Supplementary Agenda Document Pack - Integration Joint Board - 19/06/2025
North Ayrshire Council · 19 June 2025
Back to Integration Joint Board — 19 June 2025 and its agenda
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Integration Joint Board Supplementary Agenda for the consideration of the Integration Joint Boardon Thursday, 19 June 2025 at 10:00 to consider the undernoted business. Business 7 Montrose House Care Home - Arran Submit report by Kerry Logan, Head of Service ( Health & Community Care) on the outcome of the recent options appraisal for Montrose House and to outline the recommended option to IJB to provide a sustainable model for residential and nursing care (copy enclosed). 1
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Integration Joint Board 19th June 2025 Subject : Montrose House Care Home - Arran Purpose : To present to IJB the outcome of the recent options appraisal for Montrose House and to outline the recommended option to IJB to provide a sustainable model for residential and nursing care that supports older people living on the island of Arran within the available financial resource. Recommendation : The IJB is asked to approve the following recommendations: - (i) Approve the outcome of the Montrose House options appraisal and the recommended option for future delivery in Montrose House of 10 permanent beds and 1 respite bed (ii) Approve the recommended model of day care delivery for older people on the island of Arran (iii) Support the principle of and development of an admissions Policy for Montrose House to prioritise care for the residents of Arran and provide a robust admissions criteria (iv) Note the required pause on new admissions to Montrose House whilst teams reconfigure service delivery in line with the new model of care (v) Agree to declare the remainder of the Montrose House building as surplus to North Ayrshire Council and work with NAC colleagues to identify alternative uses which complement the care home facility. 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 NHS AA NHS Ayrshire and Arran SSSC Scottish Social Service Council GP General Practitioner NAC North Ayrshire Council Agenda Item 7 3
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1. EXECUTIVE SUMMARY 1.1 The new Montrose House on Arran formally opened on Monday the 22nd June 2015. Montrose House is a registered nursing and residential care home with capacity for up to 30 residents to support people over the age of 65 years, who are unable to live independently at home due to complex health conditions and age-related frailty. 1.2 Workforce pressures, due to ongoing recruitment challenges on the island over many years, have resulted in the reduction of bed spaces to ensure safe staffing levels. In December 2023 capacity was reduced from 20 to 15 permanent beds. Montrose House currently has 12 permanent residents with one additional respite bed. 1.3 In 2024/2025, Montrose House ended the year in an overspend position totalling £0.465m. This is a deteriorating financial position from previous years as illustrated in the table below. The overspend is entirely as a result of staffing costs and in particular agency costs to ensure safe staffing levels in the care home. 2022/23 2023/24 2024/25 Total Overspend £0.371m £0.395m £0.465m 1.4 This report seeks the support of IJB members to permanently reduce the maximum bed capacity in Montrose House from 15 permanent beds to 10 permanent beds, with the continuation of 1 respite bed in an ongoing basis. The paper also seeks support to implement an admissions policy to prioritise access for Arran residents with close familial and community ties on the isle of Arran. This policy will be developed taking cognisance of legal advice from North Ayrshire Council. There are two drivers for the requirement for this change, both financial and quality of care. The over-reliance on agency staffing is unsustainable from a financial perspective and as noted above is not an improving position, and secondly it is not recommended to be safe or sustainable to continue to bring up staffing levels in the care home through ongoing reliance on agency staff. The average cost of a placement in Montrose House is £107,982 per annum in comparison with the average cost of a placement in a mainland care home at £30,579 per annum. 1.5 This paper also seeks IJB approval to fully adopt an outreach model for day services on Arran, removing onsite day care provision with the permanent closure of the Stronach Day Service building – noting however that the space will continue to be utilised to provide appropriate opportunities for use to facilitate community activities for both Montrose House and day service users. 4
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1.6 These proposed changes do not affect current residents of Montrose House, unless their needs change significantly and it is no longer safe for them to remain in Montrose House, or should it be their preference to leave Montrose House. 1.7 Previous ambitions for the Montrose House site, developed as part of the Arran Initial Agreement for Caring for Ayrshire are now on hold, due to the lack of Scottish Government capital funding and it is unclear where Arran will sit in relative priority to other projects in the future when funding becomes available. It is therefore recommended that together with North Ayrshire Council that the HSCP develop options to maximise the use of the remainder of the Montrose House building and that the remainder of the building is declared as surplus to requirements. 1.8 Given the location and relative isolation of Arran there is a need to sustain an Older People’s care home on the Island to meet the local population need, however this requires to be at a lower number of beds to support sustainability from a workforce and a financial perspective and requires to be protected for access for Arran residents with ongoing Island connections. 2. BACKGROUND 2.1 The new Montrose House on Arran formally opened on Monday the 22 June 2015. This was a £5.6million new purpose built care home with capacity for up to 30 beds to support adults over the age of 65 years. This development recognised the challenge of Arran residents having to move off the island for residential care to best meet their needs. This approach also took into consideration additional stress to families and carers living on the island. 2.2 The care home building also housed Stronach Day Service, which also formally opened in June 2015, offering traditional building-based day care opportunities to older people on Arran Monday to Friday. Stronach Day Service has been closed since the pandemic in early 2020. A recent review led to a pilot outreach model which ran from May 2023 to March 2024 and was conducted in two phases in two localities on the island. The pilot served a small number of users and received positive feedback for its social benefits and respite for carers. However, it relied on existing staff, making it unsustainable due to the current and ongoing workforce challenges on the island. There are currently no staff employed within the day service at this time. It is therefore recommended to fully adopt an outreach model for day services on Arran, removing onsite day care. However, the service should only be provided when staffing allows thus addressing recruitment and resource challenges. A phased implementation should aim to serve up to six users by the end of 2025, noting however this will be entirely staffing dependent. It is suggested that a short life working group is established to develop detailed plans and oversee the phased implementation of this. 5
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2.3 Montrose House is supported by a workforce comprising of North Ayrshire Council employed staff including a Unit Manager, Senior Social Care Workers, Social Care Workers and Care Assistants. All of the care staff require to be registered with the Scottish Social Services Council (SSSC) and require to have nationally recognised social care qualifications. The table below summaries the staffing position: Title Numbers in post Vacancies Senior Social Care Worker 5 WTE 1.0 WTE Social Care Worker 7.3 WTE 4.5 WTE Care Assistant 1.0 WTE 3.0 WTE Montrose House is also supported by a wider workforce comprising of business support, cleaning, catering and gardening staff. All of these staff groups have been significantly impacted by recruitment challenges and there are also staff vacancies in these workforce areas. Several contingencies have been put in place to support depleted staffing in catering such as utilising private catering companies, agency staff and support from the local community hospital and the high school to ensure appropriate meal provision at all times however these all result in higher costs. 2.4 The local Community Nursing service and Allied Health professionals, along with GPs from the local practice, coordinate care and support with the care staff in Montrose House. This provides a high level of multidisciplinary care to all residents. Team members within Arran Services have the benefit of working closely together on a daily basis resulting in a highly responsive and cohesive team. 2.5 The Montrose Care Home team offer care and compassion to residents at the end of their lives. The Care Home team also offer comfort and support to families. Since 2021/22 there have been 28 discharges from Montrose House, with 3 discharges in 2022/23, 11 in 2023/2024, 3 in 2024/2025 and 2 so far, this financial year. 2.6 Since 2020/2021 there have been 29 admissions to Montrose House, however due to a number of factors including the integrated island support available to people in their own homes, and the impact of the COVID pandemic, this rate of admission has slowed with zero admissions in 2022/23, 6 in 2023/2024, 2 in 2024/2025 and no admissions so far, this financial year. 2.7 The highest number of admissions occurred in 2021/2022 with 12 new residents; reflecting the closure of the Cooriedoon nursing care home in Arran. At that time, the total bed usage increased to 24 beds. 2.8 The additional residents from Cooriedoon care home resulted in the HSCP requiring to utilise high levels of agency staff in an ongoing basis to ensure safe staffing levels. Staffing resources were also sourced from mainland teams and the nurse bank to ensure safe care provision for residents. Most of these staff had to travel to the island to work and given the recent instability of travel to and from the island, there was a lack of continuity of care and this was not a sustainable solution going forward. 6
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2.9 Due to a high number of older people moving to the island to retire, there are also Arran residents who, at the time of their social work assessment for their suitability for a care home placement, choose to move off the island to be closer to their family, who do not reside on the Isle of Arran. This supports families to visit regularly, and familial bonds remain strong. It can also be the case that service users needs can be best supported in a mainland care home setting due to particular care requirements. As at May 2025, 23 former Arran residents are currently residing in care homes off the island. 2.10 Due to increased workforce challenges, there was a further reduction to 15 beds in December 2023 to ensure safe care provision. The ongoing use of agency staff has not always allowed for continuity of care and the development of staff/resident familiarity and close working relationships to flourish. 3 CURRENT SITUATION 3.1 Montrose House is registered with the Care Inspectorate and subject to planned and unannounced inspections. Montrose House was initially registered only to provide residential level care, however in 2022 following the closure of the only registered nursing home on Arran, registration for Montrose House was updated to both nursing and residential level care. Montrose House has a close working relationship with the local community nursing team who provide nursing care to residents and also support the Montrose House team with governance structures and audit activity. There has been an ongoing improvement programme in Montrose House since 2023 to ensure that the quality of staffing and care provision is improved. 3.2 The latest inspection report for Montrose House Care Home, conducted on 29th October 2024, highlighted a number of positive developments and improvements. The inspection concluded that the service had made substantial progress since the previous inspection, positively impacting residents' experiences and outcomes. The service received a "Good" rating for both supporting residents' wellbeing and for leadership. It was recognised that effective methods for staffing assessment and planning had been implemented, ensuring safe and sufficient staffing levels. The introduction of robust quality assurance processes were recognised as having led to continuous service improvement, with key tasks delegated to capable staff members. The inspection also recognised that the employment of an activity coordinator had significantly enriched residents' daily lives, and that Montrose House had improved its cleanliness and infection prevention measures. 3.3 Since opening in 2015, due to health and social care staffing challenges on the island, only 20 beds could be safely staffed on an ongoing basis with the exception, as described in section 2.5, when 24 beds were utilised for a short period of time in mid- 2022. This has meant that a 10 bedded wing in the care home has never been fully utilised, and any additional beds brought in to use, required agency staff. 7
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Staff vacancies in Montrose House currently sit at over 30% and recruitment is further impacted by the lower numbers of available working population on the island. The management team on Arran have undertaken a range of activities and initiatives in an ongoing basis to both promote the roles required on Arran, and to recruit to vacancies with minimal success. 3.4 The continued use of agency staff has created a recurrent total budget overspend, which is growing year on year as detailed below alongside sustained high levels of high agency usage: Year 2022/23 2023/24 2024/25 Overspend £0.371m £0.395m £0.465m Agency Costs £0.411m £0.761m £0.620m Residents within Montrose House are subject to the HSCP’s charging policy and this income remains within the unit budget to partly offset running costs. The residential care charges for Montrose House are included in the HSCP Social Care Charging Policy - Social Care Charging Policy - Non-residential and residential care services 3.5 Considerable work was undertaken to create an Integrated Island Initial Agreement to support the whole system health and social care approach and NHS AA vision of Caring for Ayrshire. This included the redevelopment of the Montrose House to include a new Health site. These plans are now on hold, due to the lack of Scottish Government capital funding, and it is unclear where Arran will sit in relative priority to other projects in the future when funding becomes available. Recent discussions have taken place with North Ayrshire Housing and PMI colleagues to consider any opportunities to utilise the remaining space within Montrose House, with a view to identifying a proposal which would complement the residential care home. The agreement of the final configuration and number of beds in Montrose House will allow for the HSCP to formally declare the remainder of the building as surplus to requirements and for the Council to work proactively with the HSCP to identify alternative ways to maximise the use of the building. 3.6 Assessments for admissions to Care Home’s in North Ayrshire are considered as part of a holistic social work assessment and there is a requirement for a comprehensive care needs assessment to determine eligibility. The Health and Social Care Partnership will contribute towards the personal care element of care home fee’s for those who have been considered to be eligible and the Health and Community Care team has a Resource Funding Group which manages requests and approvals for this process. 8
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There is currently no specific criteria or policy for accessing Montrose House out with the agreed admissions eligibility criteria. 3.7 To ensure ongoing safe staffing levels and high quality care provision which leads to good outcomes for the residents of Montrose House there has required to be consideration of the future model of service delivery. As such an options appraisal has been undertaken with the outcome presented to the IJB Finance Working Group in June 2025. 4 ASSESSMENT 4.1 The health and social care teams on Arran have worked hard over the last few years as an integrated team, including the development of a multidisciplinary frailty group to strengthen community support available to people so they remain at home for as long as possible. The Multidisciplinary Frailty team on the island meets weekly and any discipline can refer into the group. It is led by the GP and a team comprising community nursing, physiotherapy, occupational therapy, social work and social care teams and third sector colleagues. 4.2 Recent analysis considered as part of the options appraisal has highlighted the following: • Residents of Montrose House have an average length of stay of 2.5 years, compared to the Scottish national average of 1.8 to 2.7 years • The average cost of a placement in Montrose House is £107,982 per annum in comparison with the average cost of a placement in a mainland care home at £30,579 per annum. • Around 200 hours of agency staffing is utilised on a weekly basis by Montrose House to ensure safe staffing levels. • A review of registered care homes for older people on other Scottish islands highlights similar comparable reduced bed availability. For example, Islay (population 3,500) has access to a Local Authority operated 16 bed care home which is attached to the local community hospital. There is no registered residential care home on the island of Mull (3,063). Arran’s closest largest island is Bute, which has a Local Authority operated care home that currently provides 9 beds for a population of 6,498. This proposal for Arran, presents a complement of 10 beds and 1 respite bed for a population of 4,629. • From a North Ayrshire context, the island of Cumbrae (population 1,376) does not have a care home for older people. There is an independent registered care home on the island of Cumbrae, Millport Care Centre, operated by Sanctuary Care, which provides care for adults who have a learning disability. 9
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• The Locality Social Work Team on Arran have a caseload of 260 older people who are known to the team, with 112 older people currently allocated to Social Work staff for support. • There are 160 older people living on Arran who have access to Community Alarm and Telecare services. • There are currently 55 older people living on Arran who have access to Care at Home support via the Partnership’s inhouse care at home team with a smaller number of people receiving support via self-directed support options 1 and 2. There are currently 13 older people on the waiting list for Care at Home on the island. • Information from the SSSC Scottish Social Services Workforce Data Report (on 2023 workforce) details that Scotland’s care workforce has grown to the highest levels since records began in 2008, with the care workforce making up approximately 8.1% of all Scottish employment. The report details that the rise in workforce was mainly due to increases in staff working in community-based settings within housing support, care at home and nurse agency. • Recruitment and retention challenges for health and care services on Arran have been experienced over an extended period of time – vacancy levels across both Montrose House (over 30%) and wider Partnership teams remain difficult to recruit to. • The Partnership purchased property on Arran, Glenartney, which is a 12 bedded house that provides short term accommodation for Partnership staff whilst they are working on the island, this has proved invaluable to support staff travelling from the mainland to support – but has not led to a reduced reliance on mainland support. Given the location and relative isolation of Arran there is a need to sustain an Older People’s care home on the Island to meet the local population need, however this requires to be at a lower number of beds to support sustainability from a workforce and a financial perspective and requires to be protected for access for Arran residents with ongoing Island connections. 5. PROPOSALS 5.1 This paper seeks the support of IJB members to implement a model of care delivery as per the outcome of the recent options appraisal that Montrose House will reduce, over time, its bed capacity to 10 permanent beds and 1 respite bed to ensure that the service operates within the financial resource available and to ensure continued provision of safe care. IJB as such is asked to endorse the following recommendations: 10
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(i) Approve the outcome of the Montrose House options appraisal and the recommended option for future delivery in Montrose House of 10 permanent beds and 1 respite bed (ii) Approve the recommended model of day care delivery for older people on the island of Arran (iii) Support the principle of and development of an admissions Policy for Montrose House to prioritise care for the residents of Arran and provide a robust admissions criteria (iv) Note the required pause on new admissions to Montrose House whilst teams reconfigure service delivery in line with the new model of care (v) Agree to declare the remainder of the Montrose House building as surplus to North Ayrshire Council and work with NAC colleagues to identify alternative uses which compliment the care home facility. 5.2 This proposed change does not affect current residents of Montrose House, however will have an impact on potential future residents and day services users. 5.3 Anticipated Outcomes The HSCP is seeking to ensure individuals who have familial and community ties on the isle of Arran can have access to residential and nursing care on the island where possible. This should over time reduce the number of individuals with strong island ties having to move to care homes off island. The HSCP is seeking to ensure that there is a sustainable model of care on Arran and safe staffing levels to deliver the highest quality of care to residents of Montrose House. 5.4 Measuring Impact The following measurables will be put in place: • Reduction in bed numbers, • Number of residents in care home places moving back to the island, and • Financial balance. 6. IMPLICATIONS 6.1 Financial Since 2022/2023 Montrose House has continued to have a budget overspend as described at section 1.3. This proposal will seek to address the overspend with a significant reduction in agency costs. Following implementation of the new model, financial modelling will be undertaken as part of the 2026/27 budget setting process with any recurring savings at that time being part of the budget moving forward. 11
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If the IJB were to not support the revised model there would be a recurring budget pressure of circa £0.5m per year moving forward given the ongoing and increasing reliance on agency staff and this would require to be funded as part of the budget process to mitigate a recurring overspend. 6.2 Human Resources There are no direct impacts oin the current Montrose House workforce from the proposal. There will be a reduction in Agency Staff requirements moving forward, with an overall reduction in staffing levels required. 6.3 Legal Legal advice has been sought on the admissions policy, to ensure no discrimination. 6.4 Equality/Socio-Economic A full North Ayrshire Council Equality and Children’s Rights Impact Assessment has been completed and this includes specific island impact contained within the assessment. 6.5 Risk There is an amber risk to safe staffing levels due to the variability of agency staffing and a red risk due to financial overspends. 6.6 Community Wealth Building The recommendation provides a commitment to the future provision of a Care Home service on the Island. 6.7 Key Priorities This approach continues to support people as close to home as possible. This proposed change does not affect current residents of Montrose House, who will continue to live there. 7. CONSULTATION 7.1 The Integrated Island Team has been consulted and engaged in creating a plan which ensures the sustainability of Montrose House and its workforce. 7.2 North Ayrshire Council Legal Services and HSCP Finance Teams have been consulted to ensure the legal and financial sustainability of the model proposed. For more information please contact Kerry Logan, Head of Service, HCC on [01294 317805] or [klogan@north-ayrshire.gov.uk] 12
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