3. IJB Montrose House
North Ayrshire Council · 21 August 2025
Back to Integration Joint Board — 21 August 2025 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 21st August 2025 Subject : Montrose House Care Home - Arran Purpose : As a follow up to the report presented to the IJB in June 2025, present the outcome of the recent options appraisal for Montrose House, share engagement feedback from over the summer period 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 further work undertaken over the summer period to engage and seek feedback on the proposed changes, the outputs of this engagement are shared within the report and options appraisal. (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
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GP General Practitioner NAC North Ayrshire Council 1. EXECUTIVE SUMMARY 1.1 The Integration Joint Board were presented with a report in June 2025 containing recommendations for the future provision of nursing care services within Montrose House on Arran. At that meeting the Head of Service advised that since the papers were issued there was contact regarding the proposal, questions regarding the options appraisal, consultation, engagement and impact assessment including consideration for Islands impact. Officers would undertake further work on those aspects and a proposal brought back to the IJB in August 2025 for consideration. On that basis the IJB agreed to - note (a) a further report would be brought to the IJB in August 2025; and (b) note the required pause on new admissions to Montrose House whilst teams reconfigure service delivery in line with the new model of care. 1.2 Montrose House, Arran formally opened in June 2015. The facility is a registered nursing and residential care home with the building having capacity for up to 30 residents. It aims 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. 1.3 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. 1.4 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 1.5 This report seeks the support of IJB members to adopt and implement a revised service delivery model, with the full Options Appraisal included as Appendix 1. This would see permanent bed numbers in Montrose House reduce from 15 to 10, while protecting existing respite provision (one bed) and re-introducing a flexible day care provision. The model would operate within the existing contracted staffing establishment, with a focus on reducing agency dependency and improving service sustainability. This option also aligns with the broader strategic aim of enhancing community-based care and supporting carers through increased respite availability and day care opportunities. The paper also seeks support to implement an admissions policy to prioritise access for Arran residents with
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close familial and community ties on the isle of Arran. This policy will be developed taking cognisance of legal advice from North Ayrshire Council. The flexible day care provision would comprise 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. There are two drivers for the requirement for this change, financial and quality of care. The average cost of a placement in Montrose House for 2024/25 was £107,982 per annum in comparison with the average cost of a placement in a mainland care home at £30,579 per annum. Further, the over-reliance on agency staffing is unsustainable from both a financial and quality of care perspective. Not only is this the most expensive approach to securing staff, but it is also not considered safe nor sustainable to continue to bring up staffing levels in the care home through ongoing reliance on agency staff. 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. 1.9 Extensive engagement feedback has been undertaken over the summer period and is included in detail in the options appraisal and engagement report. There is strong opposition to the reduction in bed compliment from residents, families and the wider community with 97% of respondents being unsupportive of the proposed changes with many citing concerns in relation to emotional distress for families and residents, mainland relocation and challenges with travel including ferries, the missed opportunity of a large purpose built facility, distrust of the motivations for change, the demographic and demand challenges on Arran and the pressures on other health and care services.
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1.10 Whilst hearing this feedback and being committed to continue to engage with the local community to sustain and maintain a quality care home provision on Arran, the recommendation from Officers remains unchanged. The quality and continuity of care and maintaining the provision of safe staffing levels for residents are the key priorities for the ongoing provision of registered residential and nursing care services at Montrose House. The HSCP has demonstrated over a period of time the significant efforts to attempt to secure high quality care and to mitigate and present solutions to the acute workforce challenges. Despite these efforts, interventions and investment there remain significant workforce challenges and a fragile situation in managing safe staffing levels at Montrose House. It is not acceptable or tolerable for the Health and Social Care Partnership to compromise either resident or staff safety and the proposals recommended mitigate the current risks from the 30% vacancy rate and ongoing use of agency and bank staff. It remains the duty of all public organisations to deliver care safely, meeting Care Inspectorate requirements, whilst utilising public funds in an efficient manner. The HSCP recognises that care in Montrose House will continue to be more expensive than the alternative cost of mainland care home placement, being 3.5 times more per individual in comparison. However, there continues to be a commitment to delivering a local care home service from Montrose House and the further development of integrated island services from the building if safe staffing levels can be secured and maintained. The Health and Care (Staffing) (Scotland) Act 2019, places legal duties on care home providers to ensure sufficient staffing levels and appropriate staff training – those legal requirements are required to be considered when Local Authorities and Integration Authorities plan and commission services. 2. BACKGROUND 2.1 Montrose House formally opened on 22 June 2015. The purpose build unit cost £5.6m and has capacity for up to 30 beds, to support adults over the age of 65 years. The development was in response to recognition to the challenges of 1) Arran residents having to move off the island for residential care to best meet their needs, and 2) the resulting additional stress to families and carers still living on the island. 2.2 The building also housed Stronach Day Service, which again opened in June 2015. This provided traditional building-based day care opportunities to older people on Arran from Monday to Friday. However, the Day Service has been closed since early 2020, as a result of the COVID pandemic. A recent review of day services provision resulted in a pilot outreach model which ran from May 2023 to March 2024. The pilot was conducted in two phases and in two localities on the island. It served a small number of service users and received positive feedback for its social benefits and respite for carers. However, it relied on existing staff (there are currently
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no staff employed within the day service). This made it unsustainable due to the current and ongoing workforce challenges. 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. 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 (WTE) Vacancies (WTE) Senior Social Care Worker 5 1 Social Care Worker 7.3 4.5 Care Assistant 1 3 Montrose House is also supported by a wider workforce comprising of business support, cleaning, catering and gardening staff. All staff groups have been significantly impacted by recruitment challenges. Contingencies are in place to support catering during recruitment challenges arise. (eg. utilising private catering companies, agency staff and support from the local hospital and high school), to ensure appropriate meal provision at all times. This, however, also results 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 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. Discharges include those whose care needs change and can no longer be met in Montrose House. The Montrose Care Home team offer care and compassion to residents at the end of their lives as well as comfort and support to families. 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 in recent years.
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Year Admissions 2020/21 8 2021/22 12 2022/23 0 2023/24 6 2024/25 2 2025/26 YTD 0 2.8 The peak in admissions in 2021/2022 reflects the closure of the Cooriedoon Care Home, Whiting Bay. Accommodating displaced residents increased bed usage in Montrose House to 24 beds at that time and resulted in the need secure additional staff. As a result, the Partnership employed high levels of agency staff as well as sourcing personnel from mainland teams and the nurse bank to ensure safe staffing levels. Most of the additional staff had to travel to the island to work. The instability of travel to and from the island however, meant there was a lack of continuity of care, and this was not a sustainable solution going forward. 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. There are currently 25 residents of Arran who entered into long term settings care across financial years 2000/2021 to 2025/2026. • 16% (4 residents) chose to move into Montrose House, remaining on the island • 24% (6 residents) opted for mainland care home to be close to family • 12% (3 residents) required care that could not be provided locally • 48% (12 residents) required to move to a mainland care setting due to availability on Arran This data highlights the long-term issues with staffing and capacity within Montrose House.
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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. 2.11 The HSCP currently funds 816 care home placements for adults aged over 65, both within and outwith North Ayrshire. Of these, 74% are accommodated in care homes within North Ayrshire, while 26% (210 individuals) are placed outwith the local authority area. Montrose House currently accounts for 1.6% of the total service users funded for care home placements. 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. Montrose House, 16% Mainland (no capacity), 48% Mainland (care need unmet), 12% Mainland (closer to family), 24% Long-term Care Placement for Arran Residents (2020/21 - 2025/2026
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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. 3.4 Recruitment is an ongoing issue on Arran. This is likely the symptom of a significantly ageing population on the island and the lower number of those who are working age. The Partnership has dedicated significant time, effort and resources into attempting to secure the necessary permanent workforce, in a continuing effort to avoid reliance on agency and bank staff. Measures include: • Glenartney Hotel, Brodick: This is a 13-bedroomed building, purchased in February 2023, to encourage individuals who lived off-island to secure posts on Arran and provide them with accommodation while on the island. This measure recognises the difficulties of relying on ferries and sailings, which make it unviable to commute to Arran on a daily basis. The facility has high occupancy at all times and is utilised by nursing, medical and social care staff. • Recruitment & Retention Premium: In October 2022, due to ongoing chronic recruitment challenges (Band 5 staff), a successful bid to STAC secured a recruitment and retention premium of 15%. This will remain in place until 30 September 2027. • Recruitment Videos: Recruitment videos of staff in teams with chronic vacancies were prepared and issued with job adverts. The goal was to not only showcasing the benefits of an Arran lifestyle, but to also allow potential applicants to glimpse the work environment team dynamic and improve engage with job adverts - videos often help capture more attention than text-only listings and reach a broader audience. • Appointed a Recruitment Agency: In December 2023, funding was approved to appoint the recruitment agency ‘Big Blue Dog’. Funding was secured for a 20-week recruitment campaign, launched in January 2024, supported by social media, and two-weekly catch-up review meetings. As a result, some posts received multiple views which converted into applications.
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• Social Media: A dedicated Facebook page was developed and HSCP vacancies on Arran are uploaded with links to access job applications. • Relocation costs: These are provided to staff on lower grades/bands moving to the island. • NES Recruitment & Retention Stakeholder Group: The Senior Manager, Arran Services was selected to be a member of this group due to the innovative recruitment practice and campaigns that had been delivered on Arran. This stakeholder group was developed by the National Centre for Remote and Rural Health and Care in order to work collaborative at a national level to address ongoing recruitment challenges. • Recruitment Events: The Partnership hold regular events on the mainland for all NAC posts, and these are advertised via leaflets, royal mail, West FM, newsletters, Facebook and at PPE drop off points. Staff at these events assist potential candidates, discussing role profiles. Information sessions for ‘Arran’ vacancies were held both on the mainland and on Arran. • Staff Development: The Partnership have introduced a suite staff training initiatives, including bespoke courses tailored to individual roles and departmental needs. We have also supported employees pursue further education and professional qualifications, ensuring staff are equipped with both practical skills and strategic thinking capabilities. Our commitment serves not only to enhance performance but also plays a key role in staff retention, creating a culture where individuals feel valued and invested in. By fostering continuous learning, we aim to position ourselves as an attractive employer and build a workforce ready to meet evolving challenges. Despite best efforts, new appointments have been offset by staff leaving the Partnership’s employment. The summary below provides an overview of recruitment activity over the last few years. • Montrose House Recruitment - Between January 2023 to August 2025, 65 posts were advertised for positions in Montrose House, one in five of these had to be readvertised due to lack of interest. These 65 posts resulted in 178 applications received (average of 2.7 per post). Only around a third of posts advertised (35%) where successfully filled (23 posts). • Care at Home : Since 2023, 37 care at home assistant posts have been advertised. This resulted in 22 applications being received and three new staff members being recruited. • Social Work: Between August 2022 and August 2025, 12 adverts for 10 posts were issued (two posts required readvertisement). All posts were recruited successfully. There is no information on the number of applications received. 3.5 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.
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3.6 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. 3.7 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. 3.8 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 fees 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. There is currently no specific criteria or policy for accessing Montrose House out with the agreed admissions eligibility criteria. 3.9 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 and recommendations presented to the IJB in June 2025.
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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 fortnightly 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. • Over 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. • 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
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number of people receiving support via self-directed support options 1 and 2. There are 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 – vacancy levels across both Montrose House (over 30%) and wider Partnership teams remain difficult to recruit to. • The Partnership has implemented a suite of measures to support recruitment, and whilst these are necessary to maximise the recruitment potential, they have 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: (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 further work undertaken over the summer period to engage and seek feedback on the proposed changes, the outputs of this engagement are shared within the report and options appraisal. (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.
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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. 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 through reductions in other services to mitigate a recurring overspend. 6.2 Human Resources There are no direct impacts on 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. The Health and Care (Staffing) (Scotland) Act 2019, places legal duties on care home providers to ensure sufficient staffing levels and appropriate staff training – those legal requirements are required to be considered when Local Authorities and Integration Authorities plan and commission services.
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6.3 Legal Legal advice has been sought on the admissions policy, to ensure no discrimination. The Health and Care (Staffing) (Scotland) Act 2019, places legal duties on care home providers to ensure sufficient staffing levels and appropriate staff training – those legal requirements are required to be considered when Local Authorities and Integration Authorities plan and commission services. 6.4 Equality/Socio-Economic Both an Equality and Children’s Rights Impact Assessment and an Island Impact Assessment have been completed. The full assessments will be made available on the Council’s website and for ease of access are also included as Appendix 2 to the report. The findings are summarised below. The Equality Impact Assessment concluded that maintaining the quality and continuity of care, alongside safe staffing levels, remains the central priority for Montrose House. In response to the current 30% vacancy rate and reliance on agency staff, the Health and Social Care Partnership (HSCP) proposes a reduction to 10 permanent beds and 1 respite bed, alongside the implementation of a hybrid day service model. These changes will be managed sensitively, with no current residents affected unless their care needs can no longer be met safely. An admissions policy will also be explored to prioritise individuals with familial ties to the island. While the HSCP acknowledges the strong opposition from the island community and staff, as well as the distress and financial burden associated with off-island placements, it is imperative that care is delivered safely, in line with regulatory standards and within sustainable financial parameters. Montrose House remains a valued part of integrated island services, and the HSCP is committed to its future, contingent on securing safe staffing levels. The Island Impact Assessment concludes that the proposed changes represent a necessary response to persistent staffing challenges and financial pressures. The introduction of a hybrid day service model and the reduction in bed capacity aim to enhance service sustainability, safety, and quality of care. While the prioritisation of residents with familial ties and ongoing performance monitoring are positive steps, the potential impact of off-island placements—including emotional distress and increased travel costs—remains a significant concern. Given the absence of viable alternative delivery models and mitigation mechanisms, the proposals are considered proportionate and appropriate for the island context. Further review and community engagement are planned to address any unintended consequences. 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.
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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 Consultation sought feedback on the preferred option and accompanying revised admissions policy from residents, their families, the wider community, staff, professionals, and partners. The full report is included as part of the Options Appraisal in Appendix 1. The engagement was seen as key to raising local awareness of the operational challenges we face in delivering a safe, high-quality service. Particularly around staffing constraints on the island, the increased reliance on costly agency provision, and the associated impact on continuity of care. We also sought to highlight the pressures linked to funding and emphasised the need for a sustainable delivery model that protects island-based care while aligning with our strategic aims. A number of engagement methods were utilised to ensure that our message was received as widely as possible, and as many stakeholders as possible were able to engagement and feedback to us. Methods include: • A public consultation ‘drop-in’ event was held on 22 July 2025, for residents, their families and the wider community, and was attended by c.120-150 delegates, • Survey/questionnaire was offered to community and professional stakeholders in order for their feedback to be registered (458 & 23 responses respectively) • Email to all community groups (as notified by Third Sector Partners) • Professionals' discussions • The Integrated Island Team engaged in creating a plan which ensures the sustainability of Montrose House and its workforce. • North Ayrshire Council Legal Services and HSCP Finance Teams have been considered the legal and financial sustainability of the model proposed. • Four written letters were received from Arran Community Council, Arran Council for Voluntary Services and two individuals from the local community, these are included in the engagement report.
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The consultation period ran from 15 July to 1 August 2025, extended from its original closing date to encourage greater participation. To analyse feedback, two staff members independently coded open-ended responses, grouping them into categories and identifying overarching themes. Feedback is summarised below and detailed in full in the accompanying report. • Drop In Session: The session was organised as a drop-in event to facilitate informal discussion and feedback. However, prior conversations within the community led to the majority of attendees arriving at the scheduled start time, resulting in attendance numbers exceeding the venue’s capacity. This created a challenging environment for both attendees and staff. Estimated attendance was between 120–150 individuals. • Community Survey: 458 responses were received, primarily from Arran residents (94%), with 90% reporting family connections to the island. Over two-thirds (67.4%) were aged 55 or older. While only 17.2% currently receive support from local health and social care services, 97% of non-residents of Montrose House indicated they would consider or may consider using a care home service on the island in future. • Staff and Professional Survey: 23 responses were received, with most respondents living or working on Arran and reporting awareness of recruitment challenges. 61% did not support the proposed bed reduction, and 65% expressed broader concerns about staffing, service capacity, and the impact on elderly residents. • Correspondence: Four letters submitted by community organisations and individuals reinforced concerns about service reductions, staffing, and the long-term viability of Montrose House. Suggestions included workforce development initiatives, funding proposals, and further engagement. Key Themes Identified Across All Respondents • Service Provision: Widespread concern about the reduction in permanent bed capacity. The change was viewed as insufficient to meet the needs of an ageing population and as contributing to underutilisation of a purpose-built facility. These concerns were echoed strongly during the drop-in session. • Admissions Policy: Broad support for prioritising individuals with familial ties to Arran, though many preferred criteria based on residency length or assessed need. Requests were made for clearer definitions and transparent implementation. • Impact on Residents & Families: Challenges associated with relocation to mainland care were highlighted, including reduced visitation, emotional distress, and disruption to community ties. Ferry service reliability was frequently cited. These concerns were particularly emotive during the drop-in session. • Workforce Challenges: Recruitment difficulties were widely acknowledged. Barriers included limited affordable housing, inflexible shift patterns, and geographic
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isolation. Suggestions included revising shift structures, improving pay and conditions, and increasing visibility of local job opportunities. • Pressure on Other Services: The proposed reduction in bed capacity was seen as likely to increase pressure on hospital services, home care provision, and informal carers. Risks identified included delayed discharges, bed blocking, and crisis-driven care interventions. • Day Care & Outreach Services: General interest in the proposed outreach day-care model, though views were mixed on feasibility and effectiveness. Many emphasised that day-care services should complement, not replace, residential care. • Transport: Ferry service reliability was a recurring concern, particularly in relation to off-island care placements and staff commuting. • Transparency & Consultation Process: Requests for greater clarity around the proposals, including access to supporting documents. Some expressed scepticism about the consultation process and called for further engagement before decisions are finalised. • Financial Considerations: Some respondents questioned whether the proposed changes were financially motivated. Suggestions were made for alternative funding approaches, including local taxation mechanisms and targeted investment strategies. • Community & Economic Impact: Concerns about broader implications for the island’s economy and community cohesion. Some felt that reductions in care provision could discourage new residents and affect the sustainability of local services. There is a commitment to continue to engage with the local community and workforce as plans are taken forward and to continue to ensure we can maximise all opportunities to ensure we can provide a safe and sustainable care home service for the residents of Arran both now and in the future. Caroline Cameron Director for more information, please contact Kerry Logan, Head of Service, HCC on [01294 317805] or [klogan@north-ayrshire.gov.uk] Previous reports: • IJB June 2025 – Montrose House Arran - Document.ashx Appendices: Appendix 1- Montrose House Care Home – Options Appraisal August 2025 Appendix 2 – Equality & Children’s Rights Impact Assessment and Island Communities Impact Assessment
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North Ayrshire Health & Social Care Partnership: Montrose House Care Home OPTIONS APPRAISAL V2.1 August 2025
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Contents Introduction .................................................. 1 Engagement & Consultation ....................... 2 Drop-in Session Summary ....................... 3 Community Survey ................................. 3 Staff and Professional Survey .................. 3 Correspondence .................................... 3 Key Themes Identified Across All Respondents .......................................... 4 Background & Context ................................... 5 Landscape Review ..................................... 5 Strategic Drivers ..................................... 6 Arran Demographics .................................. 6 Care Home Data Analysis ........................... 7 There are currently 25 residents of Arran who entered into long term settings care across financial years 20/21 to 25/26. .................... 7 Care Homes – North Ayrshire .................... 12 Care Homes – Island Comparison ............. 14 Workforce ................................................ 15 Recruitment ............................................. 18 Options Appraisal ........................................ 22 Option 1: Do Nothing / Status Quo ............ 22 Quality Impact ...................................... 22 Financial Impact ................................... 23 Workforce Impact ................................. 23 Benefits & Risk ..................................... 23 Option 2: Service Closure ......................... 24 Quality Impact ...................................... 24 Financial Impact ................................... 24 Workforce Impact ................................. 24 Benefits & Risk ..................................... 25 Option 3: Reduce to 10 Permanent Care Beds ................................................................ 25 Quality Impact ...................................... 26 Financial Impact ................................... 26 Workforce Impact ................................. 26 Benefits & Risk ...................................... 26 Option 4: Reduce to 10 Permanent Care Beds + 1 Respite Bed + flexible Day Care Model . 27 Quality Impact ...................................... 27 Financial Impact ................................... 27 Workforce Impact ................................. 28 Benefits & Risk ...................................... 28 Recommendation & Conclusion ................... 29 Impact Assessments.................................... 31 Appendix 1: SBAR Day Services May 2024 ..... 32 Appendix 2: Engagement .............................. 34 Montrose House Consultation Report ....... 34 Montrose House Consultation - Residents, Families and Wider Island Community ... 34 Montrose House Consultation – Staff, Professionals and Wider Partners .......... 54 Montrose House Consultation – Letter Summaries ........................................... 66 Appendices .......................................... 68 Letter 1 ................................................. 68 Letter 2 ................................................. 68 Letter 3 ................................................. 69 Letter 4 ................................................. 71 Drop In Event Flyer ................................... 74 Community Drop In Event, Stronach Room, Montrose House (22 July 25) ..................... 75 Break Out Meeting Notes: ..................... 75 Appendix 3: Big Blue Dog Recruitment Report . 2
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Version Date Author Description of Change 1.0 19 June 2025 Paul O’Donnel Intro, demographics and care home review 1.1 19 June 2025 Trudi Fitzsimmons Options Appraisal 2.0 30 June to 12 August 2025 Trudi Fitzsimmons Version control box added. Introduction added by reorganising some of the background/context info, engagement and recruitment section added. Big Blue Dog summary report added to appendix. Impact assessments summarised. Engagement report appended. Strategic drivers (local) added. Accessibility check completed. 2.0 30 June to 12 August 2025 Paul O’Donnell Landscape review of care home positions across Scotland completed. Examination of Arran's population and workforce demographics. Analysis of Arran residents who have entered long- term care and the reasons behind their placement choices. Review of annual care home approvals for residents of Arran. Comparison of admissions and discharges between Mainland and Arran. Displacement data analysis. Review of Bank Hours versus Agency usage across Q1 25/26. Assessment of Montrose House vacancy hours in relation to agency use and links to the Health and Care (Staffing) (Scotland) Act.
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1 | P a g e Introduction This report provides an overview of service delivery in Montrose House, Arran. The facility, owned by the Council and managed by the Health and Social Care Partnership (HSCP), opened on 22 June 2015. Montrose House is a registered nursing and residential care home with a capacity for up to 30 residents. Montrose House supports individuals aged 65 and over who are unable to live independently due to complex health needs and age-related frailty. It is currently the only care home on the island. Since opening in 2015, staffing challenges in Health and Social Care on the island have resulted in a reduction in capacity. The current allocation at Montrose House comprises 12 permanent residents and one additional respite bed. Since 2020/2021, there have been 29 admissions to Montrose House; however, due to several 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. Montrose House is registered with the Care Inspectorate and is 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, its registration was updated to encompass both nursing and residential-level care. Montrose House has a close working relationship with the local community nursing team, which provides nursing care to residents and also supports the Montrose House team with governance structures and audit activities. An ongoing improvement programme has been in place at Montrose House since 2023 to enhance the quality of staffing and care provision. The history of the Care Inspectorate grades is below.
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2 | P a g e 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 the development of a pilot outreach model, which was implemented from May 2023 to March 2024 and conducted in two phases across two localities on the island. The pilot served a small number of users and received positive feedback for its social benefits and the respite it provided 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. The SBAR for Day services is attached as Appendix 1 To ensure the continued provision of care on the island and to develop a sustainable and financially viable service model, a comprehensive review of the service has been undertaken. This includes an assessment of the local context, consideration of national policy developments, feedback from service users and their families, and an options appraisal. The findings of this review are presented in this report. Engagement & Consultation Consultation sought feedback on the preferred option and accompanying revised admissions policy from residents, their families, the wider community, staff, professionals, and partners. This process was seen as key to raising local awareness of the operational challenges we face in delivering a safe, high-quality service. Particularly around staffing constraints on the island, the increased reliance on costly agency provision, and the associated impact on continuity of care. We also sought to highlight the pressures linked to funding and emphasised the need for a sustainable delivery model that protects island-based care while aligning with our strategic aims.
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3 | P a g e A number of engagement methods were utilised to ensure that our message was received as widely as possible, and as many stakeholders as possible were able to engagement and feedback to us. Methods include: • A public consultation ‘drop-in’ event was held on 22 July 2025, for residents, their families and the wider community, • Survey/questionnaire was offered to community and professional stakeholders in order for their feedback to be registered (458 & 23 responses respectively • Email to all community groups (as notified by Third Sector Partners) • Professionals' discussions • The Integrated Island Team engaged in creating a plan which ensures the sustainability of Montrose House and its workforce. • North Ayrshire Council Legal Services and HSCP Finance Teams have been considered the legal and financial sustainability of the model proposed. • Four written letters were received from Arran Community Council, Arran Council for Voluntary Services and two individuals from the local community. The consultation period ran from 15 July to 1 August 2025, extended from its original closing date to encourage greater participation. To analyse feedback, two staff members independently coded open-ended responses, grouping them into categories and identifying overarching themes. Feedback from the drop-in session is summarised below and detailed in Appendix 2: Engagement. Drop-in Session Summary The session was organised as a drop-in event to facilitate informal discussion and feedback. However, prior conversations within the community led to the majority of attendees arriving at the scheduled start time, resulting in attendance numbers exceeding the venue’s capacity. This created a challenging environment for both attendees and staff. Estimated attendance was between 120–150 individuals. Community Survey 458 responses were received, primarily from Arran residents (94%), with 90% reporting family connections to the island. Over two-thirds (67.4%) were aged 55 or older. While only 17.2% currently receive support from local health and social care services, 97% of non-residents of Montrose House indicated they would consider or may consider using a care home service on the island in future. Staff and Professional Survey 23 responses were received, with most respondents living or working on Arran and reporting awareness of recruitment challenges. 61% did not support the proposed bed reduction, and 65% expressed broader concerns about staffing, service capacity, and the impact on elderly residents. Correspondence Four letters submitted by community organisations and individuals reinforced concerns about service reductions, staffing, and the long-term viability of Montrose House. Suggestions included workforce development initiatives, funding proposals, and further engagement.
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4 | P a g e Key Themes Identified Across All Respondents • Bed Capacity and Service Provision: Widespread concern about the reduction in permanent bed capacity. The change was viewed as insufficient to meet the needs of an ageing population and as contributing to underutilisation of a purpose-built facility. These concerns were echoed strongly during the drop-in session. • Admissions Policy Preferences: Broad support for prioritising individuals with familial ties to Arran, though many preferred criteria based on residency length or assessed need. Requests were made for clearer definitions and transparent implementation. • Impact on Residents and Families: Challenges associated with relocation to mainland care were highlighted, including reduced visitation, emotional distress, and disruption to community ties. Ferry service reliability was frequently cited. These concerns were particularly emotive during the drop-in session. • Recruitment and Workforce Challenges: Recruitment difficulties were widely acknowledged. Barriers included limited affordable housing, inflexible shift patterns, and geographic isolation. Suggestions included revising shift structures, improving pay and conditions, and increasing visibility of local job opportunities. • Pressure on Other Services: The proposed reduction in bed capacity was seen as likely to increase pressure on hospital services, home care provision, and informal carers. Risks identified included delayed discharges, bed blocking, and crisis-driven care interventions. • Day-Care and Outreach Services: General interest in the proposed outreach day-care model, though views were mixed on feasibility and effectiveness. Many emphasised that day-care services should complement, not replace, residential care. • Transport and Accessibility: Ferry service reliability was a recurring concern, particularly in relation to off-island care placements and staff commuting. These issues were raised repeatedly during the drop-in session. • Transparency and Consultation Process: Requests for greater clarity around the proposals, including access to supporting documents. Some expressed scepticism about the consultation process and called for further engagement before decisions are finalised. The drop-in session revealed visible distress and frustration over perceived lack of transparency. • Financial Considerations: Some respondents questioned whether the proposed changes were financially motivated. Suggestions were made for alternative funding approaches, including local taxation mechanisms and targeted investment strategies. • Community and Economic Impact: Concerns about broader implications for the island’s economy and community cohesion. Some felt that reductions in care provision could discourage new residents and affect the sustainability of local services.
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5 | P a g e Background & Context The Isle of Arran is located in the Firth of Clyde off the coast of Ayrshire. At 432km2, it is the seventh- largest Island in Scotland. The challenge of delivering health and social care to Arran's population is exacerbated by its physical separation from the mainland and the geographically dispersed nature of its population. The majority of the population resides in Lamlash, Brodick and Whiting Bay. In addition to Brodick, Lamlash, and Whiting Bay, there are nine smaller settlements with populations ranging from 40 to 250, scattered around the 56-mile radius of the island. The rest of the population lives in single or small groups of houses between these settlements. Landscape Review This landscape review provides an overview of the care home sector for older people in Scotland based on the available data from 2024. As of March 2024, Scotland has approximately 1,020 registered care homes for adults, offering around 40,079 places. This represents an 18% decline in the number of homes and a 6% decrease in capacity compared to ten years earlier. The sector is mainly operated by the private sector (about 65%), with the remaining managed by voluntary organisations and local authorities. About 34,113 residents live in these homes, over 91% of whom are aged 65 or older. Of these, roughly 30,170 are long-stay older adults, many requiring complex care. Notably, approximately 63% of these residents have a diagnosis of dementia. The main trends indicate • Reduction in capacity: The sector has experienced a gradual contraction due to financial pressures, changing care models, and closures of smaller homes. • Occupancy rates: These generally remain stable at around 85%, though there are local variations depending on home size, location, and regulatory factors.
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6 | P a g e • Residents in older people’s care homes constitute 91% of all care home residents. Within this group, the private sector is the main provider, supplying 83% (25,853) of all beds. It is estimated that Local Authority care homes currently offer 10% (3,222) of the capacity. The social care workforce in Scotland is considerable and gradually expanding, but staffing shortages remain a significant challenge. As of December 2023, the paid social services workforce was 212,780, representing about 8.1% of total employment in Scotland. In full-time equivalent terms, the workforce was around 161,750. The growth in 2023 was mainly driven by housing support and care-at-home services, along with nurse agencies providing care. However, some areas, such as residential childcare and day services, experienced steadier growth. The largest sub-sectors by workforce size include care at home/housing support, care homes for adults, and day care for children. Although growth remained modest, staff turnover and vacancies continue to be significant issues. The workforce stability index was 74.4% in 2023, and 48% of care services reported vacancies. Certain types of services, particularly care at home, housing support, and care homes, faced the most challenging recruitment problems, mainly due to a shortage of suitable, experienced, or qualified applicants. Strategic Drivers The review was carried out in line with the strategic vision of the Partnership and is underpinned our core values, to treat our service-users with Caring, Empathy, and Respect. "People who live in North Ayrshire are able to have a safe, healthy and active life." This vision is delivered by a commitment to five interlinked strategic priorities: • Enable Communities: Recognising communities as key partners, the HSCP aims to strengthen local capacity, resilience, and health literacy. Ongoing engagement will ensure services reflect local needs and aspirations. • Develop and Support Our Workforce: Addressing current and future workforce challenges is essential. The HSCP is committed to workforce planning, wellbeing, and ensuring suitable infrastructure to support service delivery. • Provide Early and Effective Support: Emphasis is placed on prevention and early intervention across all services. By acting early, the HSCP seeks to reduce crisis interventions and invest in sustainable, community-based support. • Improve Mental and Physical Health and Wellbeing: The HSCP continues to prioritise both mental and physical health, recognising increasing demand and the importance of maintaining independence and quality of life through integrated support. • Tackle Inequalities: With over 40% of residents living in areas of high deprivation, the HSCP is committed to addressing the root causes of inequality through collaborative, targeted action to improve long-term outcomes. Arran Demographics Population figures are based on the 2024 mid-year estimates from the National Register for Scotland. Arran has an estimated population of approximately 4,629, with 34.4% of residents aged 65 and older
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7 | P a g e and 26.8% living with a long-term health condition. In comparison, only 662 residents are under 18. The working-age group (18-64) comprises 2390 residents. Across Scotland, the median age of the adult social care workforce is 46, with 32% aged 55-64 and 22.5% aged 45-54. Local NHS Ayrshire and Arran plans indicate that over 63% of support services staff are aged 50 or older. Key strengths for the Arran population include: • Higher life expectancy • Low levels of deprivation • Low unemployment • High educational attainment • Low crime rates However, the island's needs, in contrast to its strengths, include: • Falling population • Geographic Access • Older Age Profile • High Dependency Ratio – a small, shrinking working-age population Care Home Data Analysis There are currently 25 residents of Arran who entered into long term settings care across financial years 20/21 to 25/26. • 16% (4 residents) chose to move into Montrose House, remaining on the island • 24% (6 residents) opted for mainland care home to be close to family • 12% (3 residents) required care that could not be provided locally • 48% (12 residents) required to move to a mainland care setting due to availability on Arran The data highlights the long-term issues with staffing and capacity within Montrose House.
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8 | P a g e The total number of Arran residents approved for care home placements over the last five years has been volatile (range 13-24), averaging 16 per year. After a dip to 13 in 2023/24, volumes rose again to 21 in 2024/25. Year to date for 2025/26 (April to August) stands at five, which extrapolates to roughly 12 if the current pace continues. Considering the population demographics on Arran, a planning range would be between 15 and 20 approvals per year.
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9 | P a g e The graph below illustrates the admission and discharge data for North Ayrshire mainland compared to Montrose House. Key highlights of the data include • For care homes on the mainland, admissions peaked at 379 in 22/23 but declined sharply by 33% in 24/25. By 24/25, discharges have exceeded admissions. • Montrose House has fewer than 13 admissions annually, and discharges have been equal to or greater than admissions over the past three financial years, however it must be noted this is largely influenced by capacity linked to staffing.
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10 | P a g e The care homes on the mainland experienced three consecutive years of net growth, adding a total of 141 residents, before suffering a net loss of 26 in the 2024/25 financial year. In comparison, Montrose House only gained residents in 21/22; since then, the figures have declined, with a net loss of 9 residents over the last three financial years.
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11 | P a g e As part of the data analysis, a comparison of displacement data for Arran and Mainland Care Homes was conducted. The data shows: • For Arran residents, the average displacement distance was 62 miles. This figure includes three individuals who chose to move to a cross-border Care Home; when excluding these cases, the average displacement was 28 miles. The maximum recorded displacement was 510 miles, and the minimum was 4.3 miles. The average distance from listed next of kin was 96 miles. • For mainland residents, the average displacement was 13 miles, reducing to 10 miles when excluding four cross-border arrangements. The maximum displacement was 509 miles, and the minimum was 0.2 miles. The average distance from next of kin was 41 miles.
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12 | P a g e Care Homes – North Ayrshire There are 16 Care Homes within North Ayrshire. Montrose House currently has a vacancy rate of 13.3%, which is significantly higher than the overall average vacancy rate across care homes in North Ayrshire, which stands at approximately 6.6%
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13 | P a g e North Ayrshire Health and Social Care Partnership currently funds 816 placements for adults over 65 in care homes within and outside North Ayrshire. Montrose House accounts for 1.6% of the total service users currently funded for care home places. Of these, 606 residents (74%) are accommodated in care homes based in North Ayrshire, while 210 residents (26%) are placed outside the local authority area.
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14 | P a g e Care Homes – Island Comparison Comparisons with other island services are covered below. We used the following classifications from the Scottish Government. Islands/island groupings with mid to high population levels, have populations which are higher than at least 60% of the islands covered in this chapter, but lower than 10% of the islands covered by this chapter. The population of these islands varies significantly. The islands in this category are: • Bute (population 6,498) • Uist & connected isles (population 4,846) • Arran (population 4,629) • Islay (population 3,228) • Mull (population 2,800) • Great Cumbrae (population 1,376) • Barra & Vatersay (population 1,264) • Whalsay (population 1,061) • Yell (population 966) • Tiree (population 653) • Unst (population 632) • Westray (population 588) • Seil (population 551) • Sanday (Orkney) (population 494)
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15 | P a g e • Hoy & Walls (population 419) • Bressay (population 368) A comparison of Care Homes within these areas found that the national average number of bed spaces available is twelve. Workforce In 2019, the Health and Care (Staffing) (Scotland) Act came into force to ensure that Health and Social Care services across Scotland have the appropriate staffing levels in place to deliver safe, high-quality care. The Act places a legal duty on NHS Boards and care providers to: • Ensure staffing levels are adequate to meet the care requirements of patients and service users. • Utilise real-time staffing data and evidence-based tools to guide staffing decisions. • Take measures to minimise the risks to patient safety and staff wellbeing caused by insufficient staffing. • Monitor and report on staffing sufficiency and the effects of decisions. Montrose House is supported by a workforce comprising North Ayrshire Council-employed staff, including a Unit Manager, Senior Social Care Workers, Social Care Workers, and Care Assistants. All care staff require registration with the Scottish Social Services Council (SSSC) and must hold nationally recognised social care qualifications. The table below summaries the staffing position as of June 2025: Title Number in post Vacancies Senior Social Care Worker 5.0 WTE 1.0 WTE Social Care Worker 7.3 WTE 4.5 WTE Care Assistant 1.0 WTE 3.0 WTE
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16 | P a g e Montrose House is also supported by a wider workforce comprising of business support, cleaning, catering and gardening staff. All these staff groups have been significantly impacted by recruitment challenges, and there are also staff vacancies in these areas of the workforce. Several contingencies have been put in place to support staffing when that team are affected by vacancies, this includes 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. Staff vacancies in Montrose House currently stand at over 30%. Key Findings for April 25 to June 25: Montrose House Staffing Data Agency staff made up the majority of temporary hours over all three months, reaching a peak of 66% in May and averaging 606.6 hours of temporary staffing. Bank staff usage remained low in comparison, with a monthly average of 699 hours versus 1079 agency hours – a 54% higher agency usage on average. The total hours requiring cover – including vacancies, sickness, annual leave and training increased by 21.6% from May to June, hitting the quarters highest level. Vacancy and Cover Demand Month Vacancy Hours Sickness/AL/Training Total Hours April 2025 1425.50 624.75 2050.25 May 2025 1281 570.00 1851.00 June 2025 1580.50 671.50 2252.00 Breakdown of Temporary Staffing Usage Month Bank Staff (hrs) Agency Staff (hrs % Agency of Temp Staff April 2025 686.00 1199.25 63.6% May 2025 582.50 1129.25 66% June 2025 828.75 909.75 52.3%
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17 | P a g e Bank Hours vs Agency Hours Bank vs Agency Hours (%)
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18 | P a g e Vacancy Hours vs Agency Hours Hours requiring cover versus agency and bank hours utilised Year 2022/23 2023/24 2024/25 Overspend £0.371m £0.395m £0.465m Agency Costs £0.411m £0.761m £0.620m Montrose House overspent in 24/25 by £465k. The current staffing data shows a persistent and unsustainable reliance on agency staff, raising issues about costs, quality, continuity of care, and compliance with the Health and Care (Staffing)(Scotland) Act requirements. The legislation emphasises the importance of sustainable workforce planning— including recruitment, retention, and the effective deployment of staff—as a key duty of care providers. While sometimes necessary to ensure safe minimum cover, over-reliance on agency staff conflicts with the long-term strategic aims of the Act. Recruitment Recruitment is an ongoing issue on Arran. This is likely the symptom of a significantly ageing population on the island and the lower number of those who are working age. • Montrose House: Between January 23 to August 25, 65 posts were advertised for positions in Montrose House, one in five of these had to be readvertised due to lack of interest. These 65 posts resulted in 178 applications received (average of 2.7 per post). Only around a third of posts advertised (35%) where successfully filled (23 posts). Table 1: Montrose House Recruitment, Jan 23 to Aug 25 by post and outcome (Source: HSCP Business Support Team) * This is total number of applications received, inclusive of all readvertisements Type of Post Post Title Successful in filling post? No of Posts No of Apps* Times Advertised
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19 | P a g e Care 38 142 45 Care Assistant 17 93 19 No 11 67 14 Yes 6 26 5 Social Care Worker 20 44 25 No 14 24 17 Yes 6 20 8 Social Care Worker (Snr) 1 5 1 Yes 1 5 1 Support 27 36 33 Activities Co-Ordinator 1 1 1 Yes 1 1 1 Catering Supervisor 7 8 9 No 5 5 7 Yes 2 3 2 Cook 6 5 7 No 4 1 5 Yes 2 4 2 Driver/Handyperson 3 11 3 No 2 6 2 Yes 1 5 1 Facilities Assistant 9 10 12 No 6 3 9 Yes 3 7 3 Unit Manager 1 1 1 Yes 1 1 1 Total 65 178 78 • Care at Home: Since 2023, 37 care at home assistant posts have been advertised. This resulted in 22 applications being received and three new staff members being recruited. • Social Work: Between August 2022 and August 2025, 12 adverts for 10 posts were issued (two posts required readvertisement). All posts were recruited successfully. There is no information on the number of applications received. Understaffed care provision poses significant risks to both the quality of care and the wellbeing of staff and service users. Inadequate staffing levels mean that people receiving care could experience delays in having their needs met, have reduced quality of support, and experience a higher likelihood of neglect or harm. Staff working in such environments often face excessive workloads, which can result in stress, burnout, and higher rates of absenteeism, further exacerbating the staffing issue. Additionally, understaffing can undermine team morale, disrupt communication, and compromise the overall safety and effectiveness of care delivery. Such a situation would never be acceptable to the Health and Social Care Partnership, and therefore bank staff are employed to address staffing shortfalls. However, this again is not without its challenges. The Care Inspectorate notes that the use of bank or non-regular staff introduces personnel to the unit who may lack familiarity with individual care plans, routines, and the specific procedures of the service, leading to inconsistent or inappropriate care. The presence of bank staff can disrupt continuity, making it harder to maintain person-centred relationships and trust. Furthermore,
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20 | P a g e temporary staff may not always be fully trained or integrated into the team, requiring additional supervision and support from regular staff, which places further strain on limited resources. These factors collectively increase the risk of errors, reduce team cohesion, and can negatively impact the overall quality of care. The Partnership has dedicated significant time and resources into securing the necessary permanent workforce, in a continuing effort to avoid reliance on agency and bank staff. Measures include: • Glenartney Hotel, Brodick: This is a 13-bedroomed building, purchased in February 2023, to encourage individuals who lived off-island to secure posts on Arran and provide them with accommodation on the island, whilst carrying out their duties. This measure recognises the difficulties of relying on ferries and sailings, which make it unviable to commute to Arran daily. The hotel always has a high occupancy and is utilised by nursing, medical and social care staff. • Recruitment & Retention Premium: In October 22, due to ongoing chronic recruitment challenges (Band 5 staff), a successful bid to STAC secured a recruitment and retention premium of 15%. This will remain in place until 30 September 2027. • Recruitment Videos: Recruitment videos of staff in teams with chronic vacancies were prepared and issued with job adverts. The goal was to not only showcasing the benefits of an Arran lifestyle, but to also allow potential applicants to glimpse the work environment team dynamic and improve engage with job adverts - videos often help capture more attention than text-only listings and reach a broader audience. • Appoint a Recruitment Agency: In December 2023, funding was approved to appoint a recruitment agency ‘Big Blue Dog’. A 20-week recruitment campaign was launched in January 2024, supported by social media, and two-weekly catch-up review meetings. As a result, some posts received multiple views which converted into applications. The results of this exercise are included in Appendix 3. • Facebook: A dedicated page was developed and HSCP vacancies on Arran are uploaded with links to access job applications. • Relocation costs: These are provided to staff on lower grades/bands moving to the island. • NES Recruitment & Retention Stakeholder Group: The Senior Manager, Arran Services was selected to be a member of this group due to the innovative recruitment practice and campaigns that had been delivered on Arran. This stakeholder group was developed by the National Centre for Remote and Rural Health and Care in order to work collaborative at a national level to address ongoing recruitment challenges. • Recruitment Events: The Partnership hold regular events on the mainland for all NAC posts, and these are advertised via leaflets, royal mail, West FM, newsletters, Facebook and at PPE drop off points. Staff at these events assist potential candidates, discussing role profiles. Information sessions for ‘Arran’ vacancies were held both on the mainland and on Arran. • Staff Development: We have introduced a suite of staff training initiatives, including bespoke courses tailored to individual roles and departmental needs. Additionally, we have supported employees in pursuing further education and professional qualifications, ensuring staff are equipped with both practical skills and strategic thinking capabilities. Our commitment serves not only to enhance performance but also plays a key role in staff retention, creating a culture where individuals feel valued and invested in. By fostering continuous learning, we aim to position ourselves as an attractive employer and build a workforce ready to meet evolving challenges.
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21 | P a g e Despite best efforts, new appointments have been offset by staff leaving the Partnership’s employ.
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22 | P a g e Options Appraisal This section presents a detailed appraisal of four strategic options for the future of Montrose House. Each option is evaluated based on financial viability, workforce sustainability, service quality, and community impact. The options under consideration are: • Option 1: Do Nothing/Status Quo • Option 2: Service Closure • Option 3: Reduce Service to 10 Permanent Care Beds • Option 4: Reduce to 10 Permanent Care Beds + 1 Respite Bed + flexible Day Care Model Option 1: Do Nothing / Status Quo Under this option, Montrose House would continue to operate with 15 permanent care beds, one respite bed, and one step-down bed. No structural or operational changes would be made to address the ongoing financial, workforce, or service delivery challenges. The day service would remain closed under the current arrangements with no access to day care opportunities on the island. Recruitment is an ongoing challenge on the island (see ‘Recruitment Section, page 18), with any positive recruitment gains offset by staff leaving employment at Montrose House. The current staffing model, which relies heavily on agency staff due to persistent vacancies, would therefore have to remain in place. The current rota is to cover the current dependency needs of the 15 residents and the 1 respite bed. With the level of vacancies and current NAC contracted staff there is no scope to reduce the staffing pattern without reducing bed numbers and remain within budget. Resident profiles have been gathered describing information on each resident's care needs, date of admission and family/relative situation. An extensive recruitment campaign, which spanned the financial years 23/24 and 24/25 assisted in recruiting 4 care staff and 1 activity coordinator over a 12-month period. However, in that same timeframe 4 social care staff left employment. There are current adverts out but no significant change to indicate the remaining vacancies will be filled in the next 12 months. The Equality Impact Assessment found that the do nothing option allowed the continuation of permanent care beds for island residents on Arran. There are already on average between 3-4 (currently 2) people at any one time either in hospital at Arran War Memorial or in the community waiting for a permanent care bed at Montrose House and a number of residents have had to choose an interim bed on the mainland over the last few years. There would need to be clear information for relatives that there will need to be some permanent care off the island and this information will need to be proactively discussed and shared with any prospective residents and their relatives. Quality Impact Maintaining the status quo would allow for the continued provision of on-island permanent care for residents of Arran, which is a significant benefit in terms of continuity of care and community cohesion. However, the quality of care is at risk due to the ongoing reliance on agency staff, which affects continuity, familiarity, and potentially the standard of care delivered. The current staffing model is fragile, with high turnover and limited success in recruitment, which undermines the ability to provide consistent, person-centred care. Social care posts require formal registration with the Care
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23 | P a g e Inspectorate which has a requirement for a formal social care qualification. The Partnership also invests in a high standard of training, learning and development for its social care roles due to the nature of care provision. Agency staff are not subject to the same registration and/or training requirements. A formal inspection, as described within this report, has highlighted the concerns regarding quality-of- care provision and staffing within the Care Home. Whilst this has improved recently, this remains fragile and is regarded as an ongoing risk. Financial Impact The financial implications of the do-nothing option are significant. Despite high staff vacancy levels Montrose House has been in an overspend position for the previous 2 financial years, ending 24/25 with a £465k overspend. A substantial portion of this overspend is attributed to the use of high-cost agency staff to cover vacancies. Despite ongoing recruitment efforts, there is little evidence to suggest that the remaining vacancies will be filled in the next 12 months, with the retention of existing staff, an ongoing risk for further financial instability. While there is some consideration of increasing charges to offset costs, this is unlikely to fully mitigate the financial pressures. The current model is not financially sustainable, and continuing with the status quo would likely result in continued or worsening overspends. Workforce Impact The workforce impact of maintaining the current model is considerable. The service has experienced persistent recruitment challenges, with a net zero gain in staffing over the past year. The reliance on agency staff not only increases costs but also places additional strain on permanent staff, who must manage the operational and clinical risks associated with a transient workforce. There is no scope to reduce staffing levels without reducing bed numbers, which would further impact service availability. The current staffing model is not resilient and does not support the development of a sustainable, skilled, and stable workforce. Benefits & Risk Benefits Risks Maintains current level of on-island permanent care provision which also supports community cohesion and reduces the need for off-island placements. Financially unsustainable – 24/25 overspend of £465k No disruption to residents, families, or staff routines High reliance on agency staff (£620k cost in 24/25), impacting continuity and quality No capital investment required Persistent workforce instability and high vacancy rates Familiarity with existing systems and environment Inability to meet increasing demand for care, particularly as the population ages Retains all current beds and services Risk of service failure due to unsustainable staffing patterns Supports continuity of care for current residents Does not align with integrated care or modern service models Hospital Discharge/Flow Missed opportunity to modernise care delivery and align with integrated, person-centred models of care
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24 | P a g e Benefits Risks No day service provision While the do-nothing option preserves the current level of on-island care provision, it is not a viable long-term solution. The model is financially unsustainable, operationally fragile, and does not support the strategic direction of integrated, community-based care. Without significant change and additional financial investment, the risks to service quality, workforce stability, and financial viability will continue to escalate. Option 2: Service Closure This option proposes the full closure of all permanent care beds at Montrose House. The permanent care function would be discontinued, and staff would be redeployed into wider community services. This would represent a fundamental shift in the model of care on Arran, with all long-term care needs met off-island. Quality Impact The closure of permanent care beds on Arran would have a profound impact on the quality of care for older residents. The absence of on-island permanent care would significantly reduce the ability to provide person-centred, community-based care for those with high-dependency needs. The loss of local provision would likely lead to increased isolation for residents placed on the mainland, particularly given the known challenges with ferry reliability and travel logistics. The emotional and psychological impact on residents and their families—particularly in terms of reduced contact and the disruption of established social networks—would be considerable. There is also a risk that such a move could be perceived as contrary to the principles of equitable access and community sustainability, particularly in the context of island-specific legislation and the Scottish Government's Island Communities Impact Assessment framework. Financial Impact From a financial perspective, this option offers the potential for significant savings circa £1.2m. The closure of permanent care beds would eliminate the high costs associated with staffing and maintaining a 24/7 residential care facility. However, these savings must be weighed against potential increases in third-party payments for off- island placements, transport costs for families, and the broader economic impact of job losses and reduced public sector presence on the island. Additionally, there would be ongoing costs associated with maintaining a partially used or vacant building, unless a full repurposing or disposal strategy is implemented. Workforce Impact The workforce implications of this option are significant. While some staff could be redeployed into wider community services, the overall reduction in service provision would likely result in redundancies, particularly among night staff and those supporting high-dependency care. This would represent a loss of skilled care workers from the island, further reducing the resilience of the local health and social care system.
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25 | P a g e Moreover, the closure of permanent care beds would remove a key employment opportunity on Arran, potentially exacerbating existing challenges around recruitment and retention in the wider care sector. The loss of experienced staff could also impact on the quality and continuity of other services, including community-based care. Benefits & Risk Benefits Risks Potential for substantial cost savings through reduced staffing and operational overheads. Loss of all on-island permanent care provision, with significant implications for residents and families. Potential to repurpose Montrose House for alternative community or health uses, subject to strategic planning. Increased isolation and emotional distress for residents placed off-island Reduced reliance on agency staff Likely redundancies and loss of skilled workforce Aligns with financial recovery goals Potential breach of island equality and access principles, risking reputational damage and community opposition. Simplified service model Strong potential for community opposition Risk of triggering legal or human rights challenges related to isolation and access to family life. Increased reliance on mainland placements, with associated travel, cost, and emotional burdens. Requirement to maintain an empty building unless it can be repurposed Likely to affect the discharge flow from the local hospital Undermining of the broader integrated care model and local service sustainability. Likely reputation damage to the Council and NHS While this option may offer financial efficiencies and a simplified service model, it is not aligned with the strategic objectives of maintaining equitable, community-based care on Arran. The risks to quality, workforce stability, and community cohesion are substantial. In the context of Arran being a remote island with no alternative care home provision, the full closure of permanent care beds would represent a significant service withdrawal and is likely to be unsustainable from both a social and political perspective. Option 3: Reduce to 10 Permanent Care Beds This option proposes a reduction in the number of permanent care beds at Montrose House from 15 to 10. There would be no respite provision, and no day care service introduced. The revised model would operate within the limits of the current contracted staffing establishment, significantly reducing the reliance on agency and bank staff. This approach aims to improve financial sustainability and workforce resilience while maintaining a level of on-island permanent care provision. The Equality Impact Assessment noted that this will have an adverse impact on relatives/families' access to visits to loved ones in permanent care. With a reduction in beds there will be at least 3 to 6 people per year accessing a mainland permanent care bed.
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26 | P a g e Quality Impact Reducing the number of permanent care beds would allow the service to operate within a more sustainable staffing model, thereby improving the consistency and quality of care. By relying less on agency staff, the service could enhance continuity, familiarity, and trust between residents and carers—key components of person-centred care. However, the reduction in bed capacity would inevitably increase waiting times for on-island placements. This may result in more residents being placed in mainland care homes, which could negatively affect their wellbeing and family contact. The impact on quality of life for residents placed off-island—particularly in terms of social isolation and reduced family visits—must be carefully considered, especially given the known challenges with ferry reliability and travel costs. Financial Impact This option offers a more financially sustainable model than the status quo. By aligning bed numbers with the available permanent workforce, the service can significantly reduce its dependency on costly agency staff. The projected reduction in agency and bank spend, combined with a more efficient use of contracted staff, would bring the Unit closer to a balanced budget. While some income would be lost due to the reduction in bed numbers, this would be offset by the savings in staffing costs. The financial modelling suggests that this option could eliminate the current overspend, making it a viable medium-term solution. Workforce Impact The workforce implications of this option are largely positive. By reducing the number of beds to match the available staffing establishment, the service can operate more predictably and sustainably. This would reduce the pressure on existing staff, improve morale, and potentially enhance recruitment and retention by offering a more manageable and supportive working environment. However, the reduction in bed numbers may limit opportunities for staff development and specialisation, particularly in managing more complex care needs. It may also reduce the overall number of care roles available on the island, which could have longer-term implications for workforce planning. Benefits & Risk Benefits Risks Improved financial sustainability through reduced agency use Greater likelihood of residents being placed in mainland care homes, with associated emotional and logistical challenges for families. Better alignment between staffing levels and service delivery Longer waiting times for permanent care beds Retains core on-island care provision, supporting community cohesion. Potential community concern over reduced provision Enhances workforce stability and morale Reduced flexibility to respond to short-term surges in demand Avoids redundancies; supports continuity of care May limit staff development opportunities Reduced operational risk and improved service resilience. No island-based respite provision
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27 | P a g e Benefits Risks Enhanced continuity and quality of care due to a more stable workforce Risk of under-provision if demand for on-island care increases beyond the reduced capacity. No island-based day care opportunities This option represents a pragmatic compromise between maintaining local care provision and addressing the financial and workforce challenges facing Montrose House. While it does not fully meet the demand for on-island care, it offers a more sustainable and resilient model that preserves core services and reduces operational risk. Careful management of admissions, transparent communication with families, and the development of a prioritised waiting list/admissions policy for island residents would be essential to mitigate the risks associated with reduced capacity. Option 4: Reduce to 10 Permanent Care Beds + 1 Respite Bed + flexible Day Care Model This option proposes a reconfiguration of Montrose House to reduce the number of permanent care beds from 15 to 10, while protecting respite provision from (one bed) and re-introducing a flexible day care provision. The model would operate within the existing contracted staffing establishment, with a focus on reducing agency dependency and improving service sustainability. This option also aligns with the broader strategic aim of enhancing community-based care and supporting carers through increased respite availability and day care opportunities. The Equality Impact Assessment noted that this will have an adverse impact on relatives/families' access to visits to loved ones in permanent care. With a reduction in beds there will be at least 3 to 6 people per year accessing a mainland permanent care bed. Quality Impact This option retains a meaningful level of on-island permanent care provision while also protecting the provision of respite capacity and day care opportunities, which is a critical support for unpaid carers and families. The reduction in bed numbers is designed to match the available workforce, thereby improving the consistency and quality of care through reduced reliance on agency staff. This is expected to enhance continuity, familiarity, and trust between residents and carers. The retention of a respite bed would increase flexibility in responding to planned and emergency respite needs, potentially preventing carer breakdown and unnecessary hospital admissions. However, as with Option 3, the reduction in permanent care beds may lead to increased waiting times and a higher likelihood of off-island placements, which could negatively impact residents and families. Financial Impact This option offers a balanced financial model. By aligning bed numbers with the available permanent workforce, the service can significantly reduce agency and bank staff costs. The increased respite provision is expected to be cost-neutral or revenue-generating, depending on occupancy and charging models. The financial modelling suggests that this option would bring the service close to a balanced budget, with reduced overspend and improved cost control. It also avoids the capital costs associated with full closure or new build options, making it a financially prudent medium-term solution.
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28 | P a g e Workforce Impact The workforce implications of this option are largely positive. By operating within the existing staffing establishment, the service can reduce pressure on staff, improve morale, and enhance recruitment and retention. The increased respite provision may also offer opportunities for staff to develop skills in short-term, outcome-focused care. However, the reduction in permanent care beds may result in a small reduction in overall staffing hours, and the service will need to manage this carefully to avoid redundancies. The model also requires continued flexibility and cross-skilling within the team to ensure resilience and responsiveness. Benefits & Risk Benefits Risks Improved financial sustainability through reduced agency reliance. Reduced permanent bed capacity may still lead to unmet demand Improved sustainability and reduced overspend Risk of under-provision if demand increases beyond the reduced capacity Retention of respite provision to support carers and prevent crisis. Requires careful workforce planning to avoid job losses Retains essential on-island care provision Some community concern over reduced permanent care capacity Reduces agency reliance; improves staff morale Increased waiting times for permanent care beds on Arran / Continued need for prioritisation and waiting list management Aligns with integrated care principles and supports carer resilience May require operational adjustments to manage dual service types Reduced workforce challenges – safer staffing Greater likelihood of residents being placed in mainland care homes, with associated emotional and logistical challenges for families. Enhanced quality and continuity of care due to a more stable workforce. Improved alignment between staffing levels and service capacity. On island day care opportunities This option represents a well-balanced approach that addresses financial and workforce challenges while maintaining essential on-island care provision. The retention of the respite bed strengthens support for carers and enhances service flexibility. While some risks remain—particularly around capacity and access—these are mitigated by the retention of a core permanent care function and the potential for future service development. This option is likely to be the most sustainable and publicly acceptable compromise in the current context.
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29 | P a g e Recommendation & Conclusion Option Quality Impact Financial Impact Workforce Impact Benefits Risks 1: Do Nothing / Status Quo Continuity of care maintained, but quality undermined by staffing instability and agency reliance Projected overspend 24/25 expected to continue £465k Persistent vacancies; high turnover; unsustainable staffing model Maintains current provision; no capital investment required Financially unsustainable; workforce instability; risk of service failure 2: Service Closure Loss of on- island permanent care; increased isolation for residents placed off- island Significant savings: all costs avoided on island (NB: the need to care for individuals will require to be met elsewhere however) Likely redundancies; loss of skilled workforce; reduced employment on island Cost savings; opportunity to repurpose building; Loss of local care; reputational risk; legal and equality concerns; community opposition 3: Reduce to 10 Permanent Care Beds Improved care quality through reduced agency use; longer waiting times for beds Removal of overspend (approx. £465k) NB requires further financial modelling Better alignment with workforce capacity; improved morale Retains on- island care; improves sustainability Increased off- island placements; reduced flexibility 4: Reduce to 10 Permanent Care Beds + 1 Respite Bed + Outreach Day Care Improved continuity and carer support; some risk of unmet demand Removal of overspend (approx. 465k) NB requires further financial modelling Sustainable staffing; supports carer resilience Retains core care provision; respite/day care provision; improves resilience Waiting times; risk of under- provision; workforce adjustment needed The options appraisal has considered four potential configurations for the future of Montrose House, each with distinct implications for quality, financial sustainability, workforce resilience, and community impact. Option 1, the status quo, is not sustainable. It maintains current service levels but at a high financial and operational cost, with persistent workforce instability and a growing risk of service failure. Option 2, full closure of permanent care beds, offers the greatest financial savings but at the cost of removing all on-island permanent care provision. This would have significant negative consequences for residents, families, and the wider community, and is likely to face strong opposition.
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30 | P a g e Option 3, reducing to 10 permanent care beds, represents a more balanced approach. It improves financial and workforce sustainability while retaining a core level of local provision. However, it does not address the growing need for respite care and may still result in increased off-island placements. Option 4, which combines a reduction to 10 permanent care beds with the retention of respite provision and day care opportunities, offers the most pragmatic and sustainable solution. It aligns service capacity with available workforce, reduces financial pressures, and enhances support for carers. While some risks remain—particularly around access and capacity, these are mitigated by the retention of essential services and the flexibility offered by access to respite. In conclusion, Option 4 is the recommendation of this option’s appraisal. It strikes a careful balance between maintaining essential on-island care, supporting carers, and ensuring the long-term sustainability of services within the constraints of workforce and budget.
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31 | P a g e Impact Assessments The preferred options was subject to both an Equality and Children’s Rights Impact Assessment and an Island Impact Assessment. The full assessments will be made available on the Council’s website, and the findings are summarised below. The Equality Impact Assessment concluded that maintaining the quality and continuity of care, alongside safe staffing levels, remains the central priority for Montrose House. In response to the current 30% vacancy rate and reliance on agency staff, the Health and Social Care Partnership (HSCP) proposes a reduction to 10 permanent beds and 1 respite bed, alongside the implementation of a hybrid day service model. These changes will be managed sensitively, with no current residents affected unless their care needs can no longer be met safely. An admissions policy will also be explored to prioritise individuals with familial ties to the island. While the HSCP acknowledges the strong opposition from the island community and staff, as well as the distress and financial burden associated with off-island placements, it is imperative that care is delivered safely, in line with regulatory standards and within sustainable financial parameters. Montrose House remains a valued part of integrated island services, and the HSCP is committed to its future, contingent on securing safe staffing levels. The Island Impact Assessment concludes that the proposed changes represent a necessary response to persistent staffing challenges and financial pressures. The introduction of a hybrid day service model and the reduction in bed capacity aim to enhance service sustainability, safety, and quality of care. While the prioritisation of residents with familial ties and ongoing performance monitoring are positive steps, the potential impact of off-island placements, including emotional distress and increased travel costs, remains a significant concern. Given the absence of viable alternative delivery models and mitigation mechanisms, the proposals are considered proportionate and appropriate for the island context. Further review and community engagement are planned to address any unintended consequences.
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32 | P a g e Appendix 1: SBAR Day Services May 2024 Author Ruth Betley, Senior Manager Topic Arran Services – Day Service Provision Date May 2024 Situation 1 The Day service on Arran has not re-started since it closed during the pandemic. Before re-starting the service, there had been a review of day service provision on both Arran and the mainland. On Arran due to the remote and rural nature of the island an opportunity to pilot an outreach day service model was taken. The pilot took place between May 2023 and March 2024. Following the first pilot of an outreach model and second pilot was carried out utilising the existing purpose built unit in Montrose House Stronach Day service. Now that the both phases of the pilot have concluded a decision on re- starting day services on Arran needs to be made. Background 2 The opportunity to review day service provision was taken as a result of the service closing during the pandemic. The pilot of an outreach model ran between May 2023-August 2023 and three health and social care staff delivered the day service to an initial five service users, in and around one of the more remote villages, Blackwaterfoot at the golf club, which has a large activity/meeting room. The service ran one day per week between 10.30 to 15.30 and a variety of activities were provided. Transport was arranged and provided by relatives and friends on the whole. There were some service users who needed transport and this was provided by adult outreach workers from the social work team. The second phase of the pilot aimed to attract more service users, as Stronach is located in Brodick and so is closer to the larger villages on the island. The second phase ran from December 2023 to March 2024. This had six service users, some were from the original pilot. Having the pilot in Stronach meant that a meal during the middle of the session could be provided and a wider range of activities could be provided, including access to the Montrose House gardens. All those involved including the service users felt there were significant social benefits for service users and all activities planned were person centred and planned according to care plans and specific outcomes. Service user’s relatives were also contacted and completed feedback questionnaires.
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33 | P a g e Comments from families of service users were very positive about both pilots and in particular the respite that the service offered for them as carers. The staff who provided the service for the pilot were all in substantive posts already and this impacted on the ability of them to fulfil their normal roles and could not be sustained in any future model. One of these roles, health care support worker is now vacant. There are currently service users assessed or in the process of being assessed for day service provision, so this represents unmet need on Arran. Action 3 Now that the pilot phase is completed and feedback has been given a decision on the next steps regarding day services on Arran is needed. At the moment there is a focus on recruiting into long standing vacancies within the permanent care team for Montrose House. This focus is planned over the summer months and will be reviewed in September in terms of success and reduction in agency usage and permanent staff being recruited. With this in mind and the challenges associated with recruitment and capacity it is felt that any plans to re-start day services on Arran will take at least 12 months to re-establish with a phased approach to staffing and service user numbers. Utilising a model of both outreach which also uses opportunities to utilise the previous day care space in Stronach. There is current resource in the budget for 12 service users, it is proposed that a phase approach is taken with a view to providing for 6 service users by the end of 2025. There are 5 daycare posts within the Day service establishment, one senior post and 4 part time day service carers. The service will aim to provide outreach care depending on numbers of eligible service users and their location on the island. In a variety of locations including within the Stronach building. A short lived working group would need to be set up to develop a plan for this initial phase, as well as considering staffing and recruitment for the day service there are other implications for Montrose House in terms of catering and cleaning staff. The use of existing staff from the social work team to support the pilot is not a sustainable option going forward. Recommendations 4 • To support the plan to re-establish day services on Arran utilising an outreach model which will provide opportunities for support across a range of locations, including within the former Stronach Day Service building. • To consider what transport options might be available and ensure that users and carers are involved in the next steps for the service. • To establish a short life working group to develop detailed plans from Spring 2025 to begin a phased start for 6 service users
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34 | P a g e Appendix 2: Engagement Montrose House Consultation Report Background North Ayrshire Health and Social Care Partnership sought feedback from residents, families and the wider island community on a proposal to update services in Montrose House on the Isle of Arran. A planned modification to the current residential care provision will be implemented. Montrose House will move from 15 permanent beds to 10 permanent care beds, and 1 respite bed. The review also includes a proposal to develop a new admissions policy that would prioritise people with familial and community ties to Arran. Introduction This report summarises the engagement activities undertaken by North Ayrshire Health and Social Care Partnership (HSCP) to gather views and feedback from residents, families, the wider island community, staff, professionals and partners. Methodology Two tailored questionnaires were created to engage with different stakeholder groups: • Residents, Families, and the Wider Island Community • Staff, Professionals and Wider Partners The questionnaires were hosted on Microsoft Forms and designed to be anonymous and accessible. The questionnaires went live on 15 July 2025 and was initially scheduled to close on 29 July 2025 but was extended to 1 August 2025 to maximise participation. The consultation was promoted across all HSCP social media platforms and circulated within the internal staff newsletter. To ensure inclusivity and reach, printed copies were made available at the local hospital and GP practices and completed responses were manually inputted into the digital form to consolidate and streamline all responses. In addition to this, the HSCP received 4 letters that have been attached as an appendix in this report. (Appendix 1) An in-person consultation drop-in session was also held on Tuesday 22 July 2025 to provide face-to-face engagement opportunities. (Appendix 2) To analyse the responses, two staff members independently reviewed all responses and allocated codes to all open-ended questions. Each code was then grouped into categories before merging into higher-level themes. In addition, a sentiment scale was used to indicate whether the response for that particular question was ‘opposed’, ‘in favour’, or ‘unsure’. Montrose House Consultation - Residents, Families and Wider Island Community There were 458 responses to the Residents, Families and Wider Island Community survey. Descriptive Statistics
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35 | P a g e Q.1 What is your age range? The age distribution chart shows that out of 458 total participants, 457 responded to the age question. The majority of respondents are older adults, with 40.3% aged 65 and over and 27.1% between 55 and 64. In contrast, younger age groups were minimally represented, with only 5.7% under the age of 35. This indicates that the survey primarily attracted an older demographic, with over two-thirds (67.4%) of participants aged 55 or older. Q.2 Are you a resident of the Isle of Arran? The pie chart shows that out of 458 respondents, the vast majority, 94% (431 individuals) identified as residents of the Isle of Arran. Only 6% (27 individuals) indicated that they are not residents. This highlights that the survey results primarily reflect the views and experiences of people living on the Isle of Arran. Q.3 If you are not a resident of the Isle of Arran, which locality do you reside in? Out of the 27 individuals who are not a resident of the Isle of Arran, 10 responded to this question asking which locality they resided in. 4 reside in the Three Towns (40%), 2 in Irvine (20%), 2 in North Coast & Cumbrae (20%), 1 in Garnock Valley (10%) and 1 in Kilwinning (10%). Garnock Valley (Beith, Dalry, Glengarnock & Kilbirnie), 10% Irvine, 20% Kilwinning, 10% North Coast & Cumbrae (West Kilbride, Fairlie, Largs & Skelmorlie), 20% Three Towns (Ardrossan, Saltcoats & Stevenston), 40% If you are not a resident of the Isle of Arran, which locality do you reside in? 0.2% 0.7% 4.8% 12.0% 14.9% 27.1% 40.3% Under 18 (1) 18-24 (3) 25-34 (22) 35-44 (55) 45-54 (68) 55-64 (124) 65+ (184) What is your age range? (N=457) No, 27, 6% Yes, 431, 94% Are you a resident of the Isle of Arran? (N=458)
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36 | P a g e Q.4 Do you have family living locally on the Isle of Arran? The majority reported having a spouse (36%) and/or wider family (35%) living locally. 18% said they have children on the island, while 10% (48 respondents) indicated they have no family living on Arran. This suggests that most participants have close or extended family ties within the local community. Q.5 Do you currently receive support from any of the following health and social care services on the island? The chart indicates that the vast majority of respondents, 82.8% (403 people) do not currently receive support from health and social care services on the Isle of Arran. Among those who do, the most used service is the Alert Alarm Service (6.8%), followed by District Nursing (2.7%), Care at Home (2.3%), and Montrose House Residency (0.4%). Additionally, 5.1% selected other services. This suggests that while some support services are in use, most respondents are not currently accessing them. For respondents that clicked ‘other’ - 1 access Occupational Therapy - 3 access respite at Montrose House - 2 access HSCP Carers Service - 1 access mental health - 3 access GP - 3 access social services - 3 access self-directed support - 4 have a family member or friend accessing support - 2 are on waiting list for services - 2 are previous service users 18% 10% 36% 35% Children (84) No family on the island (48) Spouse (165) Wider family (161) Do you have family living locally on the Isle of Arran? 2.3% 6.8% 2.7% 0.4% 82.8% 5.1% Care at Home (11) Alert Alarm Service (33) District Nursing (13) Montrose House Resident (2) No (403) Other (25) Do you currently receive support from any of the following health and social care services on the island?
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37 | P a g e Q.6 If you are not currently a Montrose House resident, do you believe you would consider using a care home service on the island in future? The chart shows that a significant majority of respondents (80% - 366 people) would consider using a care home service on the Isle of Arran in the future. An additional 17% (77 people) said “Maybe”, while only 3% (15 people) said “No.” This suggests strong potential demand or openness to local care home services among the community. Q.7 Are you aware of the current recruitment challenges across sectors on the Isle of Arran (health and social care, retail, hospitality, tourism)? The chart shows that 97% of respondents (444 individuals) were aware of the current recruitment challenges across various sectors of Isle of Arran, including health and social care, retail, hospitality, and tourism. Only 3% (14 individuals) were not aware. This indicates a widespread recognition of staffing difficulties across the island’s key industries. Maybe, 77, 17% No, 15, 3% Yes, 366, 80% If you are not currently a Montrose House resident, do you believe you would consider using a care home service on the island in future? No, 14, 3% Yes, 444, 97% Are you aware of the current recruitment challenges across sectors on the Isle of Arran (health and social care, retail, hospitality, tourism)?
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38 | P a g e Q. 8 How do you feel about the recent change in bed capacity at Montrose House (from 15 permanent beds to 10 permanent beds and 1 respite bed)? All individuals answered this question totalling 458 responses. 97.6% (447) of recipients opposed the recent change in bed capacity at Montrose House. 1.5% (7) were in favour and 0.9% (4) were unsure if it was the correct move. Key themes: Comments from the responses for this question were categorised into the following themes: • Strong Opposition and Emotional Distress • Primary Concerns About Mainland Relocation o Forced Displacement from the island/ Family Separation o Personal and Family Impact Stories • Ferry Service Complications o Visiting Challenges • Staffing and Quality of Care Perspectives o Understanding of Staffing Challenges o Conditional Support for Quality Care • Use of Purpose-Built Facility o Underuse of Purpose-Built Facility • Distrust of Motivations o Suspicion of Cost-Cutting • Demographic and Demand Considerations o Ageing Population Needs • Impact on Other Services o Pressure on Healthcare System Strong Opposition and Emotional Distress The overwhelming majority of respondents (277) expressed intense negative reactions to the bed capacity reduction at Montrose House. The emotional response was particularly strong, with participants using terms such as: "Absolutely atrocious" and "shocking and shameful" "Appalling," "disgraceful," "unacceptable," and "terrible" "Totally unacceptable" These reactions reflect deep concern about the impact on Arran's elderly population and their families. Primary Concerns about Mainland Relocation Forced Displacement from the Island and Family Separation A central worry among 105 respondents is that the reduction will force elderly residents to seek care on the mainland, separating them from their lifelong community. Key concerns include: • Elderly long-time residents being forced to leave Arran for mainland care • Isolation from family and friends due to geographic separation
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39 | P a g e • Significant emotional distress for residents who must relocate • The fundamental objection to forcing elderly people off the island for care Some examples of this are below: “This is a change in the wrong direction. Elderly long-time residents are having to leave the island for the mainland for care. MORE beds are needed, not less.” “Forcing elderly people off the island to a mainland care home for want of a local care home place is entirely unacceptable.” Personal and Family Impact Stories 44 respondents shared distressing personal experiences of family members being unable to secure beds at Montrose House These accounts include: • A father who was "extremely distressed" after being moved off the island before his death • An 87-year-old aunt who had lived her entire life on Arran but had to move south due to lack of space • A wife's mother who was sent to mainland care because there "wasn't enough space for her and her needs" • Previous positive experiences where daily visits were possible when family members were at Montrose House “My dad was moved off the island before he passed away which caused him to be extremely distressed. I do not want my mum to experience this too”. “My aunt who had lived ALL of her 87 years on Arran had to move south to live with her daughter as no room for her at Montrose house where her peers and wider family could visit.” Ferry Service Complications Visiting Challenges The unreliable ferry service compounds concern about mainland care placement and was raised by 40 respondents. Specific issues identified include: • Difficulty maintaining regular visits due to uncertain ferry schedules • Early last ferry times (6pm) forcing visits to be cut short • Expensive and nearly impossible short-notice visits • Complete impossibility of urgent visits outside ferry operating hours • Additional stress from ferry unreliability during already difficult situations “Visits from husbands and wives, children and grandchildren will be more difficult, not helped by our uncertain ferry situation.” “Visiting is expensive and almost impossible at short notice and should an urgent visit be needed impossible outside ferry times.”
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40 | P a g e Staffing and Quality of Care Perspectives Understanding of Staffing Challenges While expressing disappointment, 51 respondents acknowledge the staffing difficulties behind the reduction. Their responses include: • Recognition of recruitment challenges on the island • Understanding of difficulties in staffing residential facilities • Appreciation for the council's challenging position • Distinction between acceptable staffing-related reductions versus unacceptable cost-cutting “If this is due to recruitment issues then it is understandable. If it is just a cost cutting exercise then it is entirely unacceptable.” “I have a very clear understanding of how difficult it is to recruit staff here in the island and appreciate all the challenges that this brings to staffing a residential facility!! With this in mind I understand why the council are now in this position of thinking about reducing the beds available in Montrose house.” Conditional Support for Quality Care A small minority of 7 respondents expressed conditional support if the reduction ensures better care quality. These respondents noted: • Support if it helps with staffing and maintains good quality care • Agreement that quality of care should take priority over quantity of beds • Recognition that maintaining staff employment and care standards may justify the reduction • Acknowledgment that this approach "may well be the best way forward” “If it helps with staffing and providing good quality care, I support the move but it is a blow for Arran as the island needs a lot more in terms of residential care.” “Quality of care should take priority over quantity of beds.” Facility Utilisation Concerns Underuse of Purpose-Built Facility 149 Respondents expressed frustration about the underutilisation of Montrose House relative to its design capacity Key points include: • The facility was purpose-built and expensive but has never operated at its full 30-bed capacity • Current reduction to 10 permanent beds plus 1 respite bed represents significant underuse • The building was designed for 30 beds, making the reduction seem wasteful • Previous operation with at least 20 beds and a day care centre showed the facility's potential
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41 | P a g e “Montrose, a purpose built (expensive) facility, which has never operated at its full capacity of 30 is now going to be limited to 10 + 1 respite?” “It is a waste of a purpose-built modern facility. It does not meet the requirements for island residents.” Distrust of Motivations Suspicion of Cost-Cutting 6 respondents believe the reduction is primarily motivated by financial considerations rather than care quality. Their concerns include: • Viewing the reduction as "just a cost cutting exercise" that is "entirely unacceptable" • Perception that fewer service users means helping fewer people in need • Belief that the proposal is "more of a cost cutting exercise than a strategy to benefit the ageing community" • Suspicion that despite "window dressing," the real motive is cost reduction “Money saving idea. Just means we go from 15 to 10 service users. We help less people and those in need are ignored all in the name of cost cutting.” “This entire proposal appears to be more of a cost cutting exercise than a strategy to benefit the ageing community on Arran.” Demographic and Demand Considerations Ageing Population Needs 79 Respondents argued that Arran's ageing population requires more, not fewer, care beds Their arguments include: • Recognition of an existing ageing population with current elderly residents • Expectation that demands for residential care will only grow in coming years • Belief that an ageing population combined with unreliable mainland transport necessitates more local capacity • Assessment that the reduced number is inadequate for an island with an ageing population “We have an ageing population and already have a number of elderly residents so why reduce capacity at a time when the island is in great need.” “Arran has an ageing population, and the demand for residential care is only expected to grow in the coming years.” Impact on Other Services Pressure on Healthcare System The reduction is expected to create additional strain on other local health and social care services. Specific concerns from 17 respondents include:
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42 | P a g e • The hospital being used as an extension of Montrose House when care home beds are unavailable • Increased risk of bed blocking at the Community Hospital when patients cannot be discharged to Montrose House • Home carers being pushed to their limits before crisis situations develop • People living at home until emergency respite or immediate solutions become necessary “The hospital in Lamlash is often seen as an extension to Montrose house with wards full of patients unable to return home (as care at home are unable to provide the care they need) and unable to get a bed in Montrose house as it's at capacity.” “There is also the risk of bed blocking at the Community Hospital if there are no available beds in Montrose House for patients to be discharged to if they are unable to be looked after at home.” Q. 9 Do you have any views on the proposed admissions policy that would prioritise applicants with familial ties to Arran for access to Montrose House care home beds? All individuals answered this question totalling 458 responses. Key Themes: • Sentiment Towards Policy o In Favour of an Admissions Policy o Opposition of an Admissions Policy o Unsure of an Admissions Policy • Preferred Admissions Criteria o Residency Based Prioritisation o Familial Ties and Community Networks o Length of Residency o Needs Based Prioritisation • Concerns About the Policy o Policy Definition o Policy Implementation o Capacity Limitations o Impact on Arran Economy and Community o Perceived Injustice / Discrimination • Requests for Transparency and Consultation • Calls for increased Service Resource Sentiment Towards Policy In Favour of an Admissions Policy The majority of respondents, 296, expressed strong support for an admissions policy that prioritises Arran residents and those with familial ties to the island. “Yes those with family on the island should be prioritised over those whose family are on the mainland”, “Absolutely support this”, “brilliant and long overdue proposal”, “This should ALWAYS be a prerequisite for Montrose House beds!”, “This question is a no brainer”, “It SHOULD prioritise local/familial ties”, “An excellent idea which should be implemented regardless of the any ongoing consultation.” 164 respondents were surprised this wasn’t already in place and viewed it as common sense and long overdue.
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43 | P a g e “I can't for the life of me understand why this wouldn't already be the case. Extremely perplexing.”, “I thought that should already apply.”, “This is sensible, and should always have been the policy.” “I assume this is already in place? If not, it absolutely should be”, “I am surprised to hear that this is not already the case. This should absolutely be the admissions policy.” Opposition of an Admissions Policy However, a smaller but vocal group of 32 respondents opposed the policy, citing concerns about fairness, exclusion, and emotional distress for those without family on the island. “To uproot people against their will when they are at a very vulnerable stage in their lives I feel is cruel.”, “Why? All sections of the community need help and support.”, “I think this could be disastrous for people who have no family left and there only friends are on island.”, “This would not have worked for our elderly neighbour - she has no family and relies on lifelong friends on Arran.”, “Arguably those with familial ties to the island should be at the back of the queue because they will have family on the island to fill the gaping chasm in care provision”, “I think it is unfair to have a policy like this. Every elderly Person deserves to be considered, regardless of whether or not it they have family on the island.”, “The admissions policy should not be restricted to residents with family.” Unsure of an Admissions Policy 18 responses noted they were unsure of the proposed admissions policy and requested more detail before forming an opinion. “Seems like a good idea but not entirely convinced.”, “I'm not sure it should be as black and white as that.”, “I would need more specific details on this policy before I could comment, as this is a very generalised statement.”, “It depends how it would work” Preferred Admissions Criteria A total of 306 comments were made around preferred admissions criteria if a policy was in place. Residency Based Prioritisation The most common suggestion, with 164 comments, was to prioritise current or long-term residents, regardless of family ties. There were many concerns about people who retire to the island or having a second home on the island taking precedence over those who are island born or have lived there for a number or years. Despite this being the most cited suggestion, there were concerns around how it would work in practice, and how ‘resident’ would be defined. “People who reside permanently on Arran should have priority.”, “Anyone who lives full time on Arran deserves to receive care when necessary, on the island.”, “Residents only unless there are special reasons.”, “Too many people retire to the island with no family ties and take up all the resources.” Length of Residency A significant number, 76 respondents, felt that the policy should not just prioritise Arran residents, but the length of residency on the Island should be a key factor in prioritising admissions. “It must be for Arran residents only, with a residence on the island for a minimum of 5 years with no breaks.” , “I think people who have lived here for longer than 30 years should definitely get priority.”, “If born and bred on Arran or lived and worked here for considerable years, you should be prioritised.” Familial Ties and Community Networks
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44 | P a g e Many supported prioritising applicants with family on the island, especially to facilitate visits and maintain emotional wellbeing. “Yes, those with family on the island should be prioritised.” ,“My father ended up on the mainland in the winter due to the weather and boats not sailing. I could not visit him as often.”, “It makes sense to keep Arran residents close to their families.” However, it was felt strongly by 49 respondents that familial ties should be extended to those with strong community networks and friendships. “In the current social context friends can be as much family as blood relatives.”, “Support networks within the community are not restricted to family members.” ,“People like this should also be a high priority.” ,“Friends can be as much family as blood relatives.” Needs Based Prioritisation 17 respondents advocated for prioritisation based on clinical or social need, rather than residency or family ties. “Priority should be given on patient needs, not family connections.”, “Care should be provided for all at the point required.”, “Each case should be taken on an individual basis.” Concerns About the Policy Policy Definition Some respondents found the term vague and requested a clearer definition before making comment on the criteria, or if they agree with the proposal. “What is the clear definition of familial ties?”, “Define ‘familial ties to Arran’! Meaningless statement as is.”, “Does a grandmother or aunt count?”,” A potential minefield; a clear policy unambiguous policy is required.” Implementation Challenges 29 concerns were raised about fairness, enforceability, and unintended consequences of introducing an admissions policy. “It would have to be done in a fair and unbiased way.”, “This will split the community and create unnecessary conflict.”, “Easy to target people without family to support them or advocate for them.”, “The public isn’t stupid—it won’t be manageable.”, “I don't see how any one priority system would work well.” Capacity Limitations The reduction in bed numbers was a major concern, often seen as the root issue by 31 respondents, regardless of an admissions policy. “We do not need reduction in beds—we need more beds.”, “With only 10 permanent spaces, many people will find there isn’t a vacancy when they need it.”, “Even with prioritisation for people with familial ties the lack of beds will be an issue.”, “There is a big need for more beds rather than this” Impact on Arran’s Economy and Community 5 respondents felt the policy could deter new residents of working age to move to the Island and harm the island’s inclusivity.
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45 | P a g e “This discourages people from moving to Arran.” “It damages the local economy as incomers will consider not living here.” “We need new people in the community.”, “this is going to drive people away from the island” Requests for Transparency and Consultation Respondents asked for clearer communication of both current and proposed policies, as well as statistics of current Arran residents who are placed in care homes on the mainland. “Let us see both the existing and proposed admissions policies.”, “How many current residents have no connection to Arran?”, “I would need to see a written policy before being able to comment.”, “Would welcome more details- a difficult area”, “More clarity on what the proposals fully entail is required.” There was a strong desire for ongoing dialogue and community involvement. “Further consultation is essential.”, “Listen to the community, not the pencil pushers.” Calls for Increased Service Resource 6 comments suggested more recruitment initiatives on the island, with change in pay and shift patterns to address long standing recruitment issues. It was felt that addressing this would mean an admissions policy would not be required. “There is the staff out there—people are always desperate for work.” , “Change the working hours from 12- hour shifts to 8-hour shifts.”, “Encourage and keep staff in the homecare system to enable our older residents to get home.” , “I know that something drastic needs to be done to encourage and keep staff in the homecare system”, “Providing accommodation for workers should also be considered.” Q.10 Do you support the proposed admissions policy approach? The pie chart shows that 32% (145 people) support the proposed admissions policy approach, while 23% (105 people) oppose it. An additional 27% (125 people) are unsure, 5% (24 people) would support it with certain conditions, and 13% (59 people) selected "Other." • 14 of the respondents that chose ‘Other’ noted the admissions policy should prioritise residents. • 12 respondents felt there was a lack of information, and more clarity was needed before commenting. • 9 respondents said their support would depend on the definition of familial ties. • 8 respondents favoured residency length as the criteria. • 4 respondents made clear they support the admissions policy, not the capacity change. Q.11 The HSCP is exploring plans to restart day-care service(s) on Arran utilising a flexible day care model which would see supports delivered via an outreach service. Would you consider using an outreach day-care service if it were available? 145, 32% 105, 23% 125, 27% 24, 5% 59, 13% Do you support the proposed admissions policy approach? Yes No Not Sure I would support it with certain conditions Other
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46 | P a g e The chart shows that 73.1% of respondents (“Definitely”: 37.3% and “Possibly”: 35.8%) would consider using an outreach day care service on Arran, while only 3.3% said No and 5.2% said Unlikely, with 18.3% Unsure. Q.12 Is this a service you would be interested in learning more about? The below chart shows that 62% respondents (283) are not interested in learning more about the service while 38% (175 people) expressed interest. Q.13 If yes, please provide your name and contact details Respondents were asked to leave contact details if the option of ‘yes’ was chosen for question 12. There were 124 email addresses given and 15 phone numbers. Q.14 Do you have any concerns about the new or proposed changes? All individuals answered this question totalling 458 responses. Key Themes: • Sentiment Towards Proposed Changes o Concerns Expressed o No Concerns/ Uncertain • Core Issues raised o Bed Provision & Capacity of Services o Relocation to mainland o Personal Concerns and Community Impact o Staffing and Recruitment o Day Service Model • Systemic & Structural Concerns o Finance, Budget and Investment o Transport and Accessibility 37.3% 3.3% 18.3% 35.8% 5.2% Definitely (171) No (15) Not sure (84) Possibly (164) Unlikely (24) The HSCP is exploring plans to restart day-care service(s) on Arran utilising a flexible day care model which would see supports delivered via anout reach service. Would you consider using an out reach day-care service if it were available? No, 283, 62% Yes, 175, 38% Is this a service you would be interested in learning more about?
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47 | P a g e o Consultation Process • Requests for Transparency, Reconsideration and Further Consultation Sentiment Towards Proposed Changes Concerns Expressed A significant majority — 378 of 458 respondents — expressed concerns about the proposed changes, particularly regarding the reduction in care home beds and the future of Montrose House. “I have grave concern”, “Really very concerned”, “A GREAT many of concerns”, “I am extremely concerned about this”, “Extremely worried” Out of the 378 respondents who noted concerns: - 45 gave no specific reasons - 47 stated they had already addressed their concerns earlier in the consultation process. No Concerns/Uncertain 24 respondents indicated they had no concerns regarding the proposals. “No immediate concerns.” “No as understand why they need to happen.” Core Issues Raised There is a lot of intersectionality between the core concerns raised by respondents. Bed Provision and Capacity of Services This was the most dominant theme, cited by 169 respondents. The reduction from 15 to 10 beds was widely viewed as inadequate and dangerous, especially given Arran’s ageing population. - 31 respondents emphasised that Arran’s demographic trends demand more care provision, not less. “Arran’s population is increasingly elderly.” “We need to plan ahead for increasing beds, not reducing them.” Concerns included: • Impact on hospital and home care services. • Insufficient respite care for carers. • Underutilisation of existing facilities. “Any reduction in beds below capacity (30) is unacceptable.” “We need more beds, not fewer.” “Montrose House was purpose-built for more — why isn’t it being used?”, “too many people having to stay long term in hospitals as not enough beds available as it is.”, “I have huge concerns about the proposed reduction in residential care, and don’t believe that in-home care will be able to replace this.”, “Yes, we need more access to a local care home with more bed availability, not less!!!” 20 respondents feared this was the first step toward full closure of Montrose House.
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48 | P a g e “I feel it could be a route to closing the Montrose house which would be devastating.”, “If this ridiculous proposal goes through then next year it will be 5 beds and then closed for ever.”, “My concern is this is the slippery slope to closure.”, “I think if the amount of beds falls below ten that is the criteria for closure.” Relocation to Mainland 77 responses expressed deep concern about elderly residents being displaced to the mainland due to insufficient local care capacity. These concerns were often emotive, describing the impact as traumatic and isolating. “You are sentencing our elderly to a traumatic move to the mainland.” “Families will be divided.” “I might die on the mainland instead of on the island I have always called home.”, “This is totally cruel to the person going into care”, “The thought of having to send family or one day myself to the mainland for care and not have family local to pop in and visit and support them is terrifying”, Personal Concerns and Community Impact 84 responses shared deeply personal accounts of how the changes would affect them or their families. These stories often highlighted the emotional, logistical, and social consequences of reduced care provision. “I fear for my future self-growing older on Arran. For myself, assisted suicide will be a better option than trying to navigate the support for older people and families.”, “Without services in place to support & protect all residents this island will not have a future.”, “You might as well just shut shop on Arran”, “If my husband or myself need to go to the mainland for care how will we see each other? We have been married for 71 years.” 66 responses described the emotional toll of separation and uncertainty. “To be uprooted in their final years is appalling.” “This is terrifying — I’ve lived here all my life.” “Families are left heartbroken.”, “Extremely concerned and appalled at the neglect Arran is treated to.”, “Everything I have stressed above this made me very unwell anxiety stress etc” Staffing & Recruitment 51 respondents cited staffing shortages as a root issue and called for: • Incentivised pay for local workers • Affordable housing for staff • Recruitment strategies targeting young people “You pay a fortune for agency staff to come over rather than paying local staff a premium to cover when needed.”, “We need more affordable housing for workers.”, “Many carers who would come to the island if accommodation was provided for them and their families” Day Service Model 40 responses addressed the proposed day care model. • Most welcomed the idea and shared positive personal experiences of services before closure. • However, many expressed scepticism about feasibility due to staffing challenges. • Many emphasised that day care cannot replace residential care.
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49 | P a g e “I feel the return of day service is LONG overdue since it's closure during COVID and that it would help tremendously.”, “I heartedly agree with expanding the Day-Care service, this could be a lifeline for residents and families in need of this service.”, “The day care service is welcomed and good use of resource but the lack of residential spaces will be a major bottle neck for the care at home service, hospital and social work colleagues” “A day service is not the answer.” “What has changed that makes this feasible now?” “Replacing full-time care with part-time care will have a detrimental effect.”, “seems like someone has grouped some good sounding words together. What actually does it mean? What form would this take in reality?”., “I can confidently say there needs to be a day care centre as well as outreach. Outreach alone is not sufficient” Systemic & Structural Concerns Finance, Budgets & Investment 24 responses questioned the financial rationale behind the changes and called for better investment in local services and staff. The proposals were seen to be short sighted and lacking in a wider investment strategy. There were calls to review the resources available to NAC and invest appropriately. “This is a cost-cutting exercise, not a care strategy.” “We need investment, not reductions.”, “Our island location requires specific and bespoke solutions, not further cuts.”, “Yes, you are slowly closing down all services on the island yet millions wasted every year.”, Transport & Accessibility 25 respondents cited ferry unreliability and geographic isolation as major barriers to care and visitation. “The ferry situation makes visiting impossible.” “Transport issues compound the emotional distress.”, “Going to the mainland is extremely challenging, both for the person concerned and for their family and friends, not in the least because of the ferry situation which will continue for some foreseeable time.” , “the boat situation will make it very difficult for us and my mother in law to visit.”, “Arran is a big island. It takes time to get from one village to another. If lack of staff is a key issue, how will an outreach programme work with all the nonproductive time spent travelling between patients.” Consultation Process 14 responses criticised the consultation process as tokenistic and predetermined. Most of these responses feel that the decision has already been made, and the HSCP asking the public for views is a tick box exercise. Few comments note that the process was not advertised correctly, nor was the public given enough notice to engage. “This is a done deal.” “Concerned this is already decided regardless of any consultation exercise!”, “reading the notification it’s a fait accompli and this is just lip service”, “I know that these consultations generally mean that the decision has been made and this’s all to shut us up.” Requests for Transparency, Reconsideration and Further Consultation • 25 respondents asked for clearer communication. • 30 requested reconsiderations of the proposals. • Many called for public access to key documents like the EQIA and Island Impact Assessment.
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50 | P a g e It was felt strongly amongst these comments that there has been a lack of transparency, and the public have been left without crucial details. Comments asked for documents such as the EQIA and Island Impact Assessment to go public. “Let us see the full proposal.”, “More clarity is needed.”, “Reconsider this — it’s not workable.”, “We need more information on the challenges, constraints, options and costs and a proper chance to discuss this important issue which affects so many people on Arran.” Q.15 Would you like to be involved in Montrose House activities and future engagement sessions? The pie chart shows that 69% of respondents (316 people) are not interested in being involved in Montrose House activities and future engagement sessions, while 31% (142 people) would like to be involved. Q.16 If yes, please provide your name and contact details (email or phone number) There were 106 email addresses, and 22 phone numbers provided. Q.17 How would you like to be kept informed about future updates to Montrose House services? Email remains the most preferred method for updates (231 responses, 47.2%), followed by social media (132 responses, 27.0%) and community meetings (68 responses, 13.9%), indicating a strong overall preference for digital communication, while traditional or direct methods like phone (7 responses) and printed newsletters (45 responses) are far less favoured. ‘Other’ comments included six ‘NA’. Q.18 Any further comments? 43% (197) of all respondents chose to add further comments on this open-ended question. Key themes: • Strong resistance to bed reduction 47.2% 1.4% 9.2% 27.0% 13.9% 1.2% Email (231) Phone (7) Printed Newsletter (45) Social Media (132) Community Meetings (68) Other (6) How would you like to be kept informed about future updates to Montrose House services? No, 316, 69% Yes, 142, 31% Would you like to be involved in Montrose House activities and future engagement sessions?
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51 | P a g e • Impact on Ageing Population o Previous Service Reductions o Limiting Care Alternatives o Growing Demographic Need • Family Separation/Emotional Distress o Forced mainland placement/ community disconnection o Family separation o Mental health implications • Ferry Service Complications o Transportation Barriers • Underutilisation Concerns • Service Expansion Opportunities • Staffing Solutions & Recruitment o Improved Compensation/ hours and recruitment advertising o Staff Accommodation o Training & Development o Affordable Housing Priority • Consultation Process Concerns o Trust & Transparency Issues • Financial & Policy Motivations o Cost Saving Priority o Questioning Original Investment • Long Term Perspective o Proper facility utilisation Strong Resistance to Bed Reduction The community has expressed overwhelming opposition to the proposed reduction in bed capacity at Montrose House. 57 respondents emphasised that Arran needs more beds, not fewer, particularly given the island's ageing population. This sentiment is reinforced by concerns that the reduction will compound existing challenges created by previous care home closures on the island. “I find these proposals extremely concerning, and everyone I have spoken to today feels the same. Let's hope we can get some changes to this.” “What is being suggested here is a disgrace., There not suitable ferry service, old people will not be able to visit their loved ones. Shame on you..” Impact on Ageing Population Several key concerns emerged regarding the specific impact on elderly residents: • Previous service reductions (3 comments) - The island has already experienced the closure of two care homes in Whiting Bay, making this reduction particularly problematic “Services for the elderly on the island have been drastically reduced, yet the population is ageing. it is very difficult to get care at home which increases the need for residence. day care services and the provision of NHS Carers at home would reduce the need for residence.”
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52 | P a g e • Limited care alternatives (5 comments) - Difficulty accessing home care services increases the need for residential care options “Arran has already seen the reduction in care beds with the closure of 2 homes in Whiting Bay in recent years so this reduction in community spaces will only compound things and make life more difficult for Arran residents.” • Growing demographic need (25 comments) - The ageing population requires expanded, not reduced, care capacity “Arran needs more capacity for residential care for the elderly not less. Montrose House is not currently used to its full potential, and you should be exploring ways to increase not decrease capacity.” Family Separation and Emotional Distress Respondents frequently highlighted the devastating impact of forcing elderly residents to seek care off- island: • Forced mainland placement (19 comments) - Reducing capacity would compel families to place loved ones in mainland care facilities “A week ago we had to put my mother in a care home on the mainland. It’s a nightmare and not being able to pop in every day is heartbreaking. The state of the ferries doesn’t help of course. We always thought when the time came, she would be able to stay in Arran.” • Family separation (19 comments) - This creates significant emotional distress for both residents and their families. “Please reconsider. As I said, we have many island locals living out their final years in strange rest homes on the mainland away from their home and family. Please don’t take any away, it will only make things worse.” • Mental health implications (20 comments) - The separation is viewed as unacceptable given current understanding of its psychological impact. “Montrose house is a wonderful place. I have visited with my choir. The local school are involved. [Named Staff member] and all staff are amazing. Please keep this vital resource available for Arran people with as many beds as possible. I would be devastated if in the future, my husband and I had to be separated by water because one of us needed care in our final years. It would be so detrimental to both our health.” Ferry Service Complications Transportation Barriers The unreliable ferry services create additional challenges for families attempting to maintain connections with loved ones in mainland care, and 17 respondents left comments. “With the fiasco situation of ferries and Ardrossan harbours at the moment wouldn’t like to think of travelling to see friends or family now or in the future.”
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53 | P a g e Facility Underutilisation Concerns 13 respondents argued that Montrose House is not being used to its full capacity: • Current underutilisation - The facility is not operating at its potential capacity • Historical demand - The previous Montrose facility was consistently full, indicating ongoing need • Wasted investment - The new purpose-built facility is seen as underutilised despite significant public investment “Why waste the capacity? It’s similar to hospitals with wards shut. It doesn’t make sense when there is a demand for beds. This is not a solution, nor will it save money in the long run. “ Service Expansion Opportunities 14 Community members suggested several ways to maximise the facility's potential: • Reopening day care services - Restoring day care programs that have been missed since COVID • Respite care services - Providing respite beds for temporary care needs • Full bed capacity - Opening all 30 beds rather than reducing to fewer “Please save Montrose House. Get more beds open and respite beds and get the daycare open again. Thank you” Staffing Solutions and Recruitment Respondents identified staffing shortages as the underlying issue but proposed concrete solutions. • Improved compensation/ Hours and recruitment advertising (25 comments) - better pay and incentives to attract and retain staff “The amount spent on agency staff could have been better spent on enhancing wages for permanent staff, and as for selling the old Montrose House, which would have made ideal staff accommodation for both hospital and care home staff, to then buy a hotel was just sheer lunacy.” • Staff accommodation (15 comments)- Providing housing for workers to address recruitment challenges “If more permanent Staff accommodation could be found maybe the situation could be eased.” • Training and development (5 comments) - In-house training programmes and support for staff qualifications “Go back in time when the old Montrose House was in use with more beds and staff. need staff training for career progression.” • Affordable housing (28 comments) - Addressing the fundamental housing shortage that limits the available workforce.
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54 | P a g e “hugely improve pay and conditions, more social housing on island so carers can live in the community. Engagement with schools to come to Montrose House. been proven to be positive for both residents and children.” Consultation Process Concerns Trust and Transparency Issues 18 Respondents expressed significant scepticism about the consultation process: “This so called consultation is wholly inadequate - with lack of information and detail to enable any serious discussion. You have ensured that local elderly and, in some cases, vulnerable people are now anxious and distressed and this was evident in the faces of those attending the meeting at Montrose House on 22 July.” Financial and Policy Motivations Many respondents viewed the bed reduction as primarily financially motivated: Cost-saving priority (6 comments) “Person centred also means community centred. This proposal is not about the community, or the island needs but about cost saving.” The proposal is seen as driven by budget constraints rather than community needs. Questioning Original Investment 3 Respondents questioned why the facility was built initially “How can I relatively new building, built for purpose now be reduced to 10 beds, when the old Montrose was open it was full all the time.” “Going back years there was a waiting list to get a job in Montrose house, fast forward 20 years and millions spent on new build, staff cannot be found, maybe some research should be done to find out why.” Long Term Perspective 23 Respondents emphasised the need for sustainable, community-focused solutions such as increasing the capacity needs and making the existing investment work effectively rather than reducing its scope. “Why waste the capacity? It’s similar to hospitals with wards shut. It doesn’t make sense when there is a demand for beds. This is not a solution nor will it save money in the long run” Montrose House Consultation – Staff, Professionals and Wider Partners There were 23 respondents to the Staff, Professionals and Wider Partners survey. Descriptive Statistics
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55 | P a g e Q.1 What is your age range? The majority of respondents fall within the 55–64 age range (10 individuals), followed by the 45–54 group (8 individuals). A smaller proportion are aged 25–34 (4 individuals), and only 1 respondent is in the 35-44 range. This suggests the surveyed group is predominantly composed of individuals aged 45 and older. Q.2 Are you a resident of the Isle of Arran? An overwhelming majority, 96% (22 out of 23 participants), are residents of the Isle of Arran while only 4% (1 participant) is not. Q.3 If you are not a resident of the Isle of Arran, which locality do you reside in? Q.4 Do you travel on to the island to provide services? For the one resident who does not reside on the Isle of Arran, they have confirmed they reside within the North Coast & Cumbrae locality and do not travel on to the island to provide a service. Q.5 Do you have family on the Island? - 8 respondents reported having no family on the island. - 7 respondents each indicated living with a spouse and having wider family locally. - 1 respondent stated that their children live on the island. However, this question did not give the option for multiple answers. Q.6 Which of the following health and social care services do you support on the island? 1 8 7 7 Children No family on the island Spouse Wider family Do you have family living locally on the Isle of Arran? 4 1 8 10 25-34 35-44 45-54 55-64 What is your age range? (N=23) No, 1, 4% Yes, 22, 96% Are you a resident of the Isle of Arran?
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56 | P a g e The most commonly supported service from recipients completing this questionnaire was Montrose House (21%) and the GP Practice (19%), followed by District Nursing (17%). Allied Health Professionals and “Other” services each received 11% support, while Social Work was supported by 9%. The least supported services were Care at Home and the Alert Alarm Service, each with 6%. ‘Other’ includes: - 1 Carer’s worker - 3 Arran War Memorial Hospital workers - 1 community nursing worker Q.7 Do you believe you would refer a patient or service user to use a care home service on the island in future? A significant majority (65%, or 15 respondents) answered "Yes" when asked if they believed they would refer a patient or service user to use a care home service on the island in the future. Meanwhile, 26% (6 respondents) said "No," and 9% (2 respondents) were uncertain. 6% 6% 17% 21% 19% 11% 9% 11% Care at Home Alert Alarm Service District Nursing Montrose House GP Practice Allied Health Professional Social Work Other Which of the following health and social care services do you support on the island? Maybe, 2, 9% No, 6, 26% Yes, 15, 65% Do you believe you would refer a patient or service user to use a care home service on the island in future?
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57 | P a g e Q.8 Are you aware of the current recruitment challenges across sectors on the Isle of Arran (health and social care, retail, hospitality, tourism)? All participants (100%) answered "Yes" when asked if they were aware of the current recruitment challenges. Q.9 Do you support the proposed change in bed capacity at Montrose House (from 15 permanent beds to 10 permanent beds and 1 respite bed)? The majority of respondents (61%) did not support the proposed change. They gave a clear "no" in response to the questions and did not qualify their answers. The remaining respondents either expressed agreement or provided unclear responses. Of those categorised as 'unclear' (22%), comments included statements such as "not sure" or responses that did not directly address the question. Four professionals (17%) agreed with the proposal, with only one qualifying their feedback by stating, "If that's all we can staff, it's all we can staff." Q.10 How do you feel about the recent change in bed capacity at Montrose House (from 15 permanent beds to 10 permanent beds and 1 respite bed)? Key Themes: • Negative Stance o Bed Capacity & Service Reduction Concerns o Staffing Challenges & Recruitment Barriers o Impact on Hospital & Community Care o Ferry & Geographic Isolation Issues Yes 100% Are you aware of the current recruitment challenges across sectors on the Isle of Arran (health and social care, retail, hospitality, tourism)? 3 14 3 0 3 Yes No Not Sure I would support it with certain conditions (please specify below) Other Do you support the proposed change in bed capacity at Montrose House (from 15 permanent beds to 10 permanent beds and 1 respite bed)?
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58 | P a g e • Accepting Change • Unclear Stance Professionals were mostly negative in their views on the recent reduction in bed numbers, with 52% expressing a negative response, 26% accepting the change, and 22% providing unclear feedback. Negative Stance Bed Capacity & Service Reduction Concerns Many respondents strongly objected to the reduction in bed numbers at Montrose House, viewing it as inadequate for Arran’s ageing population and detrimental to care provision. “10 beds is just not enough to cover the need for people who have lived on Arran all their lives.”, “Previously, the island had access to Cooriedoon and 20 beds in Montrose House… the impact of only having 10 permanent beds is significant and life changing.”, “Short sighted given increasing demand across Arran.”, “Awful – the unit was 20 beds when I worked there… the future for elderly on this island is looking very sad and desperate.”, “I do not support any of the reductions in services… I cannot support the further destruction of a vital service.” Staffing Challenges & Recruitment Barriers Respondents acknowledge the difficulty in recruiting and retaining staff and offer insights into why local uptake is low. “Frustrating but appreciate the ongoing challenges with recruiting staff… a good service cannot be sustained with agency staff.”, “We need more permanent staff… it would be more sustainable if the staff was made up from the Arran community.”, “The job description hasn’t been amended in years… the shifts do not suit anyone with children.”, “If we had spent half a million pounds on a recruitment drive… it would appear more appealing to the community.” Impact on Hospital & Community Care Several responses highlight how reduced bed capacity affects hospital discharge and step-down care, creating bottlenecks in the wider health system. “There is a huge need on the island for more availability including step-down services to free up hospital beds.”, “Arran War Memorial Hospital frequently keeps patients well beyond the time when hospitalisation is necessary.”, “Reducing bed availability in Montrose House would mean less chance of freeing acute hospital beds.” Ferry & Geographic Isolation Issues The unreliability of ferry services is a recurring concern, especially in relation to off-island care and staff commuting. “The ferry situation leaves families cut off from loved ones.”, “It is not practical to have staff living on the mainland… especially in the winter.”, “The barriers created by ferry services and onward travel… detrimental to wellbeing.” Accepting Change
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59 | P a g e Those who accepted the proposal appeared to adopt a pragmatic stance, acknowledging that while the change is not ideal, it reflects the reality of ongoing recruitment challenges. ““If the reduction ensures safe and consistent service delivery… that can only be a good thing.”, “If there simply aren’t enough staff then changes must be made for the sake of the staff and the residents.”, “Safe resident care is required… if there isn’t enough staff, cutting bed numbers is the priority.” Unclear Stance Respondents categorised as 'unclear' generally did not provide comments that directly answered the question, and therefore no assumptions were made regarding their viewpoint. Q.11 Do you have any views on the proposed admissions policy that would prioritise applicants with familial ties to Arran for access to Montrose House care home beds? Key themes: • Support for Prioritising Local Residents and Family Ties • Emphasis on Residency Over Familial Ties • Requests for Clarity or Policy Details • Preference for Needs-Based Admissions Support for Prioritising Local Residents and Family Ties Most professionals (61%) agree that individuals with familial ties to Arran should be given priority access. Many of these respondents clarified that this includes those currently living on the island who have family connections there. They emphasised the importance of maintaining community connections and enabling family visits. “I think that would be a welcome policy.”, “Agree that Arran residents should have priority admissions.”, “I strongly support that if you have lived on Arran and raised a family here, then you should not have to go to the mainland.”, “It seems sensible to prioritise people with family or friends on the island.”, “I do agree that this policy would be great” Emphasis on Residency Over Familial Ties 6, 26% 12, 52% 5, 22% How do you feel about the recent change in bed capacity at Montrose House (from 15 permanent beds to 10 permanent beds and 1 respite bed)? Accepting Negative Unclear
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60 | P a g e Several responses suggested that length of residence on Arran should be the primary criterion, rather than familial ties alone. Some expressed concern that the term “familial ties” is too vague. “Anybody who doesn't have family living in Arran should not be considered. Anyone who has been living in Arran for a certain (X) number of years… should be considered.” “In my opinion, only elderly who have resided on the island should have access to beds. 'Familial ties' is not very specific.” Requests for Clarity or Policy Details A few respondents noted that they could not comment meaningfully without seeing the actual admissions policy or understanding how it would be implemented. “Can not comment as have not seen the admissions policy.”, “Many people will have familial and community ties… this policy would need to be tight.” Preference for Needs-Based Admissions Three respondents (13%) disagreed with the proposal. They felt that that clinical or personal need should be the deciding factor, rather than family or residency status. "Due to the lack of beds, there is not going to be a good way to decide who gets a bed... the best way would be deciding based on need and requirement.", "It should be on a case-by-case basis. It's difficult to define one proposition. My mother lived here for 30 years and recently moved off the island... if she were to need a space in a care home, I would rather it be here.", “Any person living on Arran should have equal access dependent on needs assessment.” Q.12 Do you support the proposed admissions policy approach? The pie chart shows that 48% (11 people) support the proposed admissions policy approach, while 0% (0 people) oppose it. An additional 39% (9 people) are unsure, 4% (1 person) would support it with certain conditions, and 9% (2 people) selected "Other”. Of the “Other”, one respondent did not answer the question, and another stated they “didn’t know enough about it”. 11, 48% 0 9, 39% 1, 4% 2, 9% Do you support the proposed admissions policy Approach? yes No Not Sure I would support it with certain conditions (please specify below) Other
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61 | P a g e Q.13 The HSCP is exploring plans to restart day-care service(s) on Arran utilising a flexible day care model which would see supports delivered via an out reach service. Would you consider referring your service users and patients to an out reach day-care service if it were available? The chart shows that 74% of respondents (“Definitely”: 56.5% and “Possibly”: 17.4%) would consider referring to an outreach day care service on Arran, while 8.7% said No and 4.3% said Unlikely, with 13.0% Not sure. Q.14 Is this a service you would be interested in learning more about? The below chart shows that 48% of respondents (11 people) expressed no interest in learning more about the service, while 52% (12 people) want to learn more about the service. Q.15 If yes, please provide your name and contact details (email or phone number) Respondents were asked to leave contact details if the option of ‘yes’ was chosen for question 14. There were 4 email addresses given and 1 phone number. Q.16 Do you have any concerns about the new or proposed changes? Key Themes: • Core Issues Raised o Staffing and Recruitment 13, 56.5% 4, 17.4% 3, 13% 1,4.3% 2,8.7% The HSCP is exploring plans to restart day-care service(s) on Arran utilising a flexible day care model which would see supports delivered via anout reach service. Would you consider referring your service users and patients to a out reach day-care servi Definitely Possibly Not sure Unlikely No Yes, 12 52% No, 11 48% Is this a service you would be interested in learning more about? Yes No
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62 | P a g e o Concerns About Bed Reduction & Service Erosion o Impact on Elderly Residents & Families o Pressure on Hospitals & Wider Services o Lack of Clarity & Transparency o Distrust in Decision Making & Governance • No Concerns / Unclear Responses The majority of staff (65%) expressed concerns about the proposed changes. Those who raised concerns focused on barriers to recruitment, including a lack of affordable housing, inflexible working patterns, and unreliable ferry services. Feedback also highlighted worries about the impact on elderly residents—such as isolation, reduced quality of life, and loss of community ties—as well as potential harm to the wider Arran community. Some respondents felt that reducing capacity is short-sighted and could lead to financial and emotional hardship for island residents. Core Issues Raised Staffing and Recruitment Respondents noted concerns around the following: • Difficulty attracting staff to Arran due to its remote location and limited housing options. • Accommodation shortages are a major barrier to recruiting and retaining healthcare workers. • Ferry disruptions (e.g., sailings mainly to Troon) make it harder for mainland staff to support island services. • Loss of bank staff “I am concerned about the staffing situation… especially around accommodation for healthcare workers.”, “There needs to be a multi-agency input to improve the whole situation.”, “I'm worried about losing my job.”, “Bank staff used to come from the mainland… ferry situation makes this more difficult.” Concerns About Bed Reduction & Service Erosion Respondents expressed strong concern about the reduction in bed numbers and the broader impact on care provision and the island’s infrastructure. “I am extremely concerned about the reduction in provision.”, “If we go down to 10 beds… less profit = unfinancially viable and we will close.”, “I firmly believe that reducing overall capacity at Montrose is having negative impacts.”, “Short sighted given increasing demand across Arran.” Impact on Elderly Residents & Families Several responses highlighted the emotional and practical consequences for elderly residents and their families, especially regarding off-island care. “Concerned about elderly being separated from friends and families.”, “If Montrose House were to close… impact on residents’ health and behaviour would be profound.”, “Concerned for any remaining elderly family on the island needing care.”, “Couples being separated… detrimental to those people.”, “The island will suffer hugely without Montrose House.” Pressure on Hospitals & Wider Services Respondents noted that reduced care home capacity would increasing pressure on hospitals and other health services locally.
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63 | P a g e “Arran War Memorial Hospital will suffer… so will Crosshouse.”, “There are already patients in both hospitals who are from Arran but can’t go home.”, “Lack of options for day services / care at home / long-term care puts strain on informal carers and hospital staff.” Lack of Clarity & Transparency Some respondents felt the consultation lacked clear information and specifics, making it difficult to understand the practical implications. “The description of the plans have given no specifics — ‘woolly’ wording.”, “This consultation will stir a lot of emotion and possibly a lot of ideas.” Distrust in Decision Making & Governance A few responses expressed frustration with mainland decision-makers and scepticism about the consultation’s impact. “Perfect example of mainland mismanagement.”, “HSCP is not working and does not work.”, “Not naive enough to think anything written here will make any difference.”, “Destroying NHS, destroying social services, destroying local community.” No Concerns / Unclear Responses A small number of respondents,21%, explicitly stated they had no concerns or felt the issue had been long overdue for review. “It’s something that should have been addressed a long time ago.” While the remaining 13% have been categorised as 'unclear', having not answered the question. Q.17 Would you like to be involved in Staff Montrose House activities and future engagement sessions? Q.18 If yes, please provide your name and contact details (email or phone number) Respondents were asked to leave contact details if the option of ‘yes’ was chosen for question 17. There were 4 email addresses given and 2 phone numbers. No, 11, 48% Yes, 12, 52% Would you like to be involved in Staff Montrose House activities and future engagement sessions?
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64 | P a g e Q.19 How would you like to be kept informed about future updates to Montrose House services? The most preferred method is Email (11 respondents), followed by Staff Meetings (9 respondents) and social media (6 respondents). Community Meetings were chosen by 4 individuals, while Printed Newsletters received only 1 response. Phone and Other were not selected by any participants. Q. 20 Any further comments? 47.8% (11) of all respondents chose to add further comments to this open-ended question. Key Themes: • Housing & Accommodation Concerns • Staffing & Recruitment Challenges • Shift Patterns & Flexibility • Community Engagement • Service Provision & Capacity • Survey & Feedback Issues • Staff Dedication & Morale Responses from professionals suggest that staff are committed to delivering quality care, but barriers are undermining recruitment, retention, and service delivery. Addressing these issues through flexible working, better housing support, improved visibility of roles, and community engagement could provide a mechanism with which to achieve the full potential of staff and facilities. Housing & Accommodation Concerns Feedback suggests concerns around housing and accommodation, particularly in relation to recruitment. Affordable housing options for rented and staff accommodation need to be explored to support workforce growth. Professionals feel that the cost of living on Arran, compared to wages, is making relocation challenging for potential staff. Professionals also feel that the availability of care at home services must be increased to meet the needs of geographically dispersed communities. The current premises for the District Nurses team are unsuitable and relocating them to Montrose House has been suggested as a potential solution. “As someone who only moved to Arran in the past 3 years I do understand the challenges around housing on the island… Affordable housing (including rented properties or staff accommodation) should be further explored to support people moving to Arran for jobs.”, “Due to the general cost of living versus wages for jobs 11 0 1 6 4 9 0 Email Phone Printed Newsletter Social Media Community Meetings Staff Meetings Other How would you like to be kept informed about future updates to Montrose House services?
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65 | P a g e such as care, moving is not always an option.”, “There needs to be more visibility locally on recruitment and vacancies for Montrose House.” Staffing & Recruitment Challenges Professionals recognise that staff shortages are significantly affecting service delivery and capacity. They see a clear need for more carers to be based on the Island. They also suggest that staffing issues at Montrose House may be discouraging local people from seeking employment there. They wish to see a drive to recruit volunteers, as well as improved visibility of recruitment efforts and advertised vacancies. Cleaning staff shortages are particularly acute, leading to physical and mental strain on the remaining lone cleaning staff. “We need more Arran-based carers and we need to engage with the community to find out the barriers as to why we don't have more Arran-based staff.”, “I understand the need for staff and its struggles… possibly a drive for attempting to get more volunteering people in.” Shift Patterns & Flexibility Professionals suggest the current 12-hour shift patterns may not be suitable for the local workforce. Alternatives such as job sharing, shorter shifts, and school-time shifts have been suggested as shift schedules are seen as a barrier for those with other responsibilities. Introducing part-time options (suggested 9am to 2 or 3 pm) could help attract more staff. “I wonder if the staffing rotas could change to allow part-time working… a working shift from 9am–2/3pm and evening shift where a person with a family could start after the other family member returns from work.”, “Flexibility in the working patterns may ease the challenges of getting those living on Arran to consider working for the council at Montrose.”, “The rigid shift patterns are off-putting to some who cannot commit due to other responsibilities.”, “Allowing for job sharing/shorter shifts/school shift times would support more of our local working-age people into post.” Community Engagement Engaging with the community is essential to better understand barriers to employment. Community discussions could help generate new ideas and approaches. “Maybe a discussion in the community could lead to new ideas and forward thinking.” “We need to engage with the community to find out the barriers.” Service Provision & Capacity Additional comments note a desire to avoid reducing services, with a preference for improving housing and scheduling arrangements instead. It was noted that Montrose House is currently underutilised despite being a purpose-built facility with ample space capacity. Expanding day services is seen as a way to reduce applications for permanent care, and a hybrid model that links day services to community resources is viewed positively. “Montrose House has plenty of capacity in a very pleasant purpose-built building.” “I think the building not being used to its full capacity is a shame.”
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66 | P a g e Survey & Feedback Issues Concerns about the design of the staff survey were noted (e.g. the inability to select multiple dependent types). The survey was also perceived as ineffective and unable to reflect the efforts and experiences of staff. “This survey only allows you to choose one option: I would have spouse, child and dependents however I can't pick all these choices so the data collected will be inaccurate.” “What an utterly dreadful and useless survey. What a pointless exercise this is.” Staff Dedication & Morale Comments noted that despite challenges, staff remain committed to providing high-quality care to residents, though there is need for appropriate support. “The staff at Montrose House are passionate about the care of residents. We would all like to see Montrose full and have a vibrant community that engages our residents.” “Arran staff are to be commended for their efforts, not abandoned by the so-called Partnership.” Montrose House Consultation – Letter Summaries Four letters were received during the consultation exercise regarding the proposed changes at Montrose House. These were submitted by the Arran Community Council, Arran Council for Voluntary Services, and two members of the local community. The content of this correspondence is collectively summarised below. Future of the Unit: Montrose House was described as a very important part of island life, and concern was expressed that its significance has been underestimated. Reference was made to the Unit never having been used to its full capacity, despite being purpose-built at a cost of over £6 million. There was concern that reducing bed numbers could lead to closure, and a view was shared that with appropriate planning and organisation, the Unit could be viable. Demographic: It was noted that the ageing demographic on the island is widely recognised. One contributor stated that residential and day care services should be increased rather than reduced. One individual expressed personal concern about the impact of the proposal on both the community and their own future care. Impact on Residents and Families: Concerns were raised about island residents, many of whom have lived on Arran for most or all of their lives, potentially being placed in care homes on the mainland. It was suggested that families and friends would face difficulties visiting residents relocated to the mainland due to unreliable ferry services and the cost of transport. One submission described this situation as resulting in elderly residents being “sentenced to a very lonely old age.” Another questioned compliance with Article 8 of the European Convention of Human Rights (the right to respect for family and private life) and called for an assessment to be undertaken. It was further requested that Mental Health Impact Assessments are undertaken for all family members who are currently affected by geographic separation from their loved ones. Staffing Issues: Feedback on staffing highlighted two perspectives: one acknowledged that recruitment and retention challenges are long-standing, while another questioned the effectiveness of recruitment efforts. It was suggested that a wider local workforce may become available if shift patterns were adjusted to better align with island transport options. A proposal was also made to revise 12-hour shifts to shorter, more flexible arrangements to facilitate employment opportunities for younger and local women. One submission
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67 | P a g e stated that Council management had shown a lack of understanding of island-specific issues, contributing to a poor working environment. The phrase “This intransigence caused the loss of many local care staff and left a toxic atmosphere” was used. A request was also made for job fairs or similar events to be held in island village centres. Housing: While one contributor noted that accommodation is available for staff working at the Unit, others identified the lack of affordable housing as a barrier to recruitment. Concern was expressed that planning policies are enabling the development of larger, more expensive properties, which may be contributing to rising house prices and limiting opportunities for younger residents to purchase homes. Support was expressed for the affordable housing initiative, and a suggestion was made to review the housing points [Housing Allocation Policy] to reflect current employment contracts, specifically, the understanding that 32- hour contracts are required to secure maximum allocation points, while current contracts are for 30 hours. Workforce Development: It was suggested that promoting education and training opportunities, such as Skills for Work courses leading to SVQ qualifications in Health and Social Care, could support future staffing. Reference was made to Argyll College, part of the University of the Highlands and Islands, as a provider, currently located on the island’s high school campus. Funding: One contributor called for more information on how the costs around Montrose House were broken down. Several budget funding options were proposed. These included using council tax revenue from second-home owners to support local care services, introducing signing-on and loyalty bonuses (similar to London weighting), and establishing a fund, charity, or lottery to address financial challenges. It was also suggested that the Scottish Government be approached for additional funding, noting that previous funding arrangements were based on the island having a ferry commute of less than one hour, no longer the case due to the relocation of services to Troon. Day and Respite Care: The value of day care, respite care, and home care services was highlighted. These services were seen as important in enabling families to continue caring for relatives at home. Concern was expressed that closure of the Unit could negatively affect day care provision. It was stated that wellbeing cafés should not be relied upon to provide day care, as they are run by volunteers and serve a different client group. Community Engagement and Process: A request was made for a further community engagement session to be held before any decisions are finalised. There was also a request for more data to be shared regarding the factors influencing the proposal. Reference was made to the Scottish Government’s Island Communities Impact Assessment guidance, and a specific question was raised: “Does your proposal take into consideration the current demographic structure of the islands and the challenges faced by populations that might have a greater percentage of older people than other areas?” Disappointment was expressed at the lack of input from Council representatives or Councillors. Immediately advertise care roles more visibly, working in partnership with the Island Plan Group, the Arran Locality Partnership and Arran Skills Group on Arran-specific campaigns modelled on the success seen in childcare recruitment.
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68 | P a g e Appendices Letter 1 Please accept these comments as very strongly held opinions & consider them sincerely. I hope to be able to express them at the meeting, but know that it will be very well attended & I many not get the opportunity. And yes! I do know what I am talking about, 45 yrs as an Occupational Therapist, mainly in Care of the Elderly in both hospitals and the community. The last 20 yrs in Inverclyde. The age demographic on the island is an issue, everyone knows that. The need for residential care & day care should be augmented, not reduced. This can be paid for by: 1. The use of the “second home owners” council tax, which should remain on the island to pay for this service – consider a “signing on” bonus and a “loyalty bonus” (similar to London weighting) This might address some of the issues – money talks! 2. A fund/charity or lottery augment finance issues many islanders would support this. 3. Do not underestimate the value of Day & respite care& home care services. This can enable families to continue caring for family members in their own homes, as is often their wish. 4. I fear for the community + my future care if this short sighted proposal comes to pass. The wheel will have to be re-invented very shortly. 5. Do not rely on many of the “well being” cafes to provide day care. Run by volunteers they have no responsibility for the health & well being of their participants who generally are not the same client group who would use health & social services day care. Letter 2 To whom it may concern, I was asked to write this on behalf of a group of local residents who attended a meeting at Montrose house on Tuesday 22nd July. There was utter disappointment when it was realised there was little to no representation from North Ayrshire Council or indeed the local representative Mr Charles Currie (as speakers). The main point of concern was the fact that importance of Montrose House was totally underestimated. We have heard it all before – low staffing levels, wings closed, inability to attract staff and the limited places available because of the above. The reality of this situation is the fact it is the only care home on the island and the shortage of bedspace has resulted in people bed blocking the hospital for months, sometimes years. Resident have sometimes been forces into care homes on the mainland (over 20), namely in North and South Ayrshire areas. These people have been sentences to a very lonely old age. Many have grown up or lived for many years on the island and surely it would be beneficial for them to be around people they have known for most of their lives. Instead they are mostly out of reach for family and friends to visit because as you well know the boat is at best unreliable and of course transport is prohibitive.
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69 | P a g e The problem could be solved with a little thought, namely changing 12 hour shifts to a more flexible schedule would permit younger and local women to work in Montrose House. There is accommodation for staff to live in while working, therefore workers could come from the mainland. The availability of Glenartney Hotel and the old lighthouse home in Lamlash were supposed to be for staff. There is also the empty wing/s all of which could attract experienced workers from the mainland. What is done to our elderly is cruel and very neglectful and for those staying in hospital it is worse. For many elderly they do not have family that can visit on the mainland and rely on friends for companionship (from Arran). I was told by one lady today she would rather die than go to live among strangers on the mainland (a shared sentiment with many). Montrose House could be viable again, the old Montrose House was a happy, warm place where people knew each other. It would only take a little bit of thought and decent organisation to turn the situation around. The Government was lyrical about social care etc. They do not produce the required results.. and with some decent planning, money could be saved in the long term. So much rhetoric… so little action. Letter 3 Response to Proposals Reducing Arran Care Home Capacity and Impact on Island Community In a collective community voice capacity, we have been asked to write on behalf of a number of local contacts and organisations. They are deeply concerned by the ongoing reduction in care home capacity on the Isle of Arran and the significant negative impacts these changes are already having on residents, families, and the wider community. We urge the Partnership to reconsider the direction of these changes and to recognise the pressing need for sustainable, high-quality, local care provision on the island. Over recent years, Arran has witnessed a dramatic decline in local residential care capacity: Cooriedoon was a 27-bed unit, was closed in January 2022 while still housing 16 residents. Reports suggest admissions may have been scaled back prior to this due to safety concerns. Montrose House our current 30-bed unit, saw its permanent care bed capacity reduced from 20 to 15 in December 2023. If the proposal is progressed it means that available residential care capacity on the island has fallen from 57 beds to just 10 permanent and 1 respite bed in under three years. This raises a serious question: Community needs obviously supported the case for investment of public funds to provide a 30 bed unit. Despite obvious demand this has never been fully delivered. Would a 10-bed unit be viewed as a sustainable long-term solution for an island community with a high proportion of older residents? Since 2020/2021, 29 admissions have been recorded to Montrose House. However, we now understand there are 23 Arran residents placed in care homes on the mainland, many of whom would otherwise have preferred to remain closer to home. Again this raises two immediate concerns: What is the total number of care home admissions from Arran overall within this period, and how many of those residents have close family or carers still living on the island? And; How are human rights implications being accounted for, particularly under Article 8 of the European Convention on Human Rights, which guarantees the right to respect for private and family life? The ferry dependency, mobility issues among elderly family members, and frequent transport disruptions present significant barriers to maintaining familial relationships, effectively severing regular contact for many.
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70 | P a g e We fully appreciate the pressures and acknowledge the high annual cost of placements at Montrose House. While this differential is understandably a concern for HSCP resource allocation, residents would be keen to know the breakdown of this cost? Is the cost artificially inflated due to high agency staffing levels, and what would the cost be with a full complement of locally recruited staff? Again, we appreciate that currently, the over-reliance on agency staf is both financially unsustainable, widely recognised as detrimental to continuity and quality of care and a major contributing factor to cost escalation. Despite repeated statements about the difficulty in recruiting, there appears to be no visible evidence of proactive recruitment advertising for Montrose House or other care roles on Arran locally: A search on MyJobScotland for "Arran" or "Isle of Arran" produced returns no relevant results. Job postings require searching by “Brodick,” a detail unlikely to be known or used by external applicants. From searches it seems there are currently no positions advertised for Montrose House specifically. In contrast, the Arran Skills Group’s recent campaign around childminding recruitment, using a localised and targeted promotional approach, has been notably successful—we would be keen to support and to maximise these approaches which has to date yielded a 66% increase in child carers. This shows that community-rooted, visible campaigns can work. 30-hour contracts restrict those applicants who may be seeking social housing as the local letting initiative offers more points for key workers, however the contract must be a minimum of 32 hours. Including HSCP managers in the Arran Skills meetings and Housing Task force group would allow for more creative out of the box thinking to enable the local health and care workforce to thrive. The declaration of the Stronach Day Centre and additional wing/s as surplus to requirements, only shortly after Montrose House celebrated its 10-year anniversary as a flagship care facility, sends a disheartening message to residents and staff. Additionally in line with the Scottish Government’s Public Sector Reform Strategy, services should be: • Person-centred and community-rooted • Co-produced and delivered in partnership with communities • Preventative, accessible, and equitable What Arran is currently witnessing is the opposite: a reduction in proximity and access to public services, a fragmentation of family and community networks, and a disempowerment of island residents from shaping care options that are appropriate to their context. We call upon the HSCP to take the following steps: Publish a breakdown of Montrose House operating costs, with a strategy to reduce costs via sustainable, local recruitment instead of agency dependency. Immediately advertise care roles more visibly, working in partnership with the Island Plan Group, the Arran Locality Partnership and Arran Skills Group on Arran-specific campaigns modelled on the success seen in childcare recruitment.
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71 | P a g e Assess the human rights impact (under Article 8) of of-island placements and prioritise local options wherever feasible. Undertake a Mental Health Impact Assessment for family members currently affected by geographic separation from loved ones. Reaffirm a long-term strategy for sustainable, high-quality care on Arran—one which values and preserves community integrity. Arran is a close-knit island with quite unique challenges—but also with unique opportunities. The community wants to support its own and assist in the solution to this challenge, the question is whether public services will support the community in doing so. We urge the Health and Social Care Partnership to work with local residents, families, and services to build a sustainable care model that respects human dignity, strengthens family bonds, and ensures that no one has to face the end of life isolated and far from home. We are open to meeting with the Partnership to discuss our concerns and offer input into constructive solutions. Yours sincerely, Bill Calderwood Chair of Arran Community and Voluntary Service (on behalf of concerned contacts and local stakeholders on Arran) Letter 4 Dear Directors and management of NAC IJB We are writing to you to declare our alarm and dismay over the possibility of North Ayrshire Council reducing the number of rooms available to Arran residents in need of care in Montrose House. Montrose House has been a very important part of Arran life for decades and innumerable numbers of Arran residents happily spent the last years of their lives there. To have that taken away and be replaced by transportation to inaccessible mainland care homes is alarming. We have many people on the island that have spent their entire lives here and the decision to send these people off island in the final years of their lives beggars belief. We do not think it is fully appreciated as to how difficult it will be for Arran families and friends to visit any care home residents that have been moved to mainland care homes, particularly now that our ferries are using Troon as a home port for the foreseeable future. We question how families on the mainland would react to travelling to visit family if their relations were deployed on Arran. The new build at Montrose House must be kept and used to the potential it was built for and ACC will offer our support in any way possible in order to ensure that that happens. The suggestion that a purpose built, publicly funded building created at a cost of plus £6 million, is to be slowly downgraded is unacceptable and would lead to the probable closing of the facility which has never been used to its full capacity in the first instance. At that time, the demand was clearly identified and public funds invested to satisfy that need. Closure of Montrose House could also have a knock- on effect to the Daycare provision on Arran which has been very effective in the past. We recognise that costs for running care homes have increased whilst funding from central government to Local Government and Health Boards has decreased since 2010. With regard to the funding of Montrose House, we understand that the use of mainland based and agency staff have caused running costs to
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72 | P a g e increase substantially and it is thought that that is one of the areas where savings can be made. The NAIHB has an obligation to look at those costs regularly but we would suggest that there could be an untapped local workforce available, as there has been in the past. However, one has to look at why there are not enough local staff working there anymore and would suggest enquiries are made into that question. One reason we know of for losing local care staff at Montrose House, since the new build was opened, was NAC management’s intransigence, and lack of understanding, and that enforcing Arran shift patterns and timings to align with those on the mainland was problematic, if not impossible for staff given the lack of public transport on the island. This intransigence caused the loss of many local care staff and left a toxic atmosphere. Any hope of employing Arran residents as care staff at Montrose House must recognise that staff shifts must allow for Arran bus times and not be dictated by the convenience of alignment with care homes elsewhere that have the luxury of excellent public transport systems. ACC also recognise that lack of affordable housing for local people is a long-realised problem that is now becoming more apparent. There are many reasons for this which should also be re-appraised. Should NAC re-assess a planning policy which seems to be allowing and encouraging increasingly bigger and more expensive properties to be built on the island when it is apparent that by doing so the effect is to increase property prices on Arran and thus prevent Arran’s young people from owning their own homes. ACC are supporting the affordable housing initiative and perhaps this needs to be promoted with a review of the points allocations changed to recognise the current contracts at 30 hours when employees need to work 32 hours to maximise the points. The future of staffing at Montrose House will, to some extent, rely on local young people educated at Arran High School. AHS has on its campus Argyll College, a branch of the University of the Highlands & Islands (UHI). The college has run Skills for Work courses within AHS and some of these courses available for pupils can lead onto SVQ qualifications in Health & Social Care once pupils are in employment. This is perhaps something to be considered and encouraged in the long term. ACC is concerned that that reducing bed numbers in Montrose House will eventually lead to its closure. ACC think that, if possible, approaches should be made to the Scottish Government for extra funding for Arran as previous additional island funding for Arran, via NAC etc, was predicated on Arran having its home port less than one hour away. This is no longer the case due to the unnecessarily large ferries being deployed to Arran by the Scottish Government, forcing a move to Troon in South Ayrshire, thus increasing costs for all concerned. ACC feels that a concerted effort to locate local care staff could create dividends and would request that job fairs, or similar, in Arran village centres could be a first step in resolving an extremely unpopular and difficult situation that the island finds itself in, primarily through no fault of its own. Before a decision can be made for the future of this key facility on Arran we ask if you will support a further community engagement session and provide that session with more data on factors that are influencing the decision. We also ask that you consider how your process complies with Scottish Governments guidelines for community needs assessments (https://www.gov.scot/publications/island-communities-impact- assessments-guidance-toolkit-2 /documents/ ) particularly the question:- Does your proposal take into consideration the current demographic structure of the islands and the challenges faced by populations that might have a greater percentage of older people than other areas?
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73 | P a g e Arran Community Council have every confidence in the local management and staff and we are very willing to assist in any way to ensure that the needs of the community can be provided as effectively as possible and the future of this facility is secured at required levels. Regards, Arran Community Council members.
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74 | P a g e Drop In Event Flyer
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75 | P a g e Community Drop In Event, Stronach Room, Montrose House (22 July 25) The session was organised as a drop-in event to facilitate informal discussion and feedback. However, prior conversations within the community led to the majority of attendees arriving at the scheduled start time, resulting in attendance numbers exceeding the venue’s capacity. This created a challenging environment for both attendees and staff. Estimated attendance was between 120–150 individuals. At the beginning of the session, attendees were given a verbal overview of the proposal, including the background and rationale. The venue layout (the room is a long space) and the absence of a microphone or hearing loop system as the plan had been for smaller round-table discussions meant that some attendees had difficulty hearing. Staff were able to respond to several questions from the full group, before the session became noisy, with multiple individuals speaking at once in an effort to express their views and some attendees voicing strong opposition to the proposal With support from the Community Councillor, the large group was then divided into four smaller discussion areas, each facilitated by a staff member. This allowed for more focused and constructive dialogue, although some individuals remained vocal, making it difficult at times to address specific concerns in detail. Feedback was collected during the session, and attendees were encouraged to complete the paper survey to ensure their views were captured more comprehensively. Break Out Meeting Notes: Venue and Meeting Arrangements • Venue space and meeting facilities (e.g. loop facilities, microphones) and setup wholly inadequate for the meeting. o The speakers couldn’t be heard and/or seen It was unclear who they were or what their roles were either. o Many examples of people not attending or leaving the meeting early due to not being able to hear speakers or contribute. • Pre-meeting advertising was completely inadequate. o Lack of widespread advertising in libraries, public spaces etc. o No mention in The Banner o Reliance on a social media post - ineffective when a large number of residents do not use social media • No Pre-meeting information (e.g. timescales, the consultation process, facts and figures underpinning the decision making) provided to enable a meaningful consultation. • Concern that this was no more than a false consultation. The comment from a NAC representative speaker about being “surprise at attendance numbers”, the perceived deliberate attempt to poorly advertise, not provide any meaningful information to enable an informed discussion and the lack of NAC representation at a senior level, led to concerns around the bed reduction being a ‘done deal’ and that no one from NAC is actually interested in a meaningful consultation, instead treating the meeting as a tick box exercise. o The need for a meaningful and wide-reaching and inclusive consultation was deemed essential • Many attendees were unclear about what the actual purpose of the meeting was for!
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76 | P a g e • The vague proposal around hybrid day-care model, with no information provided, was seen as a measure to purely distract from the issue around reducing the number of beds. o How will the daycare model be funded and staffed? • Concern was raised around the use of breakout groups (initiated to mitigate the inappropriate meeting arrangements) and the potential for filtration management, with reduced impact, where NAC decision makers were not present to hear the strength of views directly. • Concern was raised that the NAC decision makers at the appropriate level were not present and do not understand the unique challenges Arran faces. • “Okay as an early chat but in no way a consultation!” Consultation Information o What is actually being proposed? On what basis? What alternatives have been considered? o The importance of having access to the facts and figures underpinning the case was deemed essential for trust in a fair process. o What is the timescale for implementing the proposed plan? o Who is managing the list for unmet need for Arran? o Why were views and ideas not sought earlier to look for solutions before bed reductions were proposed? o Where will the money savings go from the reduced number of beds? Will this be used to ‘beef up’ day care and home care services in Arran? o What are NAC’s (and the NHS’s) statutory obligations regarding care provision for the island? Are these being met? o Moving from 3 to 1 care homes was viewed with concern, but the expectation was still that, with the building of Montrose House, care would still be provided on Arran for Arran residents. Little regard is being given to the isolation from friends and family due to the location of alternative mainland care homes, difficulty of travel (involving the challenging ferry service) and the emotional toll this will have on residents and their families if placed in mainland homes. o Infringement of human rights? o The additional impact of the difficulty associated with ferry travel appeared to have been ignored with the plans, especially with the use of Troon. o Difficulty in defining who would constitute ‘Local’, and the tension this could cause within the island community. o Rather than attracting new staff, reducing beds will reduce the attractiveness of the role, training opportunities and make recruitment and retention harder, ultimately leading to Montrose House closing permanently. Concern that this was NAC’s intention in the long term. o Arran needs a bespoke solution based on its unique situation and challenges, with facts and figures collected to support this. o Demonstrate case for additional money from central government o Appropriate consideration of the impact of the ferry difficulties too. o Arran having the highest elderly population in Scotland o Can we learn from other islands? • Need to look outside the standard boxes, ways of working and ‘siloed’ budgets to come up with a solution that is right for Arran • What happened to ‘The Arran Budget’? – pre covid, could this be a model moving forwards? • Recognition that on an island everything is interconnected, if day care services are reduced, then there is a greater requirement for support for home, care home or hospital places, so addressing issues without the whole picture is counterproductive.
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77 | P a g e o Arran has an overreliance on the third sector and a solution needs to reduce this reliance and provide a sustainable solution moving forwards. • Lack of understanding about the model of health and social care provision and their associated budgets. o How can these be better and more efficiently used moving forwards? o How can NAC look to reduce the number of beds when patients are stuck in hospital due to lack of care places and packages being available. • Is NAC’s proposal still going to the next Integrated Board Meeting? - concern that this should be withdrawn to enable proper consultation • How will information be captured and provided back following the meeting. • A proper consultation is required moving forwards: o Accurate information available in advance to enable meaningful discussion Right people, right time, right place o Wider, timely advertising o Making the information and process for proving views much more accessible o Use of existing island networks and groups to disseminate information and capture views Consultation Survey: o Inadequate o Limited reach due to restricted social media channels being used to advertise this o Need: o Actual information! – fact sheet outlining proposals, alternatives, decision making process, timescales, opportunity for engagement. Who to raise concerns too, template letter to support people raising their concerns/objections o Survey that is able to gather the depth and breadth of information necessary to properly consult islanders o Gather right information from the right people to demonstrate ‘local’ need, and ‘actual cost (rather than offset to the NHS for bed blocking), to demonstrate need, and to secure additional funding from e.g. central government Recruitment and Retention of Staff • Recognition that ‘agency’ staffing is not a long-term solution to safe staffing at Montrose House and the need for a more stable and sustainable staffing solutions moving forwards. • Money: need to invest in staff to attract new staff: o explore possibility of an Arran allowance to attract mainland workers o look at pay based on cost of living • Housing: o looking at prioritizing nurses/carers for social housing o provide ‘Auchrannie-style’ accommodation for nurses/carer living fulltime on Arran o expand ‘Glenartney- style’ accommodation for mainland workers • Advertising: Look at where and how vacancies are advertised and overhaul the recruitment process. • New ways of working: o conduct consultation with current, past and future care workers/nurses to understand their needs (wages, full time part time, job shares, dynamic working across community and hospital/Montrose House) and the barriers that have driven them from or prevent them going into the care profession.
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78 | P a g e • Island Career Pathways: Establish career pathways for workers Opportunity for engagement with Arran High School for ‘wider’ volunteering opportunities and work experience to promote nursing or care as a career. • Potential for Care qualification equivalent to their barista training qualification as a wider activity. Other: • Recognition of the Saturation of the workforce • Need to look at the workforce as a whole (NHS and NAC) and how it can be best used to support the needs of the population on Arran. • Recognition of the age distribution of the population of Arran. o Concern that by not investing in care staff and reducing available care: the island may depopulate the age-dynamic of the island will be artificially ‘engineered’ to cut costs, servicing only a younger population Word/phrases captured: Unacceptable Inhumane Cruel Shortsighted Loneliness Isolation Quality of life Friends Family
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2 | P a g e Appendix 3: Big Blue Dog Recruitment Report
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Version: 6.0 1 North Ayrshire Council Equality & Children’s Rights Impact Assessment (Full Form) Introduction This form will assist in carrying out an Equality Impact Assessment and where appropriate, Socio-Economic, Children’s Rights, Island Communities and Consumer Duty Impacts of new, revised and existing policies and practices. Guidance on how to complete assessments is given in the Council’s Equality and Children’s Rights Impact Assessment Toolkit. The form is mandatory and must be published on the Council website once the policy or practice has been approved. Section 1: General Details 1.1 Directorate/Service HSCP: Section: Health and Community Care 1.2 Name of Policy, Practice of Proposal being assessed: Arran Integrated Island Services Is it New ☐ Existing (being reviewed): ☒ Budget Proposal: ☐ Please insert Budget Reference number (if applicable) Click or tap here to enter text. 1.3 List of participants in the assessment Ailsa Weir, HSCP Senior Manager, Integrated Island Services Michelle Sutherland, HSCP Senior Manager, Primary care and Communities, Andrew Hale, NAC Team Manager, Policy & Performance Ruth Wilson, NAC Team manager (Litigation) Amy Mullen, NAC Equalities Inclusion Officer 1.4 Manager responsible for the impact assessment Name: Kery Logan
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Version: 6.0 2 Designation: Head of Health & Community Care 1.5 Timetable (should be started during the development phase of the proposal) Date Assessment Started: March 2025 Interim Review Date: 09 June 2025 HSCP Finance Working Group, 19 June 2025 IJB meeting, 04 July 2025 and 30 July 2025 review with NAC Corporate leads. Final sign off by Head of Service at the end of the form. Section 2 – Aims and Relevance 2.1 What is the purpose of the policy practice or proposal? Montrose House Care home is on the Isle of Arran and is undertaking a review due to the following: a) Older People Day Service – the traditional day service provision closed due to infection control requirements during the Covid 19 pandemic and has not re-opened. A service review, alongside stakeholder engagement, is taking place to identify a day service model which will best meet the needs of future service users, and their carers. Proposal to explore a hybrid day-case model, which will be provided in-house and community-based working alongside the activity coordinator b) Montrose House continues to face significant operational challenges related to staffing levels, due to the limited availability of social care trained staff on the island. As a result of these staffing challenges there has been a reliance on agency workers, to ensure safe staffing levels within the home. Unfortunately, at times agency staff cover can be irregular, which affects the continuity and quality of care delivery. As a result the Montrose House Care Home budget has been overspent over the last 2 financial years. At the current time there are 12 residents, and the option appraisal proposal recommends a reduction from 15 permanent beds to 10 permanent care beds and 1 respite bed. This will improve service resilience, safety and quality, by having a sustainable service with a staffing model which does not rely on agency staff. If achieved, this will result in improved safe care delivery and the overspend being reduced significantly. c) The review is also proposing the development of an admissions policy to prioritise those with familial ties on the island to access the Montrose House beds.
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Version: 6.0 3 Section 3 – Equality and Diversity 3.1 What evidence were you able to access about the relevant needs of protected groups as outlined in section 3.3 below (Please include your sources – links to equality providers and evidence can be found in both the toolkit and the Promoting Equality Page on Connects). There has been the collection and analysis of a wide range of data sources: 1. Arran Locality Profile 2017 [http://northayrshire.community/wp- content/uploads/2018/02/Locality-Profile_Arran_Final_Version_Sept2017.pdf] 2. Arran Integrated Island Service Review - Initial Review 20th July 2020 [2020- 08-17-bm-p24-arran-integrated-island-services-initial-agreement.pdf] 3. Isle of Arran – Local Island Plan March 2022 [https://www.north- ayrshire.gov.uk/Document-library/arran-local-island-plan.pdf] 4. Scottish Census 2022 [https://www.scotlandscensus.gov.uk/] 5. Health & Social Care Partnership – Integrated Island Services Management Information on workforce, workforce recruitment, financial, resident needs, etc. [internal – not for publication] The data highlights high life expectancy and low levels of younger people on the isle of Arran. 34.5% of the population on Arran are 65years +, much higher than the 20% of Scotland population. Arran’s Island Plan highlights the lack of affordable housing and low numbers of working age population that affects availability of staff, who would require to have social care experience and qualifications, to work at Montrose House. There is a 15% salary uplift available to NHS Band 5 roles and an enhanced rate of pay for council staff employed at Montrose House, reflecting the higher costs of living on an island. HSCP demographics include the island workforce, recruitment campaigns and lack of response, financial information, option appraisal information, residents’ health & social care needs, admission rates/availability of beds in Montrose House. 3.2 Are there any gaps in your evidence or areas of uncertainty? There is currently a data gap about whether existing Montrose House residents have come from a care experienced background. However, this in not felt to be materially relevant. This issue can be captured as part of the review and development of c) a new admissions policy. 3.3 From the list of protected characteristic groups identified in section 2.3 please identify any potential positive and negative impacts on any of these protected characteristics?
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Version: 6.0 4 Protected Characteristic Yes No Please Explain (Positive or Negative or Neutral) Age - Older people, children and young people – please identify which categories will be affected ☒ ☐ The implementation the proposals for a) older people day services, b) Montrose house bed reduction, and c) Montrose House new admission policy; could have a negative impact on older people. 34.5% of the population on Arran are 65years +, much higher than the 20% of Scotland population, so the likelihood of demand for a) older people day services, and b) Montrose house beds; could outweighing resources available. It is also likely that the older age population of the island will grow over the coming years. a) older people day services – it is the ambition of a new flexible day service model to offer more places to older people on Arran, than the previous traditional daily attendance model, which offered 12 places Monday to Friday. This will provide families with additional respite. b) Montrose house bed reduction - the reduction in the number of beds from the current 12 residents to 10 permanent beds and 1 respite bed, may lead to future service users having to be placed in mainland care homes resulting in increased travelling for island-based carers/ families. It is recognised that some family members may also be older and be affected by long-term conditions and disabilities. There is no requirement for existing residents to leave the care home. The review and development of c) a new admissions policy, will be informed by stakeholder
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Version: 6.0 5 Protected Characteristic Yes No Please Explain (Positive or Negative or Neutral) engagement. It is the ambition that this will create an approach to prioritise those with familial ties on the island and if requested, there will be the opportunity for service users to be on a prioritised waiting list for transfer back to the island when there is bed availability. Disability - Physical and Learning ☒ ☐ The people admitted to Montrose House experience higher levels of age-related frailty than those of a similar age. 50% of the residents suffer from dementia, with others affected by Parkinsons, Multiple Sclerosis and complex diabetes. a) older people day services – it is the ambition of a new flexible day service model to offer more places to older people on Arran, than the previous traditional daily attendance model. This will provide families with additional respite. b) Montrose house bed reduction - the reduction in the number of beds may lead to service users having to be placed in mainland care homes resulting in increased travelling for island-based carers/ families. It is recognised that some family members may also be older and be affected by long-term conditions and disabilities. The review and development of c) a new admissions policy, will be informed by stakeholder engagement. It is the ambition that this will create an approach to prioritise those with familial ties on the island and if requested, there will be the opportunity for service users to be on a prioritised waiting
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Version: 6.0 6 Protected Characteristic Yes No Please Explain (Positive or Negative or Neutral) list for transfer back to the island when there is bed availability. Gender reassignment - Where a person is living as the opposite gender to their birth ☐ ☒ Neutral – gender reassignment does not affect use of or admission to; a) older people day services or b) Montrose House beds. Pregnancy and Maternity ☐ ☒ Neutral - Montrose House is for people over 65 years only. Accessible lounges and toilets are available for women experiencing pregnancy or early post birth, when visiting residents. Race, ethnicity, colour, nationality or national origins (including gypsy/ travellers, refugees and asylum seekers) ☐ ☒ Neutral – 98.34% of the isle of Arran population are white. Race, ethnicity, colour, nationality or national origins does not affect use of or admission to; a) older people day services or b) Montrose House beds. Staff working at Montrose House have access to cultural sensitivity and racism training, as required. Religion or belief (includes religious and philosophical beliefs, including no belief) ☐ ☒ Neutral – religion or belief does not affect use of or admission to a) older people day services or b) Montrose House beds. Staff working at Montrose House support residents to access spiritual care, which best meets their needs. Sex - Women and Men ☐ ☒ There is a slightly higher female population on the island. There are Males, 2,207 and Females, 2,438.
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Version: 6.0 7 Protected Characteristic Yes No Please Explain (Positive or Negative or Neutral) Females make up 52% of the island population. Arran median male life expectancy at 81 years is the highest in North Ayrshire. Females in Arran can expect to live to over 83 years – 2.5 years above the Scottish average. This 2% difference in population and 2 years in life expectancy, does not have a materially impact on Montrose House as all residents have their own on-suite bedrooms and in the public spaces there are a range of residents’ areas and toilets available to offer single sex spaces. Staff working at Montrose House support residents to access activities which best meet their personal preferences. Sexual Orientation - Lesbian, gay and bisexual people ☐ ☒ Neutral – sexual orientation does not affect use of or admission to a) older people day services or b) Montrose House beds. Marriage and Civil Partnership - marriage between same sex couples is included ☒ ☐ The implementation of the proposals for a) older people day services – it is the ambition of a new flexible day service model to offer more places to older people on Arran, than the previous traditional daily attendance model. This will provide families with additional respite. b) Montrose house bed reduction could have a negative impact on those who are married or in a civil partnership in the event that they or their spouse cannot be accommodated in Montrose House. It is recognised that a person’s
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Version: 6.0 8 Protected Characteristic Yes No Please Explain (Positive or Negative or Neutral) spouse or partner may not be able to visit as frequently. It is recognised that this may cause anxiety and distress to both the resident and family member; and although the island social work teams will work with family members to reduce their isolation e.g. referrals for support from carers groups, this distress cannot be fully mitigated against. The review and development of c) a new admissions policy, will be informed by stakeholder engagement. It is the ambition that this will create an approach to prioritise those with familial ties on the island and if requested, there will be the opportunity for service users to be on a prioritised waiting list for transfer back to the island when there is bed availability. Human Rights ☒ ☐ The implementation of the proposals for a) The development of older people day services should offer more places than a traditional day service model and this will provide spouses, partners and families with additional respite opportunities. b) Montrose house bed reduction could have a negative impact on the human rights of older people and their families if they cannot be accommodated in Montrose House. It is recognised that a person’s spouse, partner and other family members may not be able to visit as frequently. It is recognised that this may cause anxiety and distress; and although
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Version: 6.0 9 Protected Characteristic Yes No Please Explain (Positive or Negative or Neutral) the island social work teams will work with family members to reduce their isolation e.g. referrals for support from carers groups, all of this distress cannot be mitigated against. The review and development of c) a new admissions policy, will be informed by stakeholder engagement. It is the ambition that this will create an approach to prioritise those with familial ties on the island and if requested, there will be the opportunity for service users to be on a prioritised waiting list for transfer back to the island when there is bed availability. Care Experienced - This term refers to anyone who is currently in care or has been for any length of time regardless of their age and includes Kinship Care (other family members); Looked After at Home (with support from social work); Residential Care; Foster Care; Secure Care; Adoption. ☐ ☒ Neutral – at the current time there is no assessment that captures whether someone has experienced Kinship Care (other family members); Looked After at Home (with support from social work); Residential Care; Foster Care; Secure Care; Adoption, earlier in their life. These issues do not affect use of or admission to a) older people day services or b) Montrose House beds. As such this issue does not have a material impact. This issue can be captured as part of the review and development of c) a new admissions policy.
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Version: 6.0 10 Protected Characteristic Yes No Please Explain (Positive or Negative or Neutral) Other - Poverty, homelessness, ex-offenders, isolated rural communities, carers, part-time workers, or people in a marriage/civil partnership ☒ ☐ Although 87% of Arran has a gross household income (£31k), which is above the North Ayrshire median (£24K) in almost 9 out of 10 Arran postcodes (875). It is recognised that due to the rural nature of the island, there are higher living costs and longer travel times. It is also recognised that the majority of individuals affected at Montrose House will be over the age of 65 years and living on retirement pensions. In the event that a relative requires to move off island for residential care, currently the foot passenger day return cost is £ 10.20 per adults and £5.10 per child; subject to concessions. There may also be bus/train fares from ferry to home and ferry to care home. It also costs £51.20 to take a car on a return trip. There may also be car fuel costs from ferry to home and ferry to care home. The HSCP has no mechanisms available to reduce or mitigate these costs, noting the responsibility only extends to providing care and support for the individual requiring access to residential care. 3.4 Describe any consultation or engagement undertaken, including details of the groups involved and the methods used. Montrose House Engagement Goals of Engagement
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Version: 6.0 11 The engagement will provide background information and awareness of the proposals a) older people day services b) Montrose house bed reduction and c) a new admissions policy. The proposals will highlight the positive changes, such as the re-introduction of hybrid day-case model, which will be provided in-house and community-based working alongside the activity coordinator. It will be helpful to get feedback on this approach, from community views of a workable model. The engagement will include reasons for the proposals, driven by critical staffing challenges and focussing on the difficulty in providing safe person- centred care. This will also highlight the financial pressures created due to the use of agency staff. The engagement event will provide an awareness of the admission processes/ waiting list for beds if assessed as suitable for Montrose House. What we want to achieve from engagement? Receiving feedback on the proposals; as well as providing reassurance and alleviate any concerns the community may have. This information will be fed back to the NAHSCP senior management team and will be included in the updated ECRIA and IJB report for submission in August. Montrose House Engagement drop in Event was held within Montrose House by the Arran Senior Management team on 22nd July 2025 from 1000-1200. The audience was the public, residents, families, and visitors. The drop-in session will include: • public, residents, families, and visitors provided with a leaflet/flyer in Montrose House for the Questionnaire/Online Survey. Survey can be accessed by a QR code but paper copies available for completion at face- to-face sessions and uploaded later. • Prepared, clear concise answers to questions that might be raised to ensure that all staff participating in the event are collectively sharing the same information. The details of the drop-in were emailed to 16 community groups; the details of which were provided by the Arran Community Voluntary Organisation. These groups included Brodick and Lamlash Sheltered Housing complexes, Older People Groups, Lunch Clubs, Community Councils, and patient participation groups. Posters about the drop-in session were shared at Montrose House and GP surgeries. Service Users and Partner staff. The Questionnaire/Online Survey using a QR code was available, with paper copies available too for completion. Members of the public were provided with support from variety of HSCP staff.
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Version: 6.0 12 1. Care at Home & Alert service users - completion supported by Care at home staff. 2. District Nursing caseload patients-completion supported by District Nursing staff. 3. patient participation groups- support from primary care 4. Relevant community groups-Vicki Yuill ACVS providing contact details. 5. Support from engagement team required with preparation of survey/questionnaire, QR code and analysis/overview of results. A full summary of the responses to engagement is available on the IJB webpage. Montrose House Engagement drop in Event was held within Montrose House by the Arran Senior Management team on 22nd July 2025. A public online survey was opened on the 15 July 2025 to 1st August 2025 and paper copies were also made available. Staff supported people to complete the paper copies. A staff online survey was opened on the 25th July to the 1st August 2025. There were 458 responses to the Residents, Families and Wider Island Community survey. The majority reported having a spouse (36%) and/or wider family (35%) living locally. 18% said they have children on the island, while 10% (48 respondents) indicated they have no family living on Arran. The vast majority of respondents, 82.8% (403 people) do not currently receive support from health and social care services on the Isle of Arran 97% of respondents (444 individuals) were aware of the current recruitment challenges across various sectors of Isle of Arran, 73.1% of respondents (“Definitely”: 37.3% and “Possibly”: 35.8%) would consider using an outreach day care service on Arran, while only 3.3% said No and 5.2% said Unlikely, with 18.3% Unsure. 97.6% (447) of recipients opposed the recent change in bed capacity at Montrose House. 1.5% (7) were in favour and 0.9% (4) were unsure if it was the correct move 32% (145 people) support the proposed admissions policy approach, while 23% (105 people) oppose it. An additional 27% (125 people) are unsure, 5% (24 people) would support it with certain conditions, and 13% (59 people) selected "Other.“
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Version: 6.0 13 Key themes from proposed bed changes: • Strong Opposition and Emotional Distress • Primary Concerns About Mainland Relocation o Forced Displacement from the island/ Family Separation o Personal and Family Impact Stories • Ferry Service Complications o Visiting Challenges Staffing and Quality of Care Perspectives o Understanding of Staffing Challenges o Conditional Support for Quality Care • Use of Purpose-Built Facility o Underuse of Purpose-Built Facility • Distrust of Motivations o Suspicion of Cost-Cutting • Demographic and Demand Considerations o Ageing Population Needs • Impact on Other Services o Pressure on Healthcare System There were 23 respondents to the Staff, Professionals and Wider Partners survey. 96% (22 out of 23 participants), are residents of the Isle of Arran while only 4% (1 participant) is not. The majority of respondents (61%) did not support the proposed change. Four professionals (17%) agreed with the proposal, with only one qualifying their feedback by stating, "If that's all we can staff, it's all we can staff." Questions 3.5 – 3.7 refer to the ‘Three Key needs (or aims) of the Equality Duty’ 3.5 Which aspects of the policy eliminate unlawful discrimination, harassment and victimisation? This proposed changes at Montrose House does not create unlawful discrimination, harassment and victimisation. The continued provision of care home beds and the re-instatement of day services for older people, support older people on the island to remain linked to their families and local community. 3.6 Which aspects of the policy advance equality of opportunity between people who share a relevant protected characteristic and those who do not?
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Version: 6.0 14 This proposed changes at Montrose House does not advance equality of opportunity between people who share a relevant protected characteristic and those who do not. The continued provision of care home beds and the re-instatement of day services for older people, support older people on the island to remain linked to their families and local community who may not have protected characteristics. It is recognised that the proposal for b) Montrose house bed reduction, could have a negative impact older people and their families if they cannot be accommodated in Montrose House. It is recognised that a person’s spouse, partner and other family members may not be able to visit as frequently. 3.7 Which aspects of the policy foster good relations between people who share a protected characteristic and those who do not? (Does it tackle prejudice and promote a better understanding of equality issues). This proposed changes at Montrose House foster good relations between people who share a protected characteristic and those who do not as the continued provision of care home beds and the re-instatement of day services for older people, continues to support older people on the island to remain linked to their families and members of the local community who may not have protected characteristics. It is recognised that the proposal for b) Montrose house bed reduction, could have a negative impact older people and their families if they cannot be accommodated in Montrose House. It is recognised that a person’s spouse, partner and other family members may not be able to visit as frequently. 3.8 If you have identified any negative impacts of your proposal how will you mitigate these? The implementation of the proposals for b) Montrose house bed reduction, could have a negative impact older people and their families if they cannot be accommodated in Montrose House. It is recognised that a person’s spouse, partner and other family members may not be able to visit as frequently. It is recognised that some family members may also be older or have disabilities. It is recognised that this may cause anxiety and distress to both the resident and family members; and although the island social work teams will work with families to reduce their isolation e.g. referrals for support from carers groups, all of this distress cannot be mitigated against. The review and development of c) a new admissions policy, will be informed by stakeholder engagement. It is the ambition that this will create an approach to prioritise those with familial ties on the island and if requested, there will be the opportunity for service users to be on a prioritised waiting list for transfer back to the island when there is bed availability.
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Version: 6.0 15 In the event that a relative requires to move off island for residential care, currently the foot passenger day return cost is £ 10.20 per adults and £5.10 per child; subject to concessions. There may also be bus/train fares from ferry to home and ferry to care home. It also costs £51.20 to take a car on a return trip. There may also be car fuel costs from ferry to home and ferry to care home. The HSCP has no mechanisms available to reduce or mitigate these costs, noting the responsibility only extends to providing care and support for the individual requiring access to residential care. The development of a) older people day services should offer more places than a traditional day service model and this will provide spouses, partners and families with additional respite opportunities. 3.9 Is the policy or practice intended to promote equality by permitting positive action or lead to positive outcomes for people based on a protected characteristic? The proposals for Montrose House promote positive actions through the delivery of safe care models, with the appropriate levels of staff who are suitably qualified. a) The older people day services should offer more places than a traditional day service model and this will provide spouses, partners and families with additional respite opportunities. b) The Montrose house bed reduction will ensure safe staffing levels, improved quality of care and better outcomes for residents at Montrose House.
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Version: 6.0 16 Section 4 – The Fairer Scotland Duty The Fairer Scotland Duty (‘the Duty’), Part 1 of the Equality Act 2010 places a legal responsibility on the Council to actively consider (‘pay due regard to’) how we can reduce inequalities of outcome caused by socio-economic disadvantage when making decisions. 4.1 Does the proposal have the potential to have a significant impact on inequalities of outcome caused by socio-economic disadvantage? (consider low income; low wealth; material deprivation; area deprivation; communities of place or interest, socio-economic background). Yes ☒ No ☐ If No, please go to Section 5. If Yes please provide more information under any of the below headings which are relevant, highlighting any evidence and sources of evidence used to inform your information. 4.2 Low Income/Income Poverty: Cannot afford to maintain regular payments such as bills, food and clothing. Although 87% of Arran has a gross household income (£31k), which is above the North Ayrshire median (£24K) in almost 9 out of 10 Arran postcodes (875). It is recognised that due to the rural nature of the island, there are higher living costs and longer travel times. It is also recognised that the majority of individuals affected at Montrose House will be over the age of 65 years and living on retirement pensions. In the event that a relative requires to move off island for residential care, currently the foot passenger day return cost is £ 10.20 per adults and £5.10 per child; subject to concessions. There may also be bus/train fares from ferry to home and ferry to care home. It also costs £51.20 to take a car on a return trip. There may also be car fuel costs from ferry to home and ferry to care home. The HSCP has no mechanisms available to reduce or mitigate these costs, noting the responsibility only extends to providing care and support for the individual requiring access to residential care. 4.3 Low/and or no wealth: Having enough money to meet basic living costs and pay bills but have no savings to pay for any unexpected spends and no provision for the future.
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Version: 6.0 17 Although 87% of Arran has a gross household income (£31k), which is above the North Ayrshire median (£24K) in almost 9 out of 10 Arran postcodes (875). It is recognised that due to the rural nature of the island, there are higher living costs and longer travel times. It is also recognised that the majority of individuals affected at Montrose House will be over the age of 65 years and living on retirement pensions. In the event that a relative requires to move off island for residential care, currently the foot passenger day return cost is £ 10.20 per adults and £5.10 per child; subject to concessions. There may also be bus/train fares from ferry to home and ferry to care home. It also costs £51.20 to take a car on a return trip. There may also be car fuel costs from ferry to home and ferry to care home. The HSCP has no mechanisms available to reduce or mitigate these costs. 4.4 Material Deprivation: Being unable to access basic goods and services, i.e. financial products like life insurance, repair/replace broken electrical goods, warm home, leisure/hobbies. N/A 4.5 Area Deprivation: Where you live (rural areas), where you work (accessibility of transport. Although 87% of Arran has a gross household income (£31k), which is above the North Ayrshire median (£24K) in almost 9 out of 10 Arran postcodes (875). It is recognised that due to the rural nature of the island, there are higher living costs and longer travel times. It is also recognised that the majority of individuals affected at Montrose House will be over the age of 65 years and living on retirement pensions. In the event that a relative requires to move off island for residential care, currently the foot passenger day return cost is £ 10.20 per adults and £5.10 per child; subject to concessions. There may also be bus/train fares from ferry to home and ferry to care home. It also costs £51.20 to take a car on a return trip. There may also be car fuel costs from ferry to home and ferry to care home. The HSCP has no mechanisms available to reduce or mitigate these costs. 4.6 If impacts have been identified how will these be mitigated or explored in more detail? (please outline below)
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Version: 6.0 18 The HSCP has no mechanisms available to reduce or mitigate travel costs for spouses, partners of families to visit relatives placed in a mainland care home. Section 5 – Children’s Rights When considering the Children’s Right’s Impact process, some of the key considerations include any evidence, research and consultation (specifically including any consultation or engagement with young people). 5.1 Are any Children’s Rights impacted by this proposal? (please refer to Appendix 1 of this document, where the Children’s Rights Articles have been matched against the Getting It Right For Every Child (GIRFEC) wellbeing indicators. This is solely to make it easier to identify which rights might be impacted on; the Rights are the key element of this section). Yes ☐ No ☒ 5.2 Please indicate, if possible, how many children and young people (nearest estimate) are likely to be affected by the policy or measure? Although children may visit relatives living in Montrose House or those living in mainland care homes, they are not materially affected by the proposals. 5.3 Are some children and young people more likely to be affected than others? Yes ☐ No ☐ If, Yes what groups? (consider protected characteristics – e.g. disabled young people, LGBT etc) Click or tap here to enter text.
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Version: 6.0 19 5.4 What Children’s Rights are likely to be affected by the policy/proposal? Please refer to Table 2 (Appendix 1) ‘Links between Wellbeing Indicators and Articles of the UNCRC’ and insert the relevant rights and indicators in the table below. Wellbeing indicator (e.g. safe, healthy etc) Children’s Right (e.g. 22 – refugee children) Click or tap here to enter text. Click or tap here to enter text. 5.5 What likely impact will the policy/proposal have on Children’s Rights and Wellbeing? Either Positive, Negative or Neutral. Children Rights - Click or tap here to enter text. Other Protected Characteristics Click or tap here to enter text. 5.7 What consultation or engagement has taken place with young people? Click or tap here to enter text. 5.6 If Negative impacts are identified how will these be mitigated, or the effect reduced? Click or tap here to enter text.
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Version: 6.0 20 Section 6 – Island Communities Impact (or Island Proofing) Island Proofing is about considering the particular needs and circumstances of island communities when public sector organisations exercise their functions and make decisions. This has been added to the process of assessing the Council Plan and includes a range of issues such as access to services, digital connectivity, employment and access to education, transport and access to goods and services. 6.1 Do the intended outcomes of the proposal potentially differ or have a different impact for our Island Communities? Yes ☒ No ☐ 6.2 What are the potential impacts for our Island Communities? A full Island Impact assessment has been completed and is available online. Montrose House Care home is on the Isle of Arran and is undertaking a review with the following proposals: a) Older People Day Service – the traditional day service provision closed due to infection control requirements during the Covid 19 pandemic and has not re-opened. A service review, alongside stakeholder engagement, is taking place to identify a day service model which will best meet the needs of future service users, and their carers. Proposal to explore a hybrid day-case model, which will be provided in-house and community-based working alongside the activity coordinator. b) Montrose House continues to face significant operational challenges related to staffing levels, due to the limited availability of social care trained staff on the island. As a result of these staffing challenges there has been a reliance on agency workers, to ensure safe staffing levels within the home. Unfortunately, at times agency staff cover can be irregular, which affects the continuity and quality of care delivery. The Montrose House Care Home budget has been overspent over the last 2 financial years. There are currently 12 residents, and the option appraisal proposal recommends a reduction from 15 permanent beds to 10 permanent care beds and 1 respite bed. This will improve service resilience, safety and quality, by having a sustainable service with a staffing model which does not rely on agency staff. If achieved, this will result in improved safe care delivery and the overspend being reduced significantly. c) The review is also proposing the development of an admissions policy to prioritise those with familial ties on the island to access the Montrose House beds. The proposed reduction in beds will result in safer staffing levels for Montrose House residents and higher levels of continuity of care which lead to better outcomes for people. However bed reductions may, reduce availability to beds for some individuals which means they will have to be supported off island.
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Version: 6.0 21 It is recognised that this may cause anxiety and distress for residents and family members; and although the island social work teams will work with families to reduce their isolation e.g. referrals for support from carers groups, all of this distress cannot be mitigated against. If requested, there will be the opportunity for service users who require to move to a bed place off island, to be on a prioritised waiting list for transfer back to the island when there is bed availability. It is recognised that due to the rural nature of the island, there are higher living costs and longer travel times. It is also recognised that the majority of individuals affected at Montrose House will be over the age of 65 years and living on pensions. In the event that a relative requires to move off island for residential care, currently the foot passenger day return cost is £ 10.20 per adults and £5.10 per child; subject to concessions. There may also be bus/train fares from ferry to home and ferry to care home. It also costs £51.20 to take a car on a return trip. There may also be car fuel costs from ferry to home and ferry to care home. The HSCP has no mechanisms available to reduce or mitigate these costs. 6.3 Please explain if the impacts are different for communities on different islands? We have also completed the island impact assessment. Montrose House is the only Health and social care partnership managed care home in North Ayrshire. The options appraisal highlighted the scale of care homes offered in island communities across Scotland. As there is no planned closure of Montrose House, Arran reflects the national island position. 6.4 What consultation or engagement has taken place with the Island Communities? Significant engagement has taken place as described in 3.4 of this report and a full summary of the engagement is available on the IJB webpage of the North Ayrshire Council website. 6.5 How will you address any potential barriers or wider impacts for Island Communities as identified through this assessment? The barriers have been identified by the Arran community during the engagement process and are described in section 3.4 of this report. This impact assessment clearly described where mitigations to those barriers cannot be demonstrated.
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Version: 6.0 22 Section 7 – The Consumer Duty The Consumer Duty is about the impact of Council proposals on consumers in Scotland. A Consumer is an individual or a small business that purchases, uses or receives goods or services in Scotland, that are supplied either by a business or a public body – please see What is the Consumer Duty. 7.1 Will your proposal impact on consumers? Yes ☒ No ☐ If no, please complete the ‘Assessment not required’ template by emailing northayrshireperforms@north-ayrshire.gov.uk 7.2 What are the impacts, if any, on consumers in general? Is it likely that consumers will experience harm because of this proposal? With the proposed reduction from the current 12 residents to 10 permanent beds and 1 respite bed; In the event that a relative requires to move off island for residential care, it is recognised that this may cause anxiety and distress for the resident and family member; and although the island social work teams will work with families to reduce their isolation e.g. referrals for support from carers groups, all of this distress cannot be mitigated against. There will also be longer travel times and additional travel expenses. Currently the foot passenger day return cost is £ 10.20 per adults and £5.10 per child; subject to concessions. There may also be bus/train fares from ferry to home and ferry to care home. It also costs £51.20 to take a car on a return trip. There may also be car fuel costs from ferry to home and ferry to care home. The HSCP has no mechanisms available to reduce or mitigate these costs. 7.3 What are the impacts if any, on consumers in vulnerable circumstances? Is it likely that consumers in vulnerable circumstances will experience harm because of this proposal? (please include any relevant evidence or engagement with consumers) *Vulnerable circumstances may be temporary in nature and may or may not arise as a resulted of a consumer’s protected characteristics. For more information, please see page 31 of Consumer Scotland’s draft guidance on the consumer duty. In the event that a relative requires to move off island for residential care, it is recognised that this may cause anxiety and distress for the resident and family member; and although the island social work teams will work with families to
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Version: 6.0 23 reduce their isolation e.g. referrals for support from carers groups, all of this distress cannot be mitigated against. There will also be longer travel times and additional travel expenses. Currently the foot passenger day return cost is £ 10.20 per adults and £5.10 per child; subject to concessions. There may also be bus/train fares from ferry to home and ferry to care home. It also costs £51.20 to take a car on a return trip. There may also be car fuel costs from ferry to home and ferry to care home. The HSCP has no mechanisms available to reduce or mitigate these costs. . 7.4 What consultation and engagement has taken place with consumers around your proposal? Significant engagement has taken place as described in 3.4 of this report and a full summary of the engagement is available on the IJB webpage of the North Ayrshire Council website. 7.5 What alternative proposals are there that could improve outcomes for consumers and/or reduce harm to consumers? How do these compare to the original proposal? An option appraisal alongside stakeholder engagement took place and no amendments to the proposals were made.
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Version: 6.0 24 Section 8 – Crosscutting Impacts 8.1 Have any cross-cutting impacts been identified from other Council Services or Partner Agencies (multiple discrimination or accumulated effects of multiple proposals on a protected characteristic group)? None identified. 8.2 If Crosscutting issues identified with other Services, what discussion/interaction has taken place to mitigate any potential negative impacts of accumulated proposals? None identified.
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Version: 6.0 25 Section 9 – Outcome of the Assessment 9.1 Please detail the outcome of the assessment: 1. No major alterations to the policy assessed: the Impact Assessment demonstrates the policy is robust and there is no possible discrimination or adverse impact. All opportunities to minimise negative impacts and enhance positive outcomes have been taken. ☐ Or 2. Adjust the policy: the Impact Assessment identifies potential problems or missed opportunities. Adjust the policy to address any issues identified or to better promote equality. ☐ Or 3. Continue the policy: the Impact Assessment identifies the potential for adverse impact or missed opportunities to promote equality. Set out the justifications for continuing with it in section 9.3. For the most important policies and proposals, compelling reasons will be needed. ☒ Or 4. Stop and remove the policy/proposal: following assessment a decision has been taken not to proceed with the proposal for examples due to actual or potential unlawful discrimination or other harmful impact. ☐ 9.2 For Outcome 2. in section 9.1 above - please detail recommendations, including any action required to address negative impacts identified or to better promote equality. Click or tap here to enter text. 9.3 If Outcome 3 is chosen from section 9.1 above, please outline the justifications for continuing the policy/procedure. The quality and continuity of care and maintaining the provision of safe staffing levels for residents are the key priorities for the ongoing provision of registered residential and nursing care services at Montrose House. The IJB faces significant financial pressures and the additional cost of 15 beds due to additional bank and agency staffing has been £0.5m, this is also not sustainable financially. The HSCP has demonstrated over a period of time the significant efforts to attempt to secure high quality care and to mitigate and present solutions to the acute workforce challenges. Despite these efforts, interventions and investment there remain significant workforce challenges and a fragile situation in managing safe staffing levels at Montrose House. As a result, there has been a requirement to pause new admissions to the care home and the current proposals to implement a reduction in beds at Montrose
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Version: 6.0 26 House to 10 permanent and 1 respite bed alongside the implementation of a hybrid day service model remain the recommended way forward. Any changes to the current bed numbers will be managed sensitively and no current residents affected, unless their needs can no longer be met at Montrose House or they choose to leave the care home. There will also be exploration of an admissions policy for future priority of access to Montrose House beds. It is not acceptable or tolerable for the Health and Social Care Partnership to compromise either resident or staff safety and the proposals recommended mitigate the current risks from the 30% vacancy rate and ongoing use of agency and bank staff. The HSCP recognises the high level of engagement with 10% of the island putting forward their views, and also the strong level of opposition from the island community and island staff group about the proposed bed reduction. The HSCP also acknowledges the distress caused to families and service users who have to be placed in care off island and the extra costs that this will generate for people to visit, noting that there are currently a greater proportion of residents cared for off-island than in Montrose House. However, it is the duty of all public organisations to deliver care safely, meeting Care Inspectorate requirements, whilst utilising public funds in an efficient manner. The HSCP recognises that care in Montrose House will continue to be more expensive than the alternative cost of mainland care home placement, being 3.5 times more per individual in comparison. However, there continues to be a commitment to delivering a local care home service from Montrose House and the further development of integrated island services from the site if safe staffing levels can be secured and maintained. The Health and Care (Staffing) (Scotland) Act 2019, places legal duties on care home providers to ensure sufficient staffing levels and appropriate staff training – those legal requirements are required to be considered when Local Authorities and Integration Authorities plan and commission services. 9.4 Please state the key issues, recommendations and future actions arising from the Integrated Impact Assessment. In order to ensure the quality of care, continuity of care and safe staffing levels, the current proposals will proceed to implement a reduction in beds at Montrose House to 10 permanent and 1 respite bed and begin the implementation of a hybrid day service model. There will also be exploration of an admissions policy for Montrose House beds.
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Version: 6.0 27 Section 10 – Monitoring 10.1 Describe how you will monitor the impact of this policy e.g. performance indicators used, other monitoring arrangements, who will monitor progress, criteria used to measure if outcomes are achieved, timescales including any future reviews of the impact of the proposal? The issue of staffing levels to ensure safe care will be monitored on a daily basis. Plans for admissions and waiting lists are also reviewed daily by the Integrated Island Team. The development of the new day services model will also be monitored on a monthly basis as the new model develops. The plans to develop a new admissions policy will also be subject to further engagement, at a later stage. Section 11 – Sign Off 11.1 Head of Service who has approved the impact assessment. Name: Kerry Logan Title: Head of Service Date: 13082025 Section 12 – Publication 12.1 Following approval by Head of Service, completed Impact Assessments need to be published on the Council’s External Website. Please email: northayrshireperforms@north-ayrshire.gov.uk
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Version: 6.0 28 Appendix 1 - GIRFEC Wellbeing Indicators and Children’s Rights Table 1 - GIRFEC Wellbeing Indicators Safe Protected from abuse, neglect and harm Healthy Having the best possible standards of physical and mental health; support to make healthy, safe choices Achieving Accomplishing goals and thereby boosting skills, confidence and self-esteem; ‘being all they can be’. Nurtured Having a loving and stimulating place to live and grow Active Having opportunities to take part in a wide range of activities Respected Being enabled to understand their world, being given a voice, being listened to, and being involved in the decisions that affect their wellbeing. Responsible Taking an active role within their home, school and community. Included Being a full member of the communities in which they live and learn; receiving help and guidance to overcome inequalities.
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Version: 6.0 29 Articles of the UNCRC matched against the GIRFEC indicators. Summary of the UNCRC Articles from 1 – 54 (UNICEF) Table 2 - Links between Wellbeing Indicators and Articles of the UNCRC *Please note in general the use of the term Governments, includes public sector organisations such as the Council, some articles will have stronger relevance for the work of the Council than others. Wellbeing Indicator – Safe There are 12 relevant articles of the UNCRC (Rights of the Child) linked to the Safe indicator. Article 9 – Separation from parents Children must not be separated from their parents against their will unless it is in their best interests (for example, if a parent is hurting or neglecting a child). Children whose parents have separated have the right to stay in contact with both parents, unless this could cause them harm. 10 – Family reunification Governments must respond quickly and sympathetically if a child or their parents apply to live together in the same country. If a child’s parents live apart in different countries, the child has the right to visit and keep in contact with both of them. 11 - Abduction and non-return of children Governments must do everything they can to stop children being taken out of their own country illegally by their parents or other relatives or being prevented from returning home. 19 - Protection from violence, abuse and neglect Governments must do all they can to ensure that children are protected from all forms of violence, abuse, neglect and bad treatment by their parents or anyone else who looks after them. Children and Young People have the right to be kept safe from harm. They must be given proper care by those looking after them. 22 - Refugee children If a child is seeking refuge or has refugee status, governments must provide them with appropriate protection and assistance to help them enjoy all the rights in the Convention. Governments must help refugee children who are separated from their parents to be reunited with them. Children and Young People have the right to special help and be allowed to live somewhere that is safe if they are a refugee.
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Version: 6.0 30 32 - Child labour Governments must protect children from economic exploitation and work that is dangerous or might harm their health, development or education. Governments must set a minimum age for children to work and ensure that work conditions are safe and appropriate. If they are under 16 there are laws about where, when and for how long they can work. 33 - Drug abuse Governments must protect children from the illegal use of drugs and from being involved in the production or distribution of drugs. 34 - Sexual exploitation Governments must protect children from all forms of sexual abuse and exploitation. Children and Young People have the right to never be pressurised or forced into doing anything sexual. They have the right to be protected from it. 35 - Abduction, sale and trafficking Governments must protect children from being abducted, sold or moved illegally to a different place in or outside their country for the purpose of exploitation. People should never make them do anything against their will, like marry someone for instance. 36 - Other forms of exploitation Governments must protect children from all other forms of exploitation, for example the exploitation of children for political activities, by the media or for medical research. Children and Young People have the right to be protected from being taken advantage of in any way. 37 - Inhumane treatment and detention Children and Young People have the right to be treated with respect. If they have committed a crime children should be arrested, detained or imprisoned only as a last resort and for the shortest time possible. They must be treated with respect and care and be able to keep in contact with their family. Children must not be put in prison with adults. They should not be locked up unless it is absolutely necessary, and they will get legal help. 38 - War and armed conflicts Governments must not allow children under the age of 15 to take part in war or join the armed forces. Governments must do everything they can to protect and care for children affected by war and armed conflicts. In Scotland, they have to be 16 to join the armed forces and are not normally allowed to fight until they are 18.
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Version: 6.0 31 Wellbeing Indicator – Healthy There are 4 relevant articles of the UNCRC (Rights of the Child) linked to the Healthy indicator. 3 – Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. 6 – Life, survival and development Every child has the right to life. Governments must do all they can to ensure that children survive and develop to their full potential. Children and Young People have the right to be kept safe from harm, they have the right to be alive, survive and develop through life. 24 - Health and health services Every child has the right to the best possible health. Governments must provide good quality health care, clean water, nutritious food, and a clean environment and education on health and well-being so that children can stay healthy. Children and Young People have the right to be given good healthcare (if they are ill) so they can get well again. They have the right to live in a safe, healthy environment with good food and clean drinking water. 39 - Recovery and rehabilitation of child victims Children who have experienced neglect, abuse, exploitation, torture or who are victims of war must receive special support to help them recover their health, dignity, self-respect and social life.
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Version: 6.0 32 Wellbeing Indicator – Achieving There are 4 relevant articles of the UNCRC (Rights of the Child) linked to the Achieving indicator. 4 – Implementation of the Convention Governments must do all they can to make sure every child can enjoy their rights by creating systems and passing laws that promote and protect Children’s Rights. Children and Young People have the right to have their rights protected and an environment where they can grow up safe. 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. 28 - Right to education Every child has the right to an education. Primary education must be free and different forms of secondary education must be available to every child. Discipline in schools must respect children’s dignity and their rights. Richer countries must help poorer countries achieve this. In Scotland education is free and children three years old+ are entitled to a free nursery place. 29 - Goals of education Education must develop every child’s personality, talents and abilities to the full. It must encourage the child’s respect for human rights, as well as respect for their parents, their own and other cultures, and the environment. It must help to prepare them for adult life.
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Version: 6.0 33 Wellbeing Indicator – Nurtured There are 8 relevant articles of the UNCRC (Rights of the Child) linked to the Nurtured indicator. 4 – Implementation of the Convention Governments must do all they can to make sure every child can enjoy their rights by creating systems and passing laws that promote and protect children’s rights Children and Young People have the right to have their rights protected and an environment where they can grow up safe. 5 - Parental guidance and a child’s evolving capacities Every child has the right to be registered at birth, to have a name and nationality, and, as far as possible, to know and be cared for by their parents. Children and Young People have the right to their parents being responsible to guide them through their childhood and help them learn how to use their rights. 9 – Separation from parents Children must not be separated from their parents against their will unless it is in their best interests (for example, if a parent is hurting or neglecting a child). Children whose parents have separated have the right to stay in contact with both parents, unless this could cause them harm. 10 – Family reunification Governments must respond quickly and sympathetically if a child or their parents apply to live together in the same country. If a child’s parents live apart in different countries, the child has the right to visit and keep in contact with both of them. 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. 20 - Children deprived of a family If a child cannot be looked after by their immediate family, the government must give them special protection and assistance. This includes making sure the child is provided with alternative care that is continuous and respects the child’s culture, language and religion. Children and Young People have the right to special care if they can’t live with their parents. They may be looked after by other members of their family or by a different family. 21 - Adoption Governments must oversee the process of adoption to make sure it is safe, lawful and that it prioritises children’s best interests. Children should only be adopted
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Version: 6.0 34 outside of their country if they cannot be placed with a family in their own country. 25 - Review of treatment in care If a child has been placed away from home for the purpose of care or protection (for example, with a foster family, in hospital, a care home or somewhere else away from home), they have the right to a regular review of their treatment, the way they are cared for and their wider circumstances to help make sure they are still getting what’s best for them. 27 - Adequate standard of living Every child has the right to a standard of living that is good enough to meet their physical and social needs and support their development. Governments must help families who cannot afford to provide this. Children and Young People have the right to a safe place to live, food, clothing and to take part in things they enjoy.
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Version: 6.0 35 Wellbeing Indicator – Active There are 8 relevant articles of the UNCRC (Rights of the Child) linked to the Nurtured indicator. 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. 23 - Children with disabilities A child with a disability has the right to live a full and decent life with dignity and, as far as possible, independence and to play an active part in the community. Governments must do all they can to support disabled children and their families. Children and Young People have the right to if they have any kind of disability, have special help to make sure they can join in with things. 31 - Leisure, play and culture Children and Young People have the right to rest, play and have the chance to join a wide range of artistic and cultural activities. It is really important to remember to have a balance in their life.
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Version: 6.0 36 Wellbeing Indicator – Respected There are 12 relevant articles of the UNCRC (Rights of the Child) linked to the Nurtured indicator. 2 - Non-discrimination Children and Young People have the right to have the convention that applies to everyone under the age of 18, no matter who they are, whether they are a boy or a girl, what their religion is, whether they have a disability, or what type of family they come from. 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. 4 – Implementation of the Convention Governments must do all they can to make sure every child can enjoy their rights by creating systems and passing laws that promote and protect children’s rights. Children and Young People have the right to have their rights protected and an environment where they can grow up safe. 5 - Parental guidance and a child’s evolving capacities Every child has the right to be registered at birth, to have a name and nationality, and, as far as possible, to know and be cared for by their parents. Children and Young People have the right to their parents being responsible to guide them through their childhood and help them learn how to use their rights. 8 - Protection and preservation of identity Every child has the right to an identity. Governments must respect and protect that right, and prevent the child’s name, nationality or family relationships from being changed unlawfully. Children and Young People have the right to know who they are – official records should be kept. If they are over 16 years old and adopted, they can try to find out who their birth parents are. 12 - Respect for the views of the child Every child has the right to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously. This right applies at all times, for example during immigration proceedings, housing decisions or the child’s day-to-day home life. Children and Young People have the right to speak up and have their opinions listened to and be taken seriously by adults on things that affect them.
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Version: 6.0 37 13 - Freedom of expression Every child must be free to express their thoughts and opinions and to access all kinds of information, as long as it is within the law. Children and Young People have the right to say whatever they believe as long as it does not harm or offend other people. They also have the responsibility to respect the rights and freedom of others. 14 - Freedom of thought, belief and religion Every child has the right to think and believe what they choose and also to practise their religion, as long as they are not stopping other people from enjoying their rights. Governments must respect the rights and responsibilities of parents to guide their child as they grow up. Children and Young People have the right to choose their own religion and beliefs. Their parents should help them think about this. 16 - Right to privacy Every child has the right to privacy. The law should protect the child’s private, family and home life, including protecting children from unlawful attacks that harm their reputation, for example, they shouldn’t have their personal letters opened or anyone listening in to their personal phone calls. 17 - Access to information; mass media Every child has the right to reliable information from a variety of sources, and Governments should encourage the media to provide information that children can understand. Governments must help protect children from materials that could harm them. Children and Young People have the right to access information which is important to their wellbeing. Adults should help them find information they are looking for and make sure it’s not harmful. 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. 30 - The right to learn and use the language, customs and religion of their family Every child has the right to learn and use the language, customs and religion of their family, whether or not these are shared by the majority of the people in the country where they live.
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Version: 6.0 38 Wellbeing Indicator – Responsible There are 5 relevant articles of the UNCRC (Rights of the Child) linked to the Responsible indicator. 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. 12 - Respect for the views of the child Every child has the right to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously. This right applies at all times, for example during immigration proceedings, housing decisions or the child’s day-to-day home life. Children and Young People have the right to speak up and have their opinions listened to and be taken seriously by adults on things that affect them. 14 - freedom of thought, conscience and religion Every child has the right to think and believe what they choose and also to practise their religion, as long as they are not stopping other people from enjoying their rights. Governments must respect the rights and responsibilities of parents to guide their child as they grow up. Children and Young People have the right to choose their own religion and beliefs. Their parents should help them think about this. 15 - Freedom of association Every child has the right to meet with other children and to join groups and organisations, as long as this does not stop other people from enjoying their rights. 40 - Juvenile justice A child accused or guilty of breaking the law must be treated with dignity and respect. They have the right to legal assistance and a fair trial that takes account of their age. Governments must set a minimum age for children to be tried in a criminal court and manage a justice system that enables children who have been in conflict with the law to reintegrate into society. Children and Young People have the right to be given legal assistance if they have committed a crime. The Convention also states that they should only be sent to prison if they have committed a serious crime.
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Version: 6.0 39 Wellbeing Indicator – Included There are 5 relevant articles of the UNCRC (Rights of the Child) linked to the Included indicator. 3 - Best interests of the child The best interests of the child must be a top priority in all decisions and actions that affect children. Children and Young People have the right to have their interests considered if a decision is being made by any person about them. What is best for them is what matters. 6 - Life, survival and development Every child has the right to life. Governments must do all they can to ensure that children survive and develop to their full potential. Children and Young People have the right to be kept safe from harm, they have the right to be alive, survive and develop through life. 18 - Parental responsibilities and state assistance Both parents share responsibility for bringing up their child and should always consider what is best for the child. Governments must support parents by creating support services for children and giving parents the help they need to raise their children. 23 - Children with disabilities A child with a disability has the right to live a full and decent life with dignity and, as far as possible, independence and to play an active part in the community. Governments must do all they can to support disabled children and their families. Children and Young People have the right to special help to make sure they can join in with things. 26 - Social security Every child has the right to benefit from social security. Governments must provide social security, including financial support and other benefits, to families in need of assistance. 27 - Adequate standard of living Every child has the right to a standard of living that is good enough to meet their physical and social needs and support their development. Governments must help families who cannot afford to provide this. Children and Young People have the right to a safe place to live, food, clothing and to take part in things they enjoy.
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1 APPENDIX 1 - ISLAND COMMUNITIES IMPACT ASSESSMENT ISLE OF ARRAN Please ensure this template is completed in conjunction with the Island Communities Impact Assessment (ICIA) Guidance on the Scot Gov Website Name of Policy, Strategy or Service Montrose House - Arran STEP ONE – DEVELOP A CLEAR UNDERSTANDING OF YOUR OBJECTIVES What are the objectives of the policy, strategy or service? Montrose House Care home on the Isle of Arran is undertaking a review of the existing services due to the following: a) Older People Day Service – the traditional day service provision closed due to infection control requirements during the Covid 19 pandemic and has not re-opened. A service review, alongside stakeholder engagement, is taking place to identify a day service model which will best meet the needs of future service users, and their carers. Proposal to explore a hybrid day-case model, that will be provided in-house and community-based working alongside the activity coordinator b) Montrose House continues to face significant operational challenges related to staffing levels, due to the limited availability of social care trained staff on the island. As a result of these staffing challenges there has been a reliance on agency workers, to ensure safe staffing levels within the home. Unfortunately, at times agency staff cover can be irregular, which affects the continuity and quality of care delivery. As a result the Montrose House Care Home budget has been overspent over the last 2 financial years. There are currently 12 residents, and the option appraisal proposal recommends a reduction from 15 permanent beds to 10 permanent care beds and 1 respite bed. This will improve service resilience, safety and quality, by having a sustainable service with a staffing model which does not rely
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2 on agency staff. If achieved, this will result in improved safe care delivery and the overspend being reduced significantly. c) The review is also proposing the development of an admissions policy to prioritise those with familial ties on the island to access the Montrose House beds.
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3 Do you need to consult? The service review requires robust engagement, and this is captured at in section 3 of this report. The engagement will influence the proposals and identify key barriers for mitigation, where this is available. How are islands identified for the purpose of the policy, strategy or service? This policy would only apply to Montrose House Care home on the Isle of Arran What are the intended impacts / outcomes and how do these potentially differ in the islands? – EMPHASISE HOW IT DIFFERS FROM MAINLAND Montrose House on Arran is the only Health and Social Care Partnership managed care home and as a result this policy does not apply to the mainland or the Isle of Cumbrae, where care homes are delivered by the private independent sector. Is the policy, strategy or service new? Yes. Although the service at Montrose House is well established the following new changes are proposed: a) Older People Day Service – the traditional day service provision closed due to infection control requirements during the Covid 19 pandemic and has not re-opened. A service review, alongside stakeholder engagement, is taking place to identify a day service model which will best meet the needs of future service users, and their carers. Proposal to explore a hybrid day-case model, that will be provided in-house and community-based working alongside the activity coordinator b) Montrose House continues to face significant operational challenges related to staffing levels, due to the limited availability of social care trained staff on the island. As a result of these staffing challenges there has been a reliance on agency workers, to ensure safe staffing levels within the home. Unfortunately, at times agency staff cover can be irregular, which affects the continuity and quality of care delivery. As a result the Montrose House Care Home budget has been overspent over the last 2 financial years. There are currently 12 residents, and the option appraisal proposal recommends a reduction from 15 permanent beds to 10 permanent care beds and 1 respite bed. This will improve service resilience, safety and quality, by having a sustainable service with a staffing model which does not rely on agency staff. If achieved, this will result in improved safe care delivery and the overspend being reduced significantly.
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4 c) The review is also proposing the development of an admissions policy to prioritise those with familial ties on the island to access the Montrose House beds. STEP TWO – GATHER YOUR DATA AND IDENTIFY YOUR STAKEHOLDERS What data is available about the current situation in the islands? There has been the collection and analysis of a wide range of data sources: 1. Arran Locality Profile 2017 [http://northayrshire.community/wp- content/uploads/2018/02/Locality-Profile_Arran_Final_Version_Sept2017.pdf] 2. Arran Integrated Island Service Review - Initial Review 20th July 2020 [2020-08-17-bm- p24-arran-integrated-island-services-initial-agreement.pdf] 3. Isle of Arran – Local Island Plan March 2022 [https://www.north- ayrshire.gov.uk/Document-library/arran-local-island-plan.pdf] 4. Scottish Census 2022 [https://www.scotlandscensus.gov.uk/] 5. Health & Social Care Partnership – Integrated Island Services Management Information on workforce, workforce recruitment, financial, resident needs, etc. [internal – not for publication] Do you need to consult? Yes. Montrose House Engagement - Goals of Engagement The engagement will provide background information and awareness of the proposals a) older people day services b) Montrose house bed reduction and c) a new admissions policy. The proposals will highlight the positive changes, such as the re-introduction of hybrid day- case model, that will be provided in-house and community-based working alongside the
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5 activity coordinator. It will be helpful to get feedback on this approach, from community views of a workable model. The engagement will include reasons for the proposals, driven by critical staffing challenges and focussing on the difficulty in providing safe person-centred care. This will also highlight the financial pressures created due to the use of agency staff. The engagement event will provide an awareness of the admission processes/ waiting list for beds if assessed as suitable for Montrose House. What we want to achieve from engagement? Receiving feedback on the proposals; as well as providing reassurance and alleviate any concerns the community may have. This information will be fed back to the NAHSCP senior management team and will be included in the updated ECRIA and IJB report for submission in August 2025. Montrose House Engagement drop in Event was held within Montrose House by the Arran Senior Management team on 22nd July 2025 from 1000-1200. The audience was the public, residents, families, and visitors. The drop-in session will include: • public, residents, families, and visitors provided with a leaflet/flyer in Montrose House for the Questionnaire/Online Survey. Survey can be accessed by a QR code but paper copies available for completion at face-to-face sessions and uploaded later. • Prepared, clear concise answers to questions that might be raised to ensure that all staff participating in the event are collectively sharing the same information. The details of the drop-in were emailed to 16 community groups; the details of which were provided by the Arran Community Voluntary Organisation. These groups included Brodick and Lamlash Sheltered Housing complexes, Older People Groups, Lunch Clubs, Community Councils, and patient participation groups. Posters about the drop-in session were shared at Montrose House and GP surgeries. Service Users and Partner staff
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6 The Questionnaire/Online Survey using a QR code was available, from 15 July 2025 to 1st August 2025; with paper copies available too for completion. Members of the public were provided with support from variety of HSCP staff. 1. Care at Home & Alert service users - completion supported by Care at home staff. 2. District Nursing caseload patients-completion supported by District Nursing staff. 3. patient participation groups- support from primary care 4. Relevant community groups-Vicki Yuill ACVS providing contact details. 5. Support from engagement team required with preparation of survey/questionnaire, QR code and analysis/overview of results There were 458 responses to the Residents, Families and Wider Island Community survey ∗ The majority reported having a spouse (36%) and/or wider family (35%) living locally. 18% said they have children on the island, while 10% (48 respondents) indicated they have no family living on Arran ∗ The vast majority of respondents, 82.8% (403 people) do not currently receive support from health and social care services on the Isle of Arran ∗ 97% of respondents (444 individuals) were aware of the current recruitment challenges across various sectors of Isle of Arran, ∗ 97.6% (447) of recipients opposed the recent change in bed capacity at Montrose House. 1.5% (7) were in favour and 0.9% (4) were unsure if it was the correct move. ∗ 73.1% of respondents (“Definitely”: 37.3% and “Possibly”: 35.8%) would consider using an outreach day care service on Arran, while only 3.3% said No and 5.2% said Unlikely, with 18.3% Unsure. ∗ 32% (145 people) support the proposed admissions policy approach, while 23% (105 people) oppose it. An additional 27% (125 people) are unsure, 5% (24 people) would support it with certain conditions, and 13% (59 people) selected "Other.“ Key themes: • Strong Opposition and Emotional Distress • Primary Concerns About Mainland Relocation
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7 o Forced Displacement from the island/ Family Separation o Personal and Family Impact Stories • Ferry Service Complications o Visiting Challenges • Staffing and Quality of Care Perspectives o Understanding of Staffing Challenges o Conditional Support for Quality Care • Use of Purpose-Built Facility o Underuse of Purpose-Built Facility • Distrust of Motivations o Suspicion of Cost-Cutting • Demographic and Demand Considerations o Ageing Population Needs • Impact on Other Services o Pressure on Healthcare System There were 23 respondents to the Staff, Professionals and Wider Partners survey. 96% (22 out of 23 participants), are residents of the Isle of Arran while only 4% (1 participant) is not. The majority of respondents (61%) did not support the proposed change. Four professionals (17%) agreed with the proposal, with only one qualifying their feedback by stating, "If that's all we can staff, it's all we can staff." How does any existing data differ between islands? The options appraisal paper, which has been published as an appendix to the Integration Joint Board report (IJB), 21 August 2025 is available on the IJB page of the North Ayrshire Council website. The option appraisal has undertaken a detailed analysis of the island community on Arran and comparisons with other islands with older people care homes.
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8 Care Homes – Island Comparison Comparisons with other island services are covered below. We used the following classifications from the Scottish Government. Islands/island groupings with mid to high population levels, have populations which are higher than at least 60% of the islands covered in this chapter, but lower than 10% of the islands covered by this chapter The population of these islands varies significantly. The islands in this category are: • Bute (population 6,498) • Uist & connected isles (population 4,846) • Arran (population 4,629) • Islay (population 3,228) • Mull (population 2,800) • Great Cumbrae (population 1,376) • Barra & Vatersay (population 1,264) • Whalsay (population 1,061) • Yell (population 966) • Tiree (population 653) • Unst (population 632) • Westray (population 588) • Seil (population 551) • Sanday (Orkney) (population 494) • Hoy & Walls (population 419) • Bressay (population 368) A comparison of Care Homes within these areas found that the national average of bed spaces available is twelve as described at Chart 1.
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9 Chart 1: Care Home Capacity There are 16 Care Homes within North Ayrshire. Montrose House on Arran currently has a vacancy rate of 13.3%, which is significantly higher than the overall average vacancy rate across care homes in North Ayrshire, which stands at approximately 6.6% [see chart 2].
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10 Chart 2 Vacancy % by Care Home
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11 Are there any existing design features or mitigations in place? The Health and Social Care partnership has provided accommodation for staff who travel to Arran to deliver key services on Arran. Nursing and Care staff also receive a financial enhancement to work on the isle of Arran. However, neither mitigation have resolved the staffing challenges at Montrose House. STEP THREE – CONSULTATION Who do you need to consult with? The engagement will be open to all members of the public, community organisations, residents and families using Montrose House and staff. How will you carry out your consultation and in what timescales? Montrose House Engagement drop in Event was held within Montrose House by the Arran Senior Management team on 22nd July 2025. A public online survey was opened on the 15 July 2025 to 1st August 2025 and paper copies were also made available. Staff supported people to complete the paper copies. A staff online survey was opened on the 25th July to the 1st August 2025. 10 % of the island community contributed their views. What questions will you ask when considering how to address island realities? A full analysis of the questions asked is available on the IJB page of the North Ayrshire Council website. With reference to the consultation undertaken, due to the nature of some of the feedback which includes the personal circumstances of some respondents, and in order to avoid any risk of identification, full details have not been made publicly available, however, full details of consultation responses have been shared with Integration Joint Board members on a confidential basis. What information has already been gathered through consultations and what concerns have been raised previously by island communities? Previous engagement on the island plan highlighted the following areas of concern: - Staff sustainability due to the high cost of housing, reducing the attractiveness of living on the island.
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12 - Growth in the aging population of the island and the lack of working age population to provide support, Is your consultation robust and meaningful and sufficient to comply with the Section 7 duty? The Consultation undertaken between 15 July 2025 to 1st August 2025 has been determined by officers as robust and meaningful and sufficient to comply with the Section 7 duty. STEP FOUR - ASSESSMENT Does your assessment identify any unique impacts on island communities? As a result of a lack of staffing to offer social care support, which has raised concerns about safe staffing levels the following new changes are proposed: a) Older People Day Service – the traditional day service provision closed due to infection control requirements during the Covid 19 pandemic and has not re-opened. A service review, alongside stakeholder engagement, is taking place to identify a day service model which will best meet the needs of future service users, and their carers. Proposal to explore a hybrid day-case model, that will be provided in-house and community-based working alongside the activity coordinator b) Montrose House continues to face significant operational challenges related to staffing levels, due to the limited availability of social care trained staff on the island. As a result of these staffing challenges there has been a reliance on agency workers, to ensure safe staffing levels within the home. Unfortunately, at times agency staff cover can be irregular, which affects the continuity and quality of care delivery. As a result the Montrose House Care Home budget has been overspent over the last 2 financial years. There are currently 12 residents, and the option appraisal proposal recommends a reduction from 15 permanent beds to 10 permanent care beds and 1 respite bed. This will improve service resilience, safety and quality, by having a sustainable service with a staffing model which does not rely on agency staff. If achieved, this will result in improved safe care delivery and the overspend being reduced significantly. c) The review is also proposing the development of an admissions policy to prioritise those with familial ties on the island to access the Montrose House beds.
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13 The assessment identifies that not all residents of Arran will be able to be supported at Montrose House in the future and that off island placements may cause distress and additional expenses to those visiting, as described in the section below. It should also be noted that North Ayrshire Health and Social Care Partnership currently funds 816 placements for adults over 65 in care homes within and outside North Ayrshire. Montrose House accounts for 1.6% of the total service users currently funded for care home places. Of these, 606 residents (74%) are accommodated in care homes based in North Ayrshire, while 210 residents (26%) are placed outside the local authority area. Does your assessment identify any potential barriers or wider impacts? The assessment has identified the following impacts and barriers. In the event that a relative requires to move off island for residential care, it is recognised that this may cause anxiety and distress for the resident and family member; and although the island social work teams will work with families to reduce their isolation e.g. referrals for support from carers groups, all of this distress cannot be mitigated against. There will also be longer travel times and additional travel expenses. Currently the foot passenger day return cost is £ 10.20 per adults and £5.10 per child; subject to concessions. There may also be bus/train fares from ferry to home and ferry to care home. It also costs £51.20 to take a car on a return trip. There may also be car fuel costs from ferry to home and ferry to care home. The HSCP has no mechanisms available to reduce or mitigate these costs, noting the responsibility only extends to providing care and support for the individual requiring access to residential care. How will you address these? The HSCP has no mechanisms available to reduce or mitigate the issues highlighted above. You must now determine whether in your opinion your policy, strategy or service is likely to have an effect on an island community which is significantly different from its effect on other YES.
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14 communities (including other island communities). STEP FIVE – PREPARING YOUR ICIA Assess the extent to which you consider that the policy, strategy or service can be developed or delivered in such a manner as to improve or mitigate, for island communities, the outcomes resulting from it. In the event that a relative requires to move off island for residential care, it is recognised that this may cause anxiety and distress for the resident and family member; and although the island social work teams will work with families to reduce their isolation e.g. referrals for support from carers groups, all of this distress cannot be mitigated against. There will also be longer travel times and additional travel expenses. Currently the foot passenger day return cost is £ 10.20 per adults and £5.10 per child; subject to concessions. There may also be bus/train fares from ferry to home and ferry to care home. It also costs £51.20 to take a car on a return trip. There may also be car fuel costs from ferry to home and ferry to care home. The HSCP has no mechanisms available to reduce or mitigate these costs , noting the responsibility only extends to providing care and support for the individual requiring access to residential care. Consider alternative delivery mechanisms and whether further consultation is required. There are no other delivery models available due to the lack of staffing capacity. Describe how these alternative delivery mechanisms will improve or mitigate outcomes for island communities. Any further required mitigations will continue to be assessed on an ongoing basis. Identify resources required to improve or mitigate outcomes for island communities. In order to sustain current levels of bed capacity on Arran this would require an additional £0.50million per annum, to cover agency staff costs. However this will not ensure continuity of care as staff from agencies are often not regular.
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15 STEP SIX – MAKING ADJUSTMENTS TO YOUR WORK Should delivery mechanisms/mitigations vary in different communities? Montrose House on Arran is the only Health and Social Care Partnership managed care home and as a result this policy does not apply to the mainland, where care homes are delivered by the private independent sector. Do you need to consult with island communities in respect of mechanisms or mitigations? Island communities have provided detailed feedback on the proposals. A full analysis of the questions asked is available on the IJB page of the North Ayrshire Council website. In the event of any unintended consequences of this policy being identified in the course of ongoing monitoring, consideration will be given to appropriate steps which may be required to mitigate these across different communities as required, including whether further consultation is required. Have island circumstances been factored into the evaluation process? The particular circumstances on Arran have factored into the evaluation process as set out above. Have any island-specific indicators/targets been identified that require monitoring? A target of 10 permanent beds and 1 respite bed has been identified. A suite of performance measures will be developed for the hybrid day service model as it is developed. How will outcomes be measured on the islands? Monitoring the number of residents taking up day services and the number of residents waiting for a bed at Montrose House and those being placed off island, will provide a sufficient level of information to assess the ongoing impact of the policy and any associated outcomes. A suite of performance measures will be developed for the hybrid day service model as it is developed. How has the policy, strategy or service affected island communities? This would be monitored on an ongoing basis. How will lessons learned in this ICIA inform future policy making and service delivery? This would be assessed on an ongoing basis as the policy was implemented.
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16 STEP SEVEN – PUBLISHING YOUR ICIA Have you presented your ICIA in an Easy Read format? No. Does it need to be presented in Gaelic or any other language? This is not considered proportionate for the Island or wider North Ayrshire community Where will you publish your ICIA and will relevant stakeholders be able to easily access it? The completed ICIA will be included in a report to North Ayrshire integration Board scheduled for 21 August 2025, therefore, the information will be publicly available. Who will sign-off your final ICIA and why? ICIA approved by: ……………KerryKerry Logan……………………………………………………………… Position: ……………Head of Health & Community Care……………………………………………………………… Signature: …………………………………………………………………………… Date completed: ………………12082025…………………………………………………………… ICIA approved by: …………………………………………………………………………… Position: …………………………………………………………………………… Signature: …………………………………………………………………………… Date completed: ……………………………………………………………………………