – Strategic Plan 2024-2027 • South Ayrshire HSCP – Strategic Plan 2021-2031 288
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1 of 8 Paper 25 NHS Ayrshire & Arran Meeting: Ayrshire & Arran NHS Board Meeting date: Monday 8 June 2026 Title: Whistleblowing Report – Quarter 4, January to March 2026 Responsible Director: Jennifer Wilson, Executive Nurse Director Report Author: 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 Board members are presented with this report for review and discussion of organisational activity in relation to Whistleblowing concerns raised in 2025/26 Quarter 4 (1 January – 31 March 2026). Agenda Item 13 289
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2 of 8 2.2 Background The National Whistleblowing Standards and Once for Scotland Whistleblowing policy (the Standards) were introduced on 1 April 2021. 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 2.3.1 Quarter 4 whistleblowing activity Seven concerns were received during Quarter 4 (Q4). Following initial assessment, none met the criteria for progression under the Whistleblowing Standards. Four concerns were submitted anonymously, which limited the ability to assess the matters raised or seek further information, and therefore they could not be progressed through the formal whistleblowing process. The remaining concerns comprised enquiries from individuals seeking advice on how to raise a concern, rather than substantive whistleblowing allegations. Table 1 provides detail of concerns received in Q. Overall, this reflects continued awareness and engagement with the Speak Up process during the period but does not indicate an increase in actionable whistleblowing concerns in Q4. From a patient safety perspective, initial assessment identified no immediate risks in six of the concerns received. One concern raised issues with potential implications for patient safety; in line with established governance arrangements, these matters were escalated to the relevant Area Director for appropriate action and follow-up. Concerns received Theme Division Service Comment/Action Anon • Staff conduct ACUTE UHA Support Services Concern related to staff conduct and was passed to HR colleagues for appropriate action. Anon • Personal Experience/ Grievance NA HSCP School Nurse Service Concern received by a Speak Up Advocate (SUA), Individual seeking advice on how to raise concerns 290
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3 of 8 Concerns received Theme Division Service Comment/Action anonymously about personal experience at work. Appropriate guidance/information was provided to enable them to progress concerns. Anon • Unsafe staffing levels • Lack of consistent management presence and support • High levels of violence and aggression • Breaches of staff wellbeing and health and safety obligations. NA HSCP Woodland View Concern received to Speak Up Mailbox Confidential Contact (CC). Concerns related to staff safety, wellbeing, leadership, and the day-to-day running of a ward. Concerns emailed to Caroline Cameron, Director NAHSCP, for appropriate action and investigation. Anon • Patient Safety • Patient Care ACUTE UHC Concern received by Confidential Contact (CC). Concerns related to patient safety and patient care. Concerns emailed to Vicki Campbell, Acute Director, for appropriate action and investigation. Named • Information request NA HSCP Primary and Community Services Request received for information on raising a Whistleblowing concern. Information was provided, including the Staff Guide to Raising Whistleblowing Concerns and details of the Staff Wellbeing Service. Anon • Staff Conduct ACUTE UHC Concern received by Chief Nurse – Acute. Service completed a Business-as- usual investigation. Service took appropriate steps, no further action required under Whistleblowing process. Named • Bullying and Harassment • Grievance matters • Patient care • Patient safety NA HSCP Primary and Community Services Concern received via RCN Steward/Health and Safety Representative. The issues raised relate to events from 2023/24. Whistleblowing concerns must be raised within six months of the individual becoming aware of the issue. Table 1 291
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4 of 8 2.3.2 Ongoing cases There are four investigations in progress, carried forward from previous quarters. Table 2 provides an update on these cases. These investigations are complex in nature and have required extensions to the standard 20‑day response timeframe. All extensions have been agreed with the Complainants and Commissioning Directors. Engagement with Complainants has continued throughout, and regular updates have been provided for each case. Case Division Status Theme Update Q4 2024/25 NAHSCP CMHT Stage 2 Open – Investigation complete. Draft report awaiting final approval/review Concerns under review: Patient‑care issues Poor practice Unsafe working conditions Potential abuse of authority The investigation is complete, and the draft report has been received. The draft report, improvement plan and outcome letter are with the Commissioning Director for review and final sign‑off. A meeting with the Lead Investigator will be offered to the complainant to provide feedback on the methodology, findings, and identified actions. Regular updates continue to be provided to the complainant. Q2 2025/26 NAHSCP CAMHS Stage 2 Open – Investigation ongoing Concerns under review: Workplace culture Patient-care issues Poor practice Unsafe working conditions Abusing authority There has been a change to the investigation team, with one of the investigators stepping back from the process. The remaining investigator has confirmed they are content to continue. The complainant has been informed of this change. Good progress continues to be made on this case, with meeting taking place with key individuals and evidence provided being reviewed. The investigation continues to be supported by HR throughout. Regular updates are being provided to the complainant. Q2 2025/26 NAHSCP Woodland View, ACH Stage 2 Open – Investigation ongoing Concerns under review: Patient-safety issues Patient-care issues Poor practice Unsafe working conditions The Lead Investigator (LI), supported by HR, has completed the investigation. The draft report has been shared with the Whistleblowing Team for formatting, after which it will be provided to the Commissioning Director. Regular progress updates continue to be issued to the complainant. 292
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5 of 8 Case Division Status Theme Update Q3 2025/26 NAHSCP District Nursing Stage 2 Open – Investigation ongoing Concerns under review: Service culture, Leadership behaviour, Clinical practice, Confidentiality, and staff wellbeing Comparative data has been gathered to support the investigation, including information on 1:1s, MAST, absence, complaints, and other relevant indicators. The Lead Investigator, with HR support, also undertook a staff engagement session in February. Report is being currently being drafted. Regular progress updates are being provided to the complainant. Table 2 2.3.3 Improvement plans One Improvement Plan remained open at the end of Quarter 4, linked to a case raised in 2024/25. The plan was initiated on 22 July 2025. This plan has now been completed with all updates against actions recorded and completed. The Commissioning Director has approved the plan as complete. This will be shared with the Complainant and the improvements reviewed in order to identify shared learning opportunities. 2.3.4 Training update Monthly data is provided to monitor completion of the Turas Whistleblowing eLearning modules. Table 3 shows the position for Q4 2025/26. Programme Nos Completed Increase Total No of Staff % staff completed 31/12/2025 31/03/2026 An overview (Staff) 5459 5577 118 11951 46.6% For Line Managers 377 385 8 997 88.2% For Senior Managers 492 495 3 Table 3 The data shows a limited increase over the quarter. Table 4 shows 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 375 171 113 Table 4 The Turas Whistleblowing e-learning modules has three levels of training programme: • For staff who need an overview of the Standards – 1 hour. All new staff to the organisation are encouraged to complete this. 293
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6 of 8 • 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. This is required mandatory training for all line managers. • Senior managers who are involved with receiving concerns and those members of staff who are involved in investigating, responding to, and reporting on whistleblowing concerns to the Board – 3 hours. This is required mandatory training for senior managers and those involved with investigations. The learning programmes are available on Turas Learn https://learn.nes.nhs.scot/40284 2.3.5 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 National Whistleblowing Officer (INWO). At this current time, there have been no referrals to the INWO. 2.3.6 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. This supports the long-term sustainability of safe, effective services. 2.3.7 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. By identifying issues early and embedding organisational learning, whistleblowing supports a resilient workforce. 2.3.8 Financial There is no financial impact. 2.3.9 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. 2.3.10 Equality and diversity, including health inequalities Accessible reporting routes, including anonymous options, and a completed Equality Impact Assessment help ensure fair, inclusive access to whistleblowing for all staff. 294
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7 of 8 A local Equality Impact Assessment (EQIA) is 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. 2.3.11 Best Value This paper support Best Value across the following themes. • Vision and Leadership The whistleblowing process supports a values-led culture by encouraging staff to speak up and providing senior leadership oversight. This reinforces NHSAA’s commitment to openness, psychological safety and continuous improvement. • Governance and Accountability Clear reporting routes, compliance with National Whistleblowing Standards and regular Board reporting provide assurance that concerns are handled transparently and risks to safety, quality and integrity are effectively managed. • Performance Management Whistleblowing data, KPIs and case outcomes are used to identify themes, monitor effectiveness and ensure learning from concerns is shared whilst taking into account confidentiality of those raising concerns. • Use of Resources A proportionate, risk-based approach ensures investigative effort is focused where most needed, while training supports staff and managers to respond appropriately, reducing escalation or encouraging concerns to be directed through other appropriate routes. • Effective Partnerships Effective handling of concerns relies on collaboration across services and our partners, supported by alignment with national standards. 2.3.12 Other impacts There are no other relevant impacts. 2.3.13 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. 2.3.14 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 20 April 2026 • Staff Governance Committee on 7 May 2026 2.4 Recommendation For discussion: Board members are asked to discuss the performance for Quarter 4 (January – 31 March 2026). 295
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8 of 8 Appendix 1: Please note: KPI 10 – the authorised extensions relate to cases opened in earlier 2025/26 quarters. This reflects legacy case timelines rather than delays arising within the current reporting period. 296