Agenda Document Pack - Integration Joint Board - 21/08/2025
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 Meeting Thursday, 21 August 2025 at 10:00 Council Chambers, Cunninghame House, Irvine / Hybrid via Microsoft Teams Meeting Arrangements - Hybrid Meetings This meeting will be held on a predominantly physical basis but with provision, by prior notification, for remote attendance by Elected Members in accordance with the provisions of the Local Government (Scotland) Act 2003. Where possible, the meeting will be live-streamed and available to view at https://north-ayrshire.public-i.tv/core/portal/home. 1 Apologies 2 Declarations of Interest Members are requested to give notice of any declarations of interest in respect of items of business on the Agenda. 3 Minutes The accuracy of the Minutes of the meeting held on 19 June 2025 will be confirmed and the Minutes signed in accordance with Paragraph 7 (1) of Schedule 7 of the Local Government (Scotland) Act 1973 (copy enclosed). 4 Director’s Report Submit report by Caroline Cameron, Director (NAHSCP), on developments within the North Ayrshire Health and Social Care Partnership (copy enclosed). 5 2025-26 – Month 3 Financial Performance Submit report by Eleanor Currie, Chief Finance Officer, providing an overview of the Integration Joint Board’s financial performance as at month 3 (June) (copy enclosed). 6 Montrose House Care Home - Arran Submit report by Kerry Logan, Head of Service (Health & Community Care) presenting, amongst other things, the outcome of the recent options appraisal for Montrose House (copy enclosed). 1
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7 Transformation Plan – Progress Update Submit report by Scott Hunter, Chief Social Work Officer (NAHSCP), providing an update on the progress of the HSCP Transformation Plan (copy enclosed). 8 North Ayrshire HSCP Clinical and Care Governance Report 2024-25 Submit report by Darren Fullarton, Lead Nurse/Associate Director (NAHSCP), providing an update and overview of governance activity for the period August 2024 – July 2025 for consideration by the Integration Joint Board (copy enclosed). 9 Annual Performance Report 2024-25 Submit report by Caroline Cameron, Director (NAHSCP), on the Annual Performance 2024-25 (copy enclosed). 10 NHS Ayrshire and Arran Delivery Plan 2025-2026 Submit for information NHS Ayrshire and Arran Delivery Plan 2025-2026 (copy enclosed). 11 Strategic Planning Group Meeting Minutes Submit for information the minutes of the Strategic Planning Group Meeting on 12 March 2025 (copy enclosed). 12 Urgent Items Any other items which the Chair considers to be urgent. Webcasting Please note: this meeting may be filmed/recorded/live-streamed to the Council's internet site and available to view at https://north-ayrshire.public- i.tv/core/portal/home, where it will be capable of repeated viewing. At the start of the meeting, the Provost/Chair will confirm if all or part of the meeting is being filmed/recorded/live-streamed. You should be aware that the Council is a Data Controller under the Data Protection Act 2018. Data collected during the webcast will be retained in accordance with the Council’s published policy, including, but not limited to, for the purpose of keeping historical records and making those records available via the Council’s internet site. Generally, the press and public will not be filmed. However, by entering the Council Chambers and using the press or public seating area, you acknowledge that you may be filmed and that any information pertaining to you contained in the video and oral recording of the meeting will be used for webcasting or training purposes and for the purpose of keeping historical records and making those records available to the public. In making this use of your information the Council is processing data which is necessary for the performance of a task carried out in the public interest. 2
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If you have any queries regarding this and, in particular, if you believe that use and/or storage of any particular information would cause, or be likely to cause, substantial damage or distress to any individual, please contact dataprotectionofficer@north-ayrshire.gov.uk 3
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IJB Sederunt Voting Members Joyce White (Chair) NHS Ayrshire & Arran Cllr Margaret Johnson (Vice- Chair) North Ayrshire Council Cllr Tom Marshall North Ayrshire Council Cllr Anthea Dickson North Ayrshire Council Cllr Nairn Angus-McDonald North Ayrshire Council Linda Semple NHS Ayrshire & Arran Tom Hopkins NHS Ayrshire & Arran Marc Mazzucco NHS Ayrshire & Arran Professional Advisors Caroline Cameron Director Eleanor Currie Interim Chief Finance Officer Aileen Craig IJB Monitoring Officer Iain Jamieson Clinical Director Scott Hunter Chief Social Work Officer – North Ayrshire Thelma Bowers Mental Health Adviser Darren Fullarton Associate Nurse Director/ Lead Nurse Vacany Acute Services Representative Dr Louise Wilson GP Representative Sharon Hackney Lead Allied Health Professional Lynne McNiven Public Health Representative Wendy Van Riet Director of Psychological Services Stakeholder Representatives Lorna Sim Staff Rep - NHS Ayrshire and Arran Lynda MacFarlane Staff Rep Paul Smith Carers Representative Clive Shephard Service User Representative Vacancy Independent Sector Representative Vicki Yuill Third Sector Representative 4
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North Ayrshire Health and Social Care Partnership Minute of Integration Joint Board meeting held on Thursday 19 June 2025 at 10.00 a.m. involving participation by remote electronic means and physical attendance within the Council Chambers, Irvine. Present (Physical Participation) Voting Members Joyce White, NHS Ayrshire and Arran (Chair) Councillor Margaret Johnson, North Ayrshire Council (Vice-Chair) (Chair) Councillor Nairn Angus- McDonald, North Ayrshire Council Professional Advisers Caroline Cameron, Director of Health and Social Care Partnership Thelma Bowers, Head of Service (Mental Health) (NAHSCP) Eleanor Currie, Interim Section 95 Officer Scott Hunter, Chief Social Work Officer Stakeholder Representative Lynda McFarlane, Staff Representative Lorna Sim, Staff Representative NHS Ayrshire and Arran Present (Remote Participation) Voting Members Councillor Anthea Dickson, North Ayrshire Council Linda Semple, NHS Ayrshire and Arran Marc Mazzucco, NHS Ayrshire and Arran Professional Advisers Lynne McNiven, Public Health Representative Wendy Van Riet, Director of Psychological Services Stakeholder Representative Paul Smith, Carer Representative Vicky Yuill, Third Sector Representative In Attendance (Physical Participation) Kerry Logan, Head of Service (Health and Community Care) Michelle Sutherland, Partnership Facilitator (Health & Community Care) Loretta Galloway, Unity Enterprise Alastair Reid, Director of Allied Health Professions, NHS Ayrshire & Arran Stephanie Gilfedder, AA Mental Health, NHS Ayrshire and Arran Annie Johnston, Principal Manager (HSCP Business Admin) Lauren McMath, Policy Officer (Children’s Services) Agenda Item 3 5
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Karen Andrews, Team Manager (Governance) Raymond Lynch, Senior Manager (Legal Services) Ruth Wilson, Team Leader (Litigation) Hayley Young, Senior Committee Services Officer Mark Sugden, Communications Officer Apologies Councillor Tom Marshall, North Ayrshire Council Tom Hopkins, NHS Ayrshire and Arran Sharon Hackney, Lead Allied Health Professional Darren Fullarton, Associate Nurse Director/ Lead Nurse Iain Jamieson, Clinical Director Aileen Craig, IJB Monitoring Officer 1. Apologies for Absence and Chair Remarks Apologies for Absence were noted. The Chair welcomed Linda Semple as the new NHS Non-Executive Member of the Integration Joint Board and thanked Sharon Morrow for her valuable contributions to the work of the IJB. 2. Declarations of Interest In terms of Standing Order 7.2 and Section 5.14 of the Code of Conduct for Members of Devolved Public Bodies, Linda Semple declared she was a Non-Executive Director for NHS Golden Jubilee, and Councillor Angus-McDonald declared he was Non- Executive Director of Public Health Scotland. 3. Minutes The accuracy of the Minutes of the meeting held on 1 May 2025 were confirmed and the Minutes signed in accordance with Paragraph 7(10 of Schedule 7 of the Local Government (Scotland) Act 1973. 4. Director’s Report Submitted report by Caroline Cameron, Director (NAHSCP) on the developments within the North Ayrshire Health and Social Care Partnership. The Director (NAHSCP) also provided an update on the NHS Renewal ambitions described by the first minister in his speech on 27 January 2025. Officers responded to members’ questions on various aspects of the report. Noted. 5. Children’s Services Plan Performance Report 2024-25 Submitted report by Caroline Cameron, Director (NAHSCP) on the on the Children’s Services Plan Performance Report 2024-25. The Children’s Services Action Report 6
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2024-25 was set out at Appendix 1, Children's Services Performance Indicators Report 2024-25 set out at Appendix 2 and the Whole Family Wellbeing Fund Annual Summary Report set out at Appendix 3 to the report. Officers responded to members’ questions on various aspects of the report. Noted. 6. Allied Health Professions within Acute Settings Submitted report by Alistair Reid, Director of Allied Health Professions, NHS Ayrshire & Arran on Allied Health Professions within Acute Settings. Officers responded to members’ questions on various aspects of the report. Noted. 7. Montrose House Care Home - Arran Submitted report by Kerry Logan, Head of Service (Health & Community Care) on the outcome of the recent options appraisal for Montrose House. The Head of Service (Health & Community Care) 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 and therefore the Partnership was asked to consider only recommendation 4. Officers responded to members’ questions on various aspects of the report. The Board 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. 8. Older People’s Day Service Review Submitted report by Kerry Logan, Head of Service (Health & Community Care) on the review of the delivery of day services for older people in North Ayrshire and the proposed options to IJB to identify a service model for day services. The full review was set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. The Board agreed to (a) note the outcome of the older people’s day service review completed in February 2025; (b) consider the option(s) detailed within this report for future delivery and provide approval for the preferred option, noting the described impact on service users and all other relevant stakeholders; (c) note the requirement for a temporary pause on new day service admissions whilst teams reconfigure service delivery and where possible accommodate any service users affected by service change; (d) approve the preferred Option 2 as set out in the report; and (e) note that the revised service model will undergo a formal evaluation six months after reopening. The evaluation will assess the effectiveness of service delivery, the impact on unmet need, and identify any further areas for improvement. 7
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9. 2024-25: Year End Financial Performance Submitted report by Eleanor Currie, Interim Chief Finance Officer (HSCP) to provide an overview of the Integration Joint Board’s financial performance for the year ended 2024-25 and the implications for the overall financial position. Appendix A to the report provided the financial overview of the partnership position, Appendix B provided an overview of those service changes that have financial savings attached to them and the BRAG status around the deliverability of each saving, Appendix C highlighted the movement in the budget position following the initial approved budget and Appendix D provided further details on the reserves. Officers responded to members’ questions on various aspects of the report. The Board agreed to (a) note the overall integrated financial performance for the financial year 2024-25 and the overall year-end overspend of £1.212m pre earmarking, adjusted to £3.593m after earmarking, adjusted to on-line after additional funding contributions; (b) note the progress with delivery of agreed savings; (c) approve the budget reductions detailed at paragraph 2.10; and (d) approve proposed earmarking as detailed in the report, leaving a balance of £3.161m in earmarked funds. 10. Risk Appetite Statement Submitted report by Eleanor Currie, Interim Chief Finance Officer (HSCP) on the IJB Risk Appetite Statement set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. The Board agreed to approve the IJB Risk Appetite Statement set out at Appendix 1 to the report. The Board noted that a further report would be brought to a future meeting. 11. Risk Management Strategy Submitted report by Eleanor Currie, Interim Chief Finance Officer (HSCP) on the IJB Risk Management Strategy set out at Appendix 1 to the report. The Board agreed to approve the IJB Risk Management Strategy set out at Appendix 1 to the report. The meeting ended at 12.15 pm. The full meeting proceedings can be viewed at https://north-ayrshire.public-i.tv/core/portal/home 8
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Integration Joint Board 21st August 2025 Subject : Director’s Report Purpose : This report is for awareness to advise members of North Ayrshire Integration Joint Board (IJB) of developments within North Ayrshire Health and Social Care Partnership (NAHSCP) Recommendation : IJB members are asked to note progress made to date. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran IJB Integration Joint Board HSCP Health and Social Care Partnership ADHD Attention Deficit Hyperactivity Disorder ASD Autism Spectrum Disorder MWC Mental Welfare Commission NES NHS Education in Scotland IPU Inpatient Unit SDS Self Directed Support RAMH Recovery Across Mental Health 1. EXECUTIVE SUMMARY 1.1 This report informs members of the Integration Joint Board (IJB) of the work undertaken within North Ayrshire Health and Social Care Partnership (NAHSCP), nationally, locally and Ayrshire wide. 2. BACKGROUND 2.1 This report provides IJB with up to date information on recent activity across the HSCP since the last IJB. The report will also provide COVID related information by exception. Agenda Item 4 9
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3. CURRENT POSITION National Developments Consultations/Call for Views 3.1 Children (Care, Care Experience and Services Planning) (Scotland) Bill - Organisations, public bodies academic On Tuesday 17th June the Children (Care, Care Experience and Services Planning) (Scotland) Bill was introduced. The introduction of this Bill is a significant milestone and will be instrumental in accelerating progress toward Scotland’s commitment to our care community. The eight key areas that the Bill addresses are: • Extension of eligibility to receive Aftercare support to young people who have been in care prior to their 16th birthday. • Introduction of a right to advocacy for children, young people and adults with care experience. • Actions to improve the language of care, including a universal definition of ‘care experienced’ • Legislative steps to tackle profit from residential care • Strengthening the not-for-profit principle in relation to foster care • Introduction of a national register for foster carers • Redesign of the Children’s Hearing’s System, and • Extension of the statutory responsibility to Integrated Joint Boards in the development of Children Services Plan The changes included in this Bill are only part of the wider work being undertaken across Scotland to keep The Promise. Work continues at national and local level. The Education, Children and Young People Committee will be the lead Committee as the Bill passes through Parliamentary scrutiny, and they have now issued their call for evidence which will be open until the 15 August. This can be found on the Parliament website. A North Ayrshire draft response has been submitted to the Committee. The Committee also intend to take oral evidence in Parliament and Scottish Government have advised of the intention to arrange a series of in-person collaborative sessions and group discussions to gather feedback and share ideas. 3.2 Call for Evidence : ADHD and ASD Pathways and Support Ahead of its inquiry into ADHD and ASD pathways and support, the Health, Social Care and Sport Committee has launched a call for evidence to hear the views and experiences of organisations providing support, advice, and treatment in this area. 10
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The inquiry seeks to – • understand why waiting times for diagnosis and management of ADHD and ASD are reportedly long, including the drivers of increasing demand • understand how these conditions are diagnosed and managed • understand the impact of delays on individuals • explore solutions to improve capacity of services, referral pathways and support. The consultation is open until 18 August 2025. More information on the inquiry can be found on the Scottish Parliament’s website - ADHD and ASD pathways and support Scottish Parliament Website. 3.3 Call for Views : Commissioner for Older People (Scotland) Bill The Equalities, Human Rights and Civil Justice Committee has launched an online call for views on the Commissioner for Older People (Scotland) Bill. The purpose of the Bill is to establish a Commissioner for older people in Scotland whose primary purpose would be to promote and safeguard the rights and interests of older people (defined as those who are aged 60 and over). This role would be independent from the Scottish Government. The call for views is open until 12 September 2025. 3.4 Mental Welfare Commission Annual Report 2024-25 The Mental Welfare Commission’s published their annual report which shows the wide range of work the organisation completed last year, including visits to 149 wards and units around the country, meeting individuals, families, and staff. In 2024-25, the Commission published a report on the care and treatment of people with learning disabilities and complex care needs who had remained in either a learning disability or mental health hospital for more than 10 years, and closure reports on compulsory community treatment orders, mental health in Scotland’s prisons, and an investigation into the care and treatment of Mr E. The report provides an overview of the MWC activities, achievements, and the progress they have made in promoting and safeguarding the rights of individuals with mental health issues across Scotland. 11
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3.5 Psychological Therapies and Interventions Workforce Census NHS Education for Scotland (NES) and the Scottish Government, along with other stakeholders, are gathering information to understand the current provision of psychological therapies and interventions for the Scottish population through a workforce census. Psychological interventions and therapies aim to directly reduce distress and improve the wellbeing and mental health of the population we serve. The census aims to understand the current workforce capacity and provision in delivering enhanced and specialist interventions and therapies. 3.6 Events to raise awareness of new Pension Age Winter Heating Payment Pension Age Winter Heating Payment is replacing Winter Fuel Payment in Scotland this year, with 860,000 Scottish pensioners with an income of £35,000 or less expected to receive the payment. To support the new benefit launch, Social Security Scotland is hosting online events to share information on the financial support available for Scottish pensioners. These free events, which will be held via MS Teams, may be of particular interest to staff who provide advice and support to older people of state pension age or above in Scotland, ensuring they have all the relevant information to raise awareness of the financial assistance available to help pensioners heat their homes this winter. Ayrshire Wide Developments 3.7 Celebrating innovation, integration and impact in Ayrshire NHS Ayrshire & Arran held its Quality Improvement Conference on Monday 14 July 2025 at the Alexander Fleming Education Centre, Crosshouse Hospital. This annual event offers a chance to celebrate the wide range of improvement initiatives designed to enhance care, safety, and experience for patients and staff alike. A total of 44 poster entries were received this year, including contributions from medical staff, nursing teams, pharmacists and allied health professionals, with the submissions reflecting the rich diversity and collaborative spirit of improvement work happening across NHS Ayrshire & Arran. The conference was extremely well attended, with excellent engagement from staff at all levels and professions. The energy and enthusiasm on the day was a clear testament to the ongoing commitment to quality, safety and innovation across Ayrshire and Arran services. Our NEST team, won an award on the day for their poster detailing the NEST Empowerment Model. 12
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3.8 Ayrshire Hospice – Services return to Ayr site Ayrshire Hospice services have now returned to its site at Racecourse Road, Ayr, following the successful completion of its capital build project. The redevelopment enhances the environment for patients, families and professionals alike, with facilities including a modern new inpatient unit (IPU), a connected hub building, and restored heritage spaces - all designed to support compassionate, dignified, and person-centred palliative and end of life care. Key information for health and social care professionals: • In-patient unit and on-site services are operating from Racecourse Road once again • Living Well services are also based back at Racecourse Road (and supplemented by hubs at the Dirrans Centre, Kilwinning; The Carrick Centre, Maybole, and the FABS Clinic • Community teams continue to provide support across Ayrshire and Arran as before (including the Ayrshire Hospice social work team) North Ayrshire HSCP congratulate the Hospice on meeting this key milestone and look forward to continuing to work in partnership. 3.9 Ayrshire Suicide Prevention Community Champion Awards The Ayrshire Suicide Prevention Community Champion Awards is a new initiative designed to honour the outstanding efforts of local volunteers and third sector organisations who are making a real difference in mental health and suicide prevention. Categories to choose from are as follows, and you can nominate as many people as you like. • Care and Compassion: This award is for individual volunteers or groups who have demonstrated care and compassion towards other individuals, groups or peers with exceptional care, compassion, dignity and respect. • Shining Stars: Individuals, teams or volunteers who stand out in some way in terms of their contribution and achievement, and/or going the extra mile, with examples of how they have done this and the impact they have had. • Thinking out of the Box: Individuals/teams who have done something new or different, delivered innovation, reform, a surprising or left field solution, or found solutions ‘against all the odds’ – with examples of what they have done and the impact it has had. • Collaboration and Working Together: Teams who have demonstrated exceptional team working, collaboration, working across boundaries, connectedness etc (this does not need to have been a long piece of work), with examples of what they have done and the impact it has had. 13
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• Making a Difference with Digital: Examples of thinking and/or doing things differently using digital - improvements, innovations, new approaches and ideas etc. It could be something delivered with the support of digital services, or something locally initiated and delivered. Nominations closed on Friday 8 August, and the winners will be announced at an awards ceremony to be held at WG13 in Kilmarnock on Thursday 11 September. 3.10 Award of Self-directed Support (SDS) Contract The Professional Standards (Self-directed Support) Team are pleased to announce the award of the new SDS: information and advice service contract aimed at enhancing the delivery of independent, personalised options for care and support across the Ayrshire communities. Following a robust procurement process led by North Ayrshire, the contract has been awarded to Ayrshire Independent Living Network who demonstrated their commitment to empowering people to make informed choices and take control of their own support arrangements. This pan Ayrshire contract will support the delivery of high quality, person centred information, advice and recruitment services that align with the principles of choice, dignity and independence. The new contract commenced on 1st August 2025. We are confident this partnership will bring meaningful improvements to those requiring social care support and we look forward to working with Ayrshire Independent Living Network to deliver positive information, advice and outcomes for people and their families across Ayrshire. 3.11 Community Partners Spotlight: Community Brokerage Network The Community Brokerage Network provides free information and advice on Self Directed Support (SDS) for everyone in Ayrshire, regardless of their circumstances, age, and level of ability. A Community Broker is someone who helps people find their way through the social care system, with detailed local knowledge and strong connections that can help individuals access the services, community opportunities and resources that fit their unique needs and preferences. The service is fully funded by the Scottish Government and is free of charge to use. No formal assessment or social care budget is required in order to access the service, which is open to: • Those who are unsure if they qualify for social care and don’t know where to start • Those who have been told they don't qualify for formal support and need help to explore other options 14
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• Those waiting for a needs assessment after contacting social work • Those who are struggling to get the right support with an allocated care package • Those who need help reassessing their support due to changing needs • Unpaid carers looking for support for themselves or a loved one The Community Brokerage Network has recently updated its SDS information booklet, client charter and data privacy policy. 3.12 Launch of new Mental Health Services Carers Forum A new Mental Health Services Carers Forum launches later this month, which is open to unpaid carers from across the whole of Ayrshire. These sessions will be held on the last Wednesday of the month, offering a chance to hear from a wide range of support services, share your views, and meet others in similar situations. Organised by NAHSCP, in conjunction with Carers Gateway North Ayrshire, Carers Gateway South Ayrshire, East Ayrshire Carers Centre, VoiceAbility and East Ayrshire Advocacy Services, the sessions will include guest speakers from a range of organisations. Forum events will take place for the remainder of this year as follows: Wednesday 27 August: 12.30pm to 2.30pm at Fullarton ConneXions, Irvine (with information from North Ayrshire Money Smart and Arran CVS on finances, benefits, and community mental health and wellbeing supports) Wednesday 24 September: 5pm to 7pm at the Beehive, Woodland View Hospital, Irvine (with information from North and East Ayrshire Carers Gateways on carers rights and entitlements) Wednesday 29 October: 12.30pm to 2.30pm at the Carers Cottage, Kilmarnock (with information from AILN and the Community Brokerage Network on self-directed support) Wednesday 26 November: 5pm to 7pm at the Beehive, Woodland View Hospital, Irvine (with information from VoiceAbility and East Ayrshire Advocacy Services on advocacy support) For any additional information, email mentalhealthengagement@north- ayrshire.gov.uk 15
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North Ayrshire Developments 3.13 Carers Community Fund Applications Carers Gateway North Ayrshire has announced the launch of a new Carers Community Fund, aimed at empowering local organisations to better support unpaid carers throughout the region. The fund offers grants of up to £2,000 for activities, events or projects that aim to benefit unpaid carers living in North Ayrshire. The funding is open to groups, charities and communities, and will be distributed by the North Ayrshire Carers Champions Board. Applications closed on Friday 15 August, with funding to be distributed by the end of September. All funded projects must be completed and money spent by March 31, 2026. Successful applicants will be required to complete an end-of-grant evaluation and provide evidence of expenditure. 3.14 Sponsored walk success for staff and service users of Dirrans Centre Staff and service users of the Dirrans Centre took part in a sponsored walk for the Ayrshire Hospice on Friday 18 July, raising over £850 for the charity to date through their Just Giving page and cash donations. The centre runs twice-weekly Health Walks for service users undergoing periods of rehabilitation, with a walk of 1km to 3km on Tuesdays, and a longer walk of 4km to 5km on Fridays. These not only help to improve physical and mental wellbeing, but also offer an important opportunity for social connection. The group members expressed an interest in doing a sponsored walk again this year for the Ayrshire Hospice, with the charity being close to the hearts of many. A total of 17 service users took part in the event, joined by volunteers and rehab staff. 3.15 Learning Disability Service Launch of New Exhibition Over the first half of this year, our Learning Disability Service has been a collaborator, along with Scottish Care, in a project led by the Scottish Commission for People with Learning Disabilities and funded by the Scottish Government. The project was intended to generate learning and resources which would help to promote digital inclusion and access to technology for people with learning disabilities. 16
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With the support of a diverse range of local stakeholders, the early stages of the work involved asset mapping of digital inclusion activity in North Ayrshire, undertaken by Care Connector Cheryl Stevenson. Later stages of the work saw a design team - including Ute Shauberger from Opencast and interns from the Glasgow School of Art - building on this learning and working with Cheryl and others to develop practical resources to support conversations around digital/tech opportunities, as well as guidance for services around delivering digital inclusion. Those involved in the project, including the clients who participated in co-design sessions, have generated a novel set of practical and strategic resources, which the team is excited to share at an exhibition to be held at the Harbour Arts Centre, Irvine, in August. The exhibition was launched at the Harbour Arts Centre Irvine on 8th August. 3.16 Dementia Support Service Inspection Our HSCP Dementia Support Service were inspected in July and feedback received by the Care Inspectorate saw the grades rise from Good (4) to Very Good (5) across the undernoted areas :- 1.3 Relationships – Very Good (5) 2.2 Quality Assurance – Very Good (5) 3.3 Staffing Arrangements – Very Good (5) 5.1 Care Planning – Very Good (5) Congratulations to the service for the very positive inspection outcome. 3.17 Dirrans Centre Following on from its Referrer’s Open Day last month, the Dirrans Centre opened their doors to members of the public who feel they may benefit from a period of rehabilitation on 11th July 2025. The event provided an opportunity to : • Meet the team • Learn about the rehabilitation workshops currently available • Hear directly from service users about their experiences • Complete a referral form if interested in accessing support 17
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The Dirrans Centre offers rehabilitation support to individuals living with: • Long-term health conditions • Physical disability • Brain injury • Neurological conditions To be eligible, individuals should: • Have a rehabilitation goal • Be able to participate in an initial 12-week rehabilitation programme (with further support options explored afterwards) • Be able to travel to and from the centre independently 3.18 Celebration of learning at RAMH Wellbeing & Recovery College RAMH Wellbeing & Recovery College hosted a vibrant end-of-term celebration of learning at Saltcoats Town Hall recently. With a theme of ‘Rediscovery’, the event brought together students, peers, staff and partners to recognise the transformative impact of learning on mental health recovery. The day began with an exhibition of student artwork, followed by reflections from RAMH CEO Peter Jung and guest speakers. Keynote speaker Suzie Baines spoke about reconnecting with inner strength as part of healing, and the Scottish Recovery Network highlighted the value of peer support. Students shared deeply moving stories of recovery, including a couple who spoke about the positive impact their learning journey has had on their family. Others reflected on courses like Story Trees, drama and creative writing, with performances and poetry bringing their experiences to life. The event closed with a joyful graduation ceremony celebrating each student's courage, creativity and commitment. Recovery College Coordinator Lainey McKinlay said: “In a world that often focuses on what people lack, this celebration was a powerful reminder of what people can reclaim and rediscover - confidence, creativity, connection and hope.” To learn more about the RAMH Wellbeing & Recovery College, visit the RAMH website or call 01294 447355. 18
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4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic None 4.5 Risk None 4.6 Community Wealth Building None 4.7 Key Priorities None 5. CONSULTATION No specific consultation was required for this report. User and public involvement is key for the partnership and all significant proposals will be subject to an appropriate level of Consultation. Caroline Cameron, Director [Carolinecameron@north-ayrshire.gov.uk/01294 317723] Appendices Nil 19
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Integration Joint Board 21st August 2025 Subject: 2025-26 – Month 3 Financial Performance Purpose: To provide an overview of the IJB’s financial performance as at Month 3 (June). Recommendation: It is recommended that the IJB: (a) notes the overall integrated financial performance report for the financial year 2025-26 and the current overall projected year- end overspend of £5.187m reducing to £1.175m after planned recovery actions; (b) notes the progress with delivery of agreed savings; (c) approves the actions which are being taken to progress financial recovery and that an updated recovery plan will be presented to the next IJB; and (d) notes the remaining financial risks for 2025-26; Direction Required to Council, Health Board or Both Direction to: - 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership MH Mental Health MDT Child & Adolescent Mental Health Services BRAG Blue, Red, Amber, Green UNPACS UNPACS, (UNPlanned Activities) – Extra Contractual Referrals NRAC NHS Resource Allocation Committee PAC Performance and Audit Committee MHOF Mental Health Outcome Framework MDT Multi-Disciplinary Team Agenda Item 5 21
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1. EXECUTIVE SUMMARY 1.1 The report provides an overview of the financial position for the Partnership and outlines the projected year-end outturn position informed by the projected expenditure and income commitments; these have been prepared in conjunction with relevant budget holders and services. It should be noted that, although this report refers to the position at the end of June further work is undertaken following the month end to finalise projections, therefore the projected outturn position is as current and up to date as can practicably be reported. 1.2 The projected outturn is a year-end overspend of £5.187m (1.5%) reduced to £1.175m through already identified financial recovery actions. There is an increasing risk to achieving financial balance during 2025-26, the projected outturn position is summarised below with the residual risk following already identified financial improvement actions: TOTAL Health/ NHS AA Social Care/NAC Projected Overspend @ mth3 5.187 2.271 2.916 Financial Recovery Plan Projections (4.012) (1.752) (2.260) Residual Risk 1.175 0.519 0.656 The Integration Scheme describes the required approach where there is a projected overspend on the IJB integrated budget, which includes the requirement to agree a recovery plan to balance the overspending budget. Only if the recovery plan is unsuccessful will the Health Board and Council consider making available interim funds. The projection assumes all mitigations and controls established in 2024-25 continue throughout 2025-26 as it is recognised that the same uncertainty and risks remain into 2025-26 and there needs to be tight grip and control over expenditure overall. 1.3 From the core projections, overall, the main areas of pressure are: care at home, residential placements for children, physical disability care packages, supplementary staff in wards, staff costs in Montrose House and Unplanned Activities (UnPACs) within the lead partnership for mental health. 1.4 The projected IJB outturn position has been adjusted to reflect the impact of Lead Partnership services. The overspend in relation to North Lead Partnership services for Mental Health is not fully attributed to the North HSCP as a share has been allocated to East and South HSCPs, similarly the impact of the outturn on East and South led services has been shared with North, both on an NRAC basis in line with the agreed risk sharing mechanism. There is a requirement for the 3 IJBs to be aware of the position for Lead Partnership services and plans to deliver services from 22
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within allocated budget, on that basis further information will be brought forward with further detail on Lead Partnership services. 1.5 Since the setting of the budget in March 2025 the 2025/26 financial position has been adversely impacted by the below factors out-with the control of the IJB. • National Care Home Contract (NCHC) – the recent increase to the NCHC rate to reflect the impact of the nursing pay award resulted in an additional unfunded cost of £0.175m. • NHS Board allocation for the Employers National Insurance increase confirmed at 60% of funding – full year impact £0.664m • The current allocation for the Agenda for Change costs in relation to the reduced working week are currently being queried with the NHS finance team to ensure we receive our ‘fair share’ of the funding. The current funding allocated is £0.659m, the cost of covering all reduced hours is £1.497m, currently calculating actual cover costs and will request NHS AA review funding allocation. • Pay settlements for both NHS and Local Government staff have been agreed for 2025/26, the current assumption is that the shortfall between budget planning assumptions and actual settlements will be fully funded. 2. CURRENT POSITION 2.1 The report includes an overview of the financial position including commitments against the available resource, explanations for the main budget variances and an update on progress in terms of savings delivery. 2.2 FINANCIAL PERFORMANCE – AT MONTH 3 At month 3 against the full-year budget of £342.146m there is a projected year-end overspend of £5.187m (1.5%). The Integration Scheme outlines that there is an expectation that the IJB takes account of the totality of resources available to balance the budget in year. Following this approach, an integrated view of the financial position should be taken, however it is useful to note that this overall position consists of a projected overspend of £2.916m in social care services and a projected overspend of £2.271m in health services. Appendix A provides the financial overview of the Partnership position. The sections that follow outline the significant variances in service expenditure compared to the approved budgets. The projections for some areas will be subject to fluctuations as they depend on recruitment plans for new funding and also the capacity of providers to take on work. Appendix F provides information on the costs of bank and agency staff. 23
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2.3 Health and Community Care Services Against the full-year budget of £98.721m there is a projected overspend of £4.124m (4.2%) and the main variances are: a) Care home placements – net projected overspend of £0.060m. This includes a provision for an average of 7 interim beds and reflects the recent increase to the NCHC to reflect the impact of the nursing pay award resulted in an additional unfunded cost of £0.175m. The budgeted number of permanent placements was 765 and at month 3 there were 783 placements resulting in a projected overspend of £0.616m. The plan to manage down the number of permanent placements to reach the target is challenging due to the need to minimise delayed discharge from hospital and to continue to support those in critical and substantial need in the community. The overspend is partially offset by income recovered from charging orders which is projected to be £0.556m over recovered. This income is challenging to predict as it depends on the length of the legal process and time taken to sell the property that the charging order is registered to. b) Care at home is projected to be £1.641m overspent. The position reflects the cost of meeting the significant demand and level of provision for care at home support. c) Physical Disability Services – projected overspend of £0.923m split as follows: £1.268m over in residential placements, £0.178m under in direct payments and £0.167m under in community care packages. d) Integrated Island Services is projected to overspend by £0.266m. The most significant variance is a projected overspend at Montrose House of £0.189m which relates to the net overspend on agency staff (i.e. net of underspend on employee costs) and overspends across property, continence and medical supplies, admin and transport. Arran Patient Transfer contract is projected to overspend by £0.040m. e) Specialist Rehab wards – projected overspend of £0.214m (Redburn ward £0.253m overspend and Douglas Grant £0.039m underspend). The overspend is due to cover costs for vacancies as well as supplementary staffing for patients who require one to one support. f) Wards 1 and 2 – Projected overspend of £0.827m. The overspend is due to increased use of supplementary staffing. All rehabilitation wards are operating at 100% occupancy supporting a high level of patient needs/complexity, which places pressure on staffing levels and the use of bank and agency staff to support additional patient observations. The senior manager has developed an action 24
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plan which will reduce this overspend and the reduction is reflected in the recovery plan. g) District Nursing – projected to overspend by £0.100m mainly due to an overspend on continence supplies. 2.4 Mental Health Services Against the full-year budget of £114.884m there is a projected overspend of £0.940m (0.8%) prior to the re-allocation of the Lead Partnership variance to East and South HSCP. The main variances are: • Learning Disabilities are projected to underspend by £0.424m mainly due to community care packages (£0.886m under), direct payments (£0.335m over) and residential placements (£0.064m over). This improvement reflects the positive impact of assertive reviews of care packages and increased clawbacks from direct payments. • Community Mental Health services are projected to underspend by £0.095m across community care packages (£0.527m under), direct payments (£0.168m over), residential placements (£0.381 over) and Nethermains (£0.103m under). The main reason for underspend in community packages is the availability and capacity of adult community providers to deliver new packages of care. • There is a projected underspend of £0.353m in relation to the cost of Hospital Based Complex Continuing Care (HBCCC), this reflects the impact of change in provision for these services. There were plans to reinvest this in the service, but these plans are on hold as the funding is needed to contribute to the recovery plan. • The Lead Partnership for Mental Health is projected to be £1.806m overspent and the main variances are as follows: • Adult Inpatients – projected overspend by £0.372m due to overspends in supplementary staff for enhanced observations (1:1 and 2:1) and use of bank staff. There is an overspend of £0.159m at month 3 but this is partially offset by a recharge to another HSCP on a cost basis for an outwith authority placements which has incurred additional costs in relation to usage of supplementary staffing due to sustained enhanced observations. There is a favourable impact from the opening of the adult mental health assessment hub which has seen the adult inpatient areas with reduced occupancy. • The UNPACS (Unplanned Activities) budget – projected overspend of £1.369m based on current placements. This reflects two new placements agreed at the high-cost care package group in July 2025. UnPACS placements are for individuals with very specific needs that 25
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require a higher level of security and/or care from a staff group with a particular skill set/competence. There are no local NHS secure facilities for women, people with a learning disability or people with neurodevelopmental disorder. This can necessitate an UNPACs placement with a specialist provider which can be out-of-area. The nature of mental health UNPACs spend is that it is almost exclusively on medium- or long-term complex secure residential placements which are very expensive so a small change in placements can have a high budgetary impact. Due to the complexity and risk involved, transitions between units or levels of security can take many months. Applications to approve a placement are made to the Associate Medical Director for Mental Health who needs to be satisfied that the placement is appropriate and unavoidable prior to this being agreed. • Learning Disability Services – projected to overspend by £0.101m. This relates to the potential delays in achieving the saving from Trindlemoss moving from a nursing to social care model. The progress with this was impacted by the requirement to close Ward 7A. It is assumed that Ward 7A will be online as the use of bank staff will reduce. • Elderly Inpatients – projected overspend of £0.264m due to the use of supplementary staffing. The elderly mental health wards continue to operate at full occupancy and at times with waiting lists, with several patients who are on enhanced observations and bank costs remain high. • Eating Disorders – projected to overspend by £0.129m due to the staffing level being higher than the funding allocation. This is being considered alongside the overall resource allocation. • Enhanced Mental Health Outcome Framework – following the 2024/25 review there was £0.275m of unallocated funds. These were to be reinvested this in the service, but these plans are on hold as the funding is needed to contribute to the recovery plan. • Psychiatry – is projected to overspend by £0.269m mainly due to junior doctor costs. A mitigation plan is being developed and the rota for junior doctors is being reviewed. • MH Pharmacy – is projected to overspend by £0.396m due to increased demand and cost of medicines and in particular the cost of Buvidal. This overspend is after investing £0.510m on a Pan Ayrshire basis (£0.170m per HSCP). 26
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• Action 15 – is projected to overspend of £0.268m due legacy costs from the 2024/25 review of funding. There are £0.487m of reserves held for this and these will be requested as part of the recovery plan. Innovation Fund – projected underspend of £0.025m assuming that the posts to be redeployed as part of the EMHOF review are actioned. • The turnover target for vacancy savings for the Lead Partnership is held within the Lead Partnership as this is a Pan-Ayrshire target. There is a projected over recovery of the vacancy savings target of £0.701m in 2025-26. Further information is included in the table below: Vacancy Savings Target (£1.160m) Projected to March 2026 £1.861m Over/(Under) Achievement £0.701m 2.5 Children and Justice Services Against the full-year budget of £45.781m there is a projected overspend of £2.530m (5.5%) and the main variances are: a) Care Experienced Children and Young People is projected to overspend by £2.857m. Some of these costs are offset by the contribution from the Home Office for Unaccompanied Asylum-Seeking Children which is detailed below. The main areas within this are noted below: • The children’s residential placements are projected to overspend by £2.728m based 32 placements in month 3. This demonstrates an increase of 4 places since the start of the financial year. There are a number of factors leading to this challenging position: o We have 32 places available in our internal children’s houses, due to demand these have been operating at 100% occupancy or over for some time, leading to increased use of external placements where residential care is required. o There remains an acute shortage of foster carers leading to residential care being necessary in emergency placement situations. o The requirement to support Unaccompanied Asylum-Seeking Children (UASC) under the National Transfer Scheme and to support trafficked young people who have been identified in North Ayrshire. o A number of young people in residential care have requested Continuing Care, whereby a young person can remain in their placement until age 21. o Where appropriate young people are placed to meet their educational needs, the cost of Residential School Placements in the most cases is shared 50/50 with Education services. 27
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o Contractual inflation has still to be agreed for the majority of placements and it is likely that this will increase the projected costs of residential places which is outwith the control of the service. o Children’s Services are continuing to work with other services including Education and Housing to address the challenges through the work of the ‘Brighter Pathways’ Programme Board and associated workstreams. • Looked After and Accommodated Children (fostering, adoption, kinship etc) is projected to be £0.919m underspent. • Children with disabilities – there is a net projected overspend of £0.866m across residential placements (£1.312m over), direct payments (£0.312m under) and community packages (£0.134m under). • Residential respite – placements are overspent by £0.073m. These short- term placements are used to prevent an admission to full time care or to avoid placement breakdown. • Employee costs – are projected to overspend by £0.150m, largely due to staffing levels in the children’s houses and regrading of posts. • Care Leavers – projected underspend of £0.071m in rent costs. • Section 29 Payments (Throughcare Team) are projected to overspend by £0.064m. b) Head of Service – is projected to underspend by £0.548m. This consists of a projected overspend of £0.196m to the previous saving in relation to the staff reconfiguration in the children’s houses which was not achieved in 23-24 or 24- 25 and this is offset by the grant funding in relation to Unaccompanied Asylum- Seeking Children (UASC), which is projected to amount to £0.792m and which contributes to costs incurred across a number of C&F service areas. c) C&F Health Team – is projected to overspend by £0.121m mainly in relation to the Band 6 to 7 regrade for Health Visitors and the progression of posts up the Band 7 scale. Part of this recurring cost has been incorporated into budget pressures for 2025/26. 2.6 ALLIED HEALTH PROFESSIONALS (AHP) The non-employee costs element of the AHP services are projected to be on-line. All underspends in employee costs have contributed to payroll turnover. 28
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2.7 CHIEF SOCIAL WORK OFFICER This is projected to underspend by £0.205m. The carers contract is projected to underspend by £0.050m and there is an over-recovery of income in Learning and Development for social work student placements. 2.8 MANAGEMENT AND SUPPORT Management and Support Services are projected to underspend by £1.115m and the main areas of variance are: • There is projected slippage on the LD and MH transition funding of £0.246m due to delays in children transitioning into adult services. This involves complex planning by services with service users and families and can change over time based on assessed need when moving into adult services. • The 2024-25 budget included a budgeted deficit on the social care side of £0.437m which is offset by a budgeted surplus of £0.437m on the health side of the budget. • There is also a balance of overachieved savings of £0.061m as a result of the 25/26 budget decision • NHS shortfall in savings of £0.406m which is not coded to specific areas and held centrally until recurring savings can be identified. • An over-recovery of payroll turnover of £1.200m for social care services and an over-recovery of £0.403m for health services as outlined in the table below. The turnover targets and achievement for the financial year for Health and Social Care services outwith the Lead Partnership is noted below: Social Care Health Vacancy Savings Target (£3.400m) (£1.567m) Projected to be achieved by March 2026 £4.600m £1.970m Over/(Under) Achievement £1.200m £0.403m The areas contributing to the health and social care vacancy savings are spread across a wide range of services with vacancy savings being achieved in most areas. As part of the recovery plan, the vacancy scrutiny group has been enhanced with the Heads of Service and professional leads attending. Each post is scrutinised and filled only where deemed necessary with a recruitment freeze now implemented for all non-essential posts. For 2025/26 there will be a further recruitment delay with vacancy scrutiny approved vacancies being held for four weeks before they are advertised to create more payroll turnover. This will be for all vacancies except clinical or registered services vacancies or those which will incur cover costs. 29
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The turnover target for the North Lead Partnership for Mental Health services is detailed separately within the Lead Partnership information at section 2.4. 2.9 Savings Progress a) The approved 2025-26 budget included £4.019m of savings. BRAG Status Position at Budget Approval £m Position at Month 3 £m Red - - Amber 2.984 2.148 Green 1.035 0.998 Blue - 0.873 TOTAL 4.019 4.019 b) The main area to note is that the shortfall in the day care saving – the recommendations following the Older People’s Day Service Review were presented to the IJB in June 2025. The IJB supported a proposed model of day services which does not deliver the full savings target with a shortfall of £95k. The savings target will be re-adjusted for future monitoring. c) The Chief Officer presented a proposal to the Joint Staffing and Recruitment Panel in June 2025 to revise the leadership structure for the IJB finance team which includes the removal of the Head of Service position. These supported changes will deliver a saving of £101k which will be added to the plan and compensate for the reduction in recurring savings from the day care review. Appendix B provides an overview of those service changes which do have financial savings attached to them and the BRAG status around the deliverability of each saving. 2.10 Budget Changes The Integration Scheme states that “either party may increase it’s in year payment to the Integration Joint Board. Neither party may reduce the payment in-year to the Integration Joint Board nor Services managed on a Lead Partnership basis…. without the express consent of the Integration Joint Board.” Appendix C highlights the movement in the budget position following the initial approved budget. Reductions Requiring Approval: Ref Description Amount (£000) 1 ICT Budget Transfers (0.005) 2 Development of People working in Childrens SW – Children’s Social Care Uplift for Commissioned Services (0.390) 30
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3 Prescribing CRES (saving) (0.715) 4 Training Grade Adjustment – April and May (0.071) 5 NAHSCP contribution to pan Ayrshire Vision Support Service (South Lead) (0.005) 6 NAHSCP contribution to Pan Ayrshire Community Store (South Lead) (0.155) 2.11 Pan Ayrshire Lead Partnership services and Large Hospital Set Aside Lead Partnerships: - The IJB position is adjusted to reflect the impact of Lead Partnership services. The outturn for all Lead Partnership services is shared across the 3 Partnerships on an NRAC basis. The outturn in relation to North Lead Partnership services is not fully attributed to the North IJB as a share is allocated to East and South Partnerships; similarly, the impact of the outturn on East and South led services is shared with North. At Month 3 the MH lead partnership is projected to overspend by £1.806m (£0.591m NRAC share for East and £0.517m for South). South HSCP (month 3 info) – projected overspend of £0.134m of which £0.050m will be allocated to North. The variance is mainly due to an overspend of £0.080m in the community store. This includes the costs of replacing mattresses, repairs and maintenance contract and equipment costs. There is also a projected overspend of £0.058m in the Family Nurse Partnership as the SG funding was based on the mid- point of the salary scale and all post are now at the top point of the scale. This will be a pressure in 2026/27. East HSCP (month 2 info) - projected overspend of £0.106m (of which £0.040m will be allocated to North). The main variances are: • Primary Care (including Dental) projected overspend of £0.673m. This is due to increased spend on Primary Care Contracting and Support £0.408m, mainly due to ongoing additional costs in Diabetic Retinopathy, additional Consultant costs and additional costs at Community Hospitals. In addition, there are projected increased costs in Primary Medical Services £0.581m due to additional staffing costs, as well as in Ayrshire Urgent Care Services £0.047m. These additional costs are partially offset by staffing savings in Dental services £0.363m. • There are projected additional costs in Prison and Police Healthcare £0.093m, mainly due to prescribing. • The projected overspend in Other Lead Services £0.116m, relates to additional staffing costs in Area Wide Evening Services. Work is being undertaken to continue to reduce costs in the current year. • The additional pressures in Lead Partnership services highlighted above are partially offset by staffing savings in pan-Ayrshire Allied Health Professions 31
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Services £0.774m. This is based on current vacancies however this will potentially reduce over the course of the year as posts are recruited to. Overall, East Ayrshire hosted services are projected to overspend by £0.106m at this early stage of the financial year. Work will be undertaken to reduce costs in areas overspending within hosted services over the course of 2025/26. Set Aside: - Work has been undertaken with partnerships to progress and develop set aside arrangements to fully implement the legislative requirement. This includes arrangements in relation to the use of Directions, Joint Commissioning Plans and overall progression towards fair share allocations of resources. Further work has been undertaken through the Ayrshire Finance Leads group to establish baseline resources for each partnership and how these compare to the NRAC “fair share” of resources. Ayrshire Finance Leads have now agreed a baseline methodology for set aside budgets which involves using the four full years prior to the pandemic, 2016/17 – 2019/20 inclusive. The HSCPs require to agree their final share of the baseline with each other, however the aggregate will remain unchanged. The table below shows the cost of the historic baseline at 2024/25 prices. The 2025/26 actual usage information is not known until later in the year. IJB Baseline at 2024/25 prices (£) East 31.870 North 39.966 South 34.488 Total 106.324 The annual budget for Acute Services is £485.7 million. The directorate is overspent by £7.4 million after 3 months. This was caused by overspends on medical and nursing staff, together non pay overspends on equipment and supplies. These are required due to the level of operational pressure experienced. Unfunded beds contributed an overspend of £1.7 million after 3 months. Within the overall £7.4 million overspend Medicine are over by £3.0 million, Emergency Care by £2.7 million, Surgery by £0.7 million, Labs and Diagnostics by £1.2 million and Women and Children by £0.6 million. Underspends on other budgets of £0.8 million make up the difference. 32
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There is a material underlying deficit caused by: • Length of Stay (LoS) and emergency admission rates in NHS Ayrshire and Arran acute hospitals are above the Scottish average. • High expenditure on medical and nursing agency staff, high rates of absence and vacancies causing service pressure. • Delayed transfers of care and high acuity of patients. The IJBs and the Health Board work closely in partnership to maintain service and improve performance. In respect of Lead Partnership Services, the 3 Chief Officers and CFOs have met to consider improvements in the reporting and visibility of financial and operational performance for those services which we lead or are led by another HSCP. Actions have been agreed to develop more regular shared information to be shared across all 3 IJBs with an intention to incorporate this further detail into future financial monitoring reports during 2025/26. 2.12 FINANCIAL RISKS There are a number of financial risk areas that impact or may impact on the financial position. • Current overspend areas, especially in low volume / high-cost services e.g. Children’s residential placements, UNPACs, and supplementary staffing across community, mental health and learning disability wards. • Growing demand for services. • Staff recruitment and retention challenges across a number of service areas. • The expectation that performance will continue to be maintained or improved despite the significant resource challenges. • Ongoing delivery costs of Scottish Government policy directives, particularly where these are not fully funded or inflation proofed. • Both NHS and Local Government pay awards are settled, these are both higher than the budget assumptions for 2025-26, if the pay awards are not fully funded then this will present an in-year cost pressure. • Unearmarked reserves are depleted, there is no scope to absorb in-year variances, with any overspends requiring additional funding from partners. • The ongoing review of the Integration Schemes, where there is a focus on financial arrangements and risk share. • The wider system financial challenges and impact across the whole system, for example the financial position of NHS AA and the decisions taken to reduce the Board’s deficit may have impacts on other parts of the health and care system. 33
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• Removal of brokerage for NHS Boards, NHS AA have been asked by Scottish Government to deliver further financial improvement beyond their Board approved financial plan. • The overall sustainability of commissioned care providers, with eNICs compounding historic challenges re financial sustainability, there is a heightened risk of provider failure leading to handing back of care and contracts. • The ongoing ability to source packages of care for service users. • Progress with the work to develop set aside arrangements and the risk sharing arrangements agreed as part of this. • The recurring underlying levels of overspend which may impact on the Partnership’s ability to continue to sustain service levels in the future. • The use of supplementary staffing for enhanced observations across a number of service areas and the use of high-cost agency staff to support frontline service delivery in areas where there are recruitment challenges. • Agenda for Change Pay Reform programme – including Nursing Band 5-6 re- grade, protected learning time and reduction to the working week. • Scot Excel inflationary increases for children’s service are significantly higher than assumed. • There is a risk in relation to recovering recharge income in relation to the LD Assessment and Treatment patients from outwith Ayrshire. These risks will continue to be monitored during 2025-26. 2.13 RESERVES The IJB opening reserves position, subject to completion of the 24/25 audit, is summarised in the table below. General Fund Reserve Earmarked Reserves Total Unearmarked External Funding HSCP £m £m £m £m Balance – 1 April 2025 - 2.381 0.780 3.161 Anticipated Drawdown - (2.381) (0.780) (3.161) Balance – 31 March 2026 - - - - The £0.780m HSCP earmarked reserve relates to the Service Redesign and Change Fund which is fully committed in 2025/26. Further detail on the reserves is given in Appendix D. 34
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2.14 Financial Recovery Plan The IJB set a balanced budget for 2025/26 on 20th March 2025. This did not include any draw on reserves but did include the approval of £4.019m of savings to achieve financial balance. Services will continue to work towards implementing the recovery plan to deliver cost reduction targets while carefully managing the level of risk. This will include the preparation of equality impact assessments. The management actions and governance framework outlined below which were agreed in 2024/25 will continue throughout 2025/26: PREVIOUSLY AGREED MANAGEMENT ACTIONS/CONTROLS: • Review of expenditure authorisation levels across the Partnership and escalation of specific decisions to senior officers. In particular, a new governance group has been introduced, involving the Director and Heads of Service, to oversee the agreement of higher value packages of care (above £40,000 per annum). • Staff communication in relation to discretionary/non-essential spend. • Review of temporary posts and robust vacancy management/approval. The vacancy scrutiny group now has representation from all of the Heads of Service and a recruitment freeze will be implemented for all but essential frontline posts. • Restrictions on all but essential overtime working. • Ongoing review of future year savings or transformation programmes to identify scope for acceleration. • Maximise opportunities from the recently reopened Independent Living Fund (ILF) Scotland. PREVIOUSLY AGREED GOVERNANCE MEASURES: • Establishment a ‘Finance Working Group’, chaired by the IJB Chair or Vice Chair. The Director and Heads of Service are members of the group. It meets monthly to facilitate increased oversight and scrutiny of the financial position and transformation programme as well as detailed budget planning for future financial years. • Strengthened support from Finance Team to front line services and increased engagement with Heads of Service and Senior Management Teams, including line by line reviews of all budget areas. PROPOSED ADDITIONAL MANAGEMENT ACTIONS/CONTROLS: In addition to these measures further control measures have been agreed for 2025/26 to enhance the scrutiny of the overspend and support the recovery plan. 35
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These are: • Recruitment delay – there will be a recruitment drag with vacancy scrutiny approved vacancies being held for four weeks before they are advertised to create more payroll turnover. This will be for all vacancies except clinical or registered services vacancies or those which will incur cover costs. • High-cost care package group – the remit of this group will be expanded to include care packages for children with a disability and all UNPACs placement requests. • Oversight group for looked after and accommodated children in residential care – this group meets fortnightly to actively review all placements PROPOSED RECOVERY ACTIONS AT MONTH 3: • The proposed recovery action is outlined in Appendix E. This includes a mix of cost reduction targets across various services and a drawdown of all of the reserves held for Action 15 and the Enhanced Mental Health Outcome Framework. The reduces the projected overspend per below: TOTAL Health/ NHS AA Social Care/NAC Projected Overspend @ mth3 5.187 2.271 2.916 Financial Recovery Plan Projections (4.012) (1.752) (2.260) Residual Risk 1.175 0.519 0.656 • This plan will be reviewed each month and further recovery actions will be presented to the IJB for approval. PROPOSALS 3.1 Anticipated Outcomes Continuing to closely monitor the financial position will allow the IJB to take corrective action where required to deliver services in 2025-26 from within the available resource, thereby limiting the financial risk to the funding partners. The transformational change programme will have the greatest impact on the financial sustainability of the partnership, the IJB require to have a clear understanding of progress with the delivery of the transformation plan. 3.3 Measuring Impact Ongoing updates to the financial position will be reported to the IJB throughout 2025- 26. 4. IMPLICATIONS 4.1 Financial 36
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The outturn is an overall year-end overspend of £5.187m (1.5%) prior to recovery action. The report outlines the main variances for individual services. The IJB unearmarked reserve balance is zero. This current position poses a financial risk to North Ayrshire Council and NHS Ayrshire and Arran. 4.2 Human Resources The report highlights vacancy or turnover savings achieved during the year. Services will review any staffing establishment plans and recruitment in line with normal practice when implementing service change and reviews as per agreement with the IJB. Tight vacancy scrutiny management arrangements are in place for the HSCP. 4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk Para 2.12 highlights the financial risks. The report falls in line with the agreed risk appetite statement which is a low-risk appetite in respect to adherence to standing financial instructions, financial controls and financial statutory duties and a high-risk appetite in relation to finance and value for money. The ‘financial viability of the HSCP’ risk on our strategic risk register. 4.6 Community Wealth Building None. 4.7 Key Priorities The ability to deliver on our strategic priorities may be compromised due to the greater financial risk faced in 2025-26 and the increased focus required on financial rather than service improvement. This will be kept under close scrutiny throughout 2025-26. If we are unable to successfully develop a financial recovery plan to achieve financial balance, consideration may be given to revising the strategic commissioning plan. 5. CONSULTATION 5.1 This report has been produced in consultation with relevant budget holders and the Partnership Senior Management Team. 5.2 The IJB financial monitoring report is shared with the NHS Ayrshire and Arran Director of Finance and North Ayrshire Council’s Head of Finance after the report has been finalised for the IJB. 37
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Caroline Cameron, Director Author – Eleanor Currie, Chief Finance Officer [eleanorcurrie@north-ayrshire.gov.uk] 38
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PUBLIC INFORMATION 2025-26 Budget Monitoring Report–Objective Summary as at 30th June 2025 Appendix A Budget Outturn Projected Over/ (Under) Spend Variance Budget Outturn Projected Over/ (Under) Spend Variance Budget Outturn Projected Over/ (Under) Spend Variance £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 COMMUNITY CARE AND HEALTH 77,621 80,360 2,739 21,100 22,485 1,385 98,721 102,845 4,124 : Locality Services 32,841 33,879 1,038 5,942 6,041 99 38,783 39,920 1,137 : Community Care Service Delivery 40,560 42,184 1,624 0 40,560 42,184 1,624 : Rehabilitation and Reablement 2,118 2,097 (21) 0 2,118 2,097 (21) : Long Term Conditions 886 928 42 10,625 11,706 1,081 11,511 12,634 1,123 : Community Link Workers 392 387 (5) 0 0 0 392 387 (5) : Integrated Island Services 824 885 61 4,533 4,738 205 5,357 5,623 266 MENTAL HEALTH SERVICES 35,933 35,419 (514) 78,951 80,405 1,454 114,884 115,824 940 : Learning Disabilities 26,924 26,500 (424) 750 750 0 27,674 27,250 (424) : Community Mental Health 7,013 6,917 (96) 1,714 1,715 1 8,727 8,632 (95) : Addictions 1,996 2,002 6 1,941 1,941 0 3,937 3,943 6 : HBCCC 0 0 0 353 0 (353) 353 0 (353) : Lead Partnership Mental Health NHS Area Wide 0 0 0 74,193 75,999 1,806 74,193 75,999 1,806 CHILDREN & JUSTICE SERVICES 40,026 42,422 2,396 5,755 5,889 134 45,781 48,311 2,530 : Irvine, Kilwinning and Three Towns 3,138 3,188 50 0 0 0 3,138 3,188 50 : Garnock Valley, North Coast and Arran 3,558 3,612 54 0 0 0 3,558 3,612 54 :Intervention Services 1,799 1,808 9 0 0 0 1,799 1,808 9 : Care Experienced Children & Young people 27,094 29,951 2,857 0 0 0 27,094 29,951 2,857 : Head of Service - Children & Families 1,299 751 (548) 0 0 0 1,299 751 (548) : Justice Services 2,709 2,709 0 0 0 0 2,709 2,709 0 : C&F Health Team 429 403 (26) 4,995 5,116 121 5,424 5,519 95 : Lead Partnership NHS Children's Services 0 0 0 760 773 13 760 773 13 CHIEF SOCIAL WORK OFFICER 1,928 1,723 (205) 0 0 0 1,928 1,723 (205) PRIMARY CARE 0 0 0 55,147 55,078 (69) 55,147 55,078 (69) ALLIED HEALTH PROFESSIONALS 0 11,330 11,330 0 11,330 11,330 0 MANAGEMENT AND SUPPORT COSTS 11,059 9,559 (1,500) 3,296 3,681 385 14,355 13,240 (1,115) OUTTURN ON A MANAGED BASIS 166,567 169,483 2,916 175,579 178,868 3,289 342,146 348,351 6,205 Return Hosted Over/Underspends to East 0 0 0 0 (591) (591) 0 (591) (591) Return Hosted Over/Underspends to South 0 0 0 0 (517) (517) 0 (517) (517) Receive Hosted Over/Underspends South 0 0 0 0 50 50 0 50 50 Receive Hosted Over/Underspends East 0 0 0 0 40 40 0 40 40 OUTTURN ON AN IJB BASIS 166,567 169,483 2,916 175,579 177,850 2,271 342,146 347,333 5,187 TOTAL Partnership Budget - Objective Summary Council Health 2025/26 Budget 39
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PUBLIC INFORMATION 2025-26 Savings Tracker Appendix B Social Care: Ref Description Deliverability Status at budget setting Deliverability June 2025 2025/26 Saving Previously Agreed Savings (Full year impact) 1 Review of Day Care provision Green Green 0.100 2 Service redesign (CAAST Team and Corporate Parenting team) Green Green 0.034 Adjustments 3 Payroll Turnover Green Green 0.099 Mental Health 4 LD Responder Service Amber Amber 0.150 Children, Families & Criminal Justice 5 Brighter Pathways Amber Amber 1.000 Community Care & Health 6 Review of Day Care provision Amber Amber 0.107 7 Care at Home Amber Green 0.500 Cross Service 8 Care Package Review (all services) Amber Amber 0.200 9 Deletion of vacant posts Green Blue 0.056 10 Increase to charging Green Green 0.186 11 Admin Post Savings Green Blue 0.114 12 Financial Inclusion Green Blue 0.357 TOTAL SOCIAL CARE SAVINGS 2.903 40
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PUBLIC INFORMATION Health: Ref Description Deliverability Status at budget setting Deliverability June 2025 2025/26 Saving Adjustments 13 Increase recharge to East Ayrshire for beds at Woodland View Green Blue 0.010 14 Payroll Turnover Green Green 0.079 Other Savings 15 Admin Savings Amber Blue 0.186 16 Trindlemoss House - move to social care model Amber Amber 0.250 17 EICT/Rehab Amber Blue 0.150 18 Community MH/Wellbeing Review Amber Amber 0.100 19 Ward 7A - Woodland View Amber Amber 0.341 TOTAL HEALTH SAVINGS 1.116 TOTAL NORTH HSCP SAVINGS 4.019 41
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PUBLIC INFORMATION 2025-26 Budget Reconciliation Appendix C COUNCIL Period Permanent or Temporary £'m Initial Approved Budget 137.739 Adjustments to baseline 0.014 Revised Budget 137.753 Resource Transfer 25/26 1-3 25.462 Additional Funding - 24/25 Adult Social Care RLW 1-3 P 0.073 Additional Funding RLW 1-3 P 0.126 Additional Funding - Money Smart 1-3 P 0.094 ICT Transfers 1-3 P (0.005) Additional Funding - Whole Family Wellbeing Funds 1-3 T 0.179 CJSW - S27 1-3 P 3.280 Development of People working in Childrens SW 1-3 P (0.390) Roundings 3 (0.005) 166.567 HEALTH Period Permanent or Temporary £'m Initial Budget exc set aside 161.934 Month 10-12 Adjustments and adjusting for the full year impact of part years amounts and temporary funding. 8.532 Revised Budget 170.466 Resource Transfer 24/25 24.640 Resource Transfer 25/26 (25.462) NORTH NATIONAL INS 25-26 AMBUS 1 0.997 PRESCRIBING 25-26 AMBUSH 1 2.754 PRESCRIBING CRES 25-26 AMBUSH 1 (0.715) Training Grade Adj - April 1 (0.058) Training Grade Rates Adj - April 1 0.030 MH: Anticipate PDS Dementia (North) 25/26 1 0.094 MH: Anticipate Delivery of Veteran Specific 25/26 1 0.105 Anticipated RWW from SG 1 0.659 Anticipate 20% Tranche 2 ADP 1 0.174 Training Grade Adj - May 2 (0.013) Bwp 25-26 East Chest Heart Stroke 2 0.001 Bwp 25-26 East Nest Expansion 2 0.023 Bwp 25-26 East - Sds Advice Service 2 0.013 Bwp 25-26 East Sub Prescribing 2 0.170 25-26 South Budget Paper - North Substitute Prescribing 2 0.170 25-26 South Budget Paper - Pan Ayrshire Chest Heart And Stroke 2 0.001 25-26 North Budget Paper - Pan Ayrshire (vision Support Service 2 (0.005) 25-26 North Budget Paper - Pan Ayrshire (communitystore) 2 (0.155) HD52: EARLY INTERVENTION PSYCHOSIS 3 0.100 25-26 Pay Award Increase North 3 1.179 ANTICIPATED BUDGETS INCL HERE (NOT IN LEDGER) 3 0.412 Roundings (0.001) 175.579 TOTAL COMBINED BUDGET 342.146 Social Care Budget Reported at Month 3 Health Budget Reported at Month 3 42
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PUBLIC INFORMATION 25-26 IJB Reserves Position Appendix D Area of Reserves Balance at 31 March 2025 Earmarked Funds £ : Alcohol & Drug Partnership 353 : Mental Health Action 15 135 : Primary Care Improvement Fund 46 : Service Redesign / Challenge Fund 780 : Family Wellbeing Fund 934 : Breastfeeding Network 36 : MH Recovery and Renewal /Enhanced MH Outcome Framework 365 : Early Intervention in Psychosis 92 : LD funding 82 : Donation (Police Scotland) 1 : Primary Care Improvement Fund IP 303 : GP Premises Improvements - tranches 1 and 2 3 : Dental Practice Improvement 29 : Appropriate Adult 2 Total Earmarked 3,161 43
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PUBLIC INFORMATION Financial Recovery Action Plan Appendix E a) Care home placements (60) This will bring the overall budget for placements and charging order income online. b) Physical Disability Services (res, community and DPs) (575) Some PD residential packages £575K will move to the older people Care Home placements budget. When they transfer, the older people placements will need to manage this transfer within the existing budget. c) Specialist Rehab wards (75) Based on planned action developed by the senior manager. d) Wards 1 and 2 (275) Based on planned action developed by the senior manager. e) Care at Home (300) Reflects the potential reduction to costs as an impact of the SG investment in unscheduled care TOTAL (1,285) a) Learning Disabilities 0 b) Community Mental Health services 0 c) Lead Partnership for Mental Health : - Adult Inpatients (150) Inpatient Review being undertaken - Elderly Inpatients (50) Inpatient Review being undertaken - Psychiatry (150) Junior doctor rota still to be revised. - Action 15 Reserves (486) Draw down of the full pan Ayrshire reserve - agreed with the CFOs at East and South - Enhanced MH Outcome Framework Reserves (624) Draw down of the full pan Ayrshire reserve - agreed with the CFOs at East and South NORTH AYRSHIRE ELEMENT 38.65% (564) TOTAL (564) Health and Community Care Services Mental Health Services No cost reduction proposed but the service need to maintain the current position. All new placements need to be offset by discharges or reductions from care package reviews. 44
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PUBLIC INFORMATION SERVICE AREA Cost reduction target Comment Children and Justice Services a) Residential Placements (1,000) Based on some placements moving to tenancies and other placements moving from external to in-house provision. TOTAL (1,000) ALLIED HEALTH PROFESSIONALS 0.000 No cost reduction proposed but the service need to maintain the current position. CHIEF SOCIAL WORK OFFICER 0.000 No cost reduction proposed but the service need to maintain the current position. MANAGEMENT AND SUPPORT a) Payroll turnover (200) Increase to the current projection based on dragging vacancies for 4 weeks after vacancy scrutiny approval. b) Transition slippage (100) Based on historic slippage. c) Contractual inflation (25) TOTAL (325) OTHER AREAS b) Agenda for Change - assume fully funded (838) Based on 100% cost of the half hour reduction in working week being funded. (838) TOTAL RECOVERY ACTION (4,012) Remaining projected overspend 1,175 45
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PUBLIC INFORMATION Bank and Agency Costs to Month 3 Appendix F 1) NHS 4863 (Registered) 4864 (Unregistered) TOTAL AAC074 NORTH CORE SLT ADULT 2,243 2,243 AAC403 WARD 1 WOODLANDS VIEW 9,685 75,132 84,817 AAC406 WARD 2 WOODLANDS VIEW 9,022 126,262 135,284 AAC410 ACH REDBURN REHAB WARD NRS 10,059 46,963 57,022 AAC412 ACH DOUGLAS GRANT REHAB WD NRS 5,673 10,014 15,687 AAD401 WARD 3 WOODLANDS VIEW NURSING 3,234 137,568 140,802 AAD402 WARD 4 WOODLANDS VIEW NURSING 682 10,902 11,584 AAH047 NEW CLONBEITH NURSING(JURA) 36,558 26,708 63,266 AAH415 WVIEW THE GLEN ECT 1,311 627 1,938 AAH417 WVIEW WARD 10 ACUTE MH NRS 1,342 40,645 41,987 AAH423 WVIEW WARD 8 ACUTE MH NRS 4,896 256,513 261,409 AAH460 WARD 5 WOODLANDS VIEW 358 3,075 3,433 AAH466 WVIEW WARD 7B REHAB MH NRS 2,302 2,302 AAH492 NEW DUNURE NURSING(CLONBEITH) 11,907 42,643 54,550 AAH494 MH BED MANAGEMENT 4,792 4,792 AAT001 TRINDLEMOSS 19,288 54,297 73,585 AAW047 ARRAN HOSPITAL NURSING 18,134 12,265 30,399 ACA412 CAMHS UNSCHEDULED CARE 377 377 ACF001 EARLY YRS-C/F TEAM 1 300 300 ACN012 PACKAGE OF CARE (P) - AMG 35,869 35,869 ACN047 ARRAN DN 11,599 11,599 ACP002 NC POC TEAM 2 287 287 ACP003 NC POC TEAM 3 2,389 2,389 ADN033 IRVINE DN 101- 101- ADN042 NORTH WEST COAST DN 10,003 10,003 ADN075 GARNOCK VALLEY DN 9,705 9,705 ADN080 NORTH DN TEAM LEADERS 22,209 22,209 ALA047 LADY MARGARET NURSING 4,839 2,529 7,368 AML146 LD HEALTH CHECKS 12,238 12,238 AML392 NORTH CLDT 5,777 164 5,941 AML402 LDS MANAGEMENT 2,286 2,286 AML442 North Partnership Management 8,268 8,268 AMN412 CMHT NURSING-NORTH AYRSHIRE 1,229 1,229 AMN415 WVIEW WARD 7C FORENSIC REHAB N 358 25,982 26,340 AMN419 DAY ACTIVITIES TEAM 10,208 10,208 AMN425 INTENSIVE COMMUNITY NURSING TEAM 11,180 11,180 AMN431 ADULT MENTAL HEALTH LIASION TEAM 1,798 1,798 AMN446 WVIEW WARD 6 LOW SECURE NRS 12,933 37,194 50,127 AMN454 WARRIX AVE 18,214 19,161 37,375 ANU632 ICFN - COMMUNITY PHLEBOTOMY 3,303 3,303 AWV438 WVIEW WARD 7A LD A+T NRS 20,658 320,728 341,386 AXC407 WVIEW WARD 9 ACUTE MH NRS 6,480 93,989 100,469 AXC418 WVIEW WARD 11 ACUTE MH NRS 6,589 43,722 50,311 315,161 1,432,403 1,747,564 2) AGENCY COSTS Cost Centre Description Actual Expenditure Montrose House Brodick 128,839 Ld Acm 13,864 Mh Acm 13,606 156,309.00 Bank 46
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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 Agenda Item 6 47
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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 48
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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. 49
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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 50
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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. 51
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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. 52
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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 53
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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. 54
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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. 55
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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. 56
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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 57
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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. 58
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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. 59
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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. 60
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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. 61
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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 62
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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 63
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North Ayrshire Health & Social Care Partnership: Montrose House Care Home OPTIONS APPRAISAL V2.1 August 2025 64
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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 65
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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. 66
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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. 67
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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. 68
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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. 69
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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. 70
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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. 71
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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 72
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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. 73
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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. 74
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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. 75
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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. 76
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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. 77
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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% 78
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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. 79
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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) 80
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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 81
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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% 82
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17 | P a g e Bank Hours vs Agency Hours Bank vs Agency Hours (%) 83
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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 84
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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, 85
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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. 86
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21 | P a g e Despite best efforts, new appointments have been offset by staff leaving the Partnership’s employ. 87
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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 88
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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 89
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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. 90
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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. 91
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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 92
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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. 93
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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. 94
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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. 95
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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. 96
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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. 97
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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. 98
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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 99
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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 100
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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) 101
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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? 102
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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)? 103
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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 104
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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.” 105
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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 106
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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: 107
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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. 108
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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 109
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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. 110
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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 111
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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? 112
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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. 113
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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. 114
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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. 115
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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? 116
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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.” 117
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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.” 118
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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. 119
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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 120
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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? 121
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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? 122
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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)? 123
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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 124
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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 125
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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 126
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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 127
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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. 128
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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? 129
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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? 130
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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.” 131
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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 132
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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. 133
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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. 134
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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. 135
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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. 136
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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 137
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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? 138
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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. 139
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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! 141
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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. 142
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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. 143
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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 144
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2 | P a g e Appendix 3: Big Blue Dog Recruitment Report 145
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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 146
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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. 147
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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? 148
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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 149
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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 150
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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. 151
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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 152
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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 153
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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. 154
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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 155
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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. 156
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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.“ 157
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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? 158
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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. 159
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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. 160
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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. 161
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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) 162
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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. 163
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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. 164
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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. 165
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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. 166
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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 167
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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. 168
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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. 169
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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 170
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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. 171
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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 172
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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. 173
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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. 174
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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. 175
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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. 176
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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. 177
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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 178
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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. 179
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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. 180
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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. 181
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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. 182
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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. 183
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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. 184
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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 185
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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. 186
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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. 187
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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 188
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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 189
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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 190
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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. 191
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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. 192
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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]. 193
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10 Chart 2 Vacancy % by Care Home 194
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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. 195
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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. 196
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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. 197
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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. 198
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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. 199
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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: …………………………………………………………………………… 200
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Integrated Joint Board 21st August, 2025 Subject : Transformation Plan – Progress Update Purpose : This paper updates the IJB on the progress of the HSCP transformation plan. Recommendation : The Integration Joint Board are asked to note the progress to date. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required x 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership IJB Integrated Joint Board PID Project Initiation Document SDS Self Directed Support 1. EXECUTIVE SUMMARY 1.1 The North Ayrshire HSCP Transformation Plan 2024-27 is an ambitious programme of change consisting of a range of improvement and reform projects across all service areas, each aiming to improve the quality of our services and contribute to the long- term sustainability of health and care in North Ayrshire. This report highlights key activity and general updates on progress made in the last six months. 2. BACKGROUND 2.1 The 3 year Transformation Plan was approved by IJB in March 2024. There are 77 change projects and programmes on the plan, from across every area of the partnership. The Plan is kept under review and updated through the Transformation Board. 2.2 Six-month progress updates were provided to IJB in September 2024, December 2024 and a further update on Q3 at the meeting on 6th February 2025. It has been agreed that updates will be every six months. 2.3 Through 24-25 the financial outlook deteriorated, and the need for transformation and the redesign of services became more urgent and more important to the long-term sustainability of the functions for which we are responsible. At the same time our Agenda Item 7 201
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capacity for change diminished due to increasing demands on people’s capacity including the short-term actions required to deliver the financial recovery plan. There remains a focus and commitment across services to progress the high priority areas agreed as part of the Plan. Key Activity 2.4 January to March 2025 January • ‘Focus on Adult Health and Community Care’ with a review of 24/25 and five new projects initiated, as well as the successful closure on the plan of the Blue Badges project. February • ‘Focus on Children, Families, and Justice’, with a review of 24/25 and a deep dive into the progress of the Brighter Pathways programme. March • The fourth Ayrshire-wide Innovation Event with colleagues from Public Health Scotland presenting their Innovation Strategy; the Service Design Academy provided an overview of their approach (which is the Scottish Government approach) to service design. We also had colleagues from South Ayrshire sharing their new Integrated Impact Assessment, as well as a useful recap from the Digital Health and Care Scotland 2025 conference in Edinburgh. • The Health and Social Care Transformation conference 2025 was also in March, and North Ayrshire was well represented, learning about the progress of the national Digital Front Door programme as well as other policy and strategy updates, alongside a range world-class industry and health and social care speakers. AI was a key theme with a number of impactful examples from the health sector. • ‘Focus on Mental Health and Learning Disabilities’ with a review of 24/25, one new project was initiated, and one new project added to the Plan. April to June 2025 April • A new Pan-Ayrshire Digital and Data Integration Group met for the first time. This was an action from the Digital and Data Plan and the first priority for the group is to address network access issues across our shared estate. The group also discussed opportunities for collaborating around skills development and improving data sharing. June • Successful implementation of phase 1 our new Care Management System, Eclipse. • Fifth Innovation Event with colleagues from the SSSC talking about their new resource 23 Things to support your practice and learning in Technology Enabled Care; SAMH on their Digital Strategy; NHS Ayrshire & Arran on their 202
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evaluation of AI clinical documentation tools (Heidi and Corti); Edinburgh Council on their pilot of Magic Notes, the AI note-taking tool designed for social work that's being rolled out in areas of Ayrshire later this year; and also South Ayrshire HSCP talking about their use of data and dashboards in evaluating the quality of external providers. The past six months have also seen teams work closely with internal audit to review the governance and monitoring arrangements for the transformation programme. There was a deep dive into Brighter Pathways, as an example of a large programme, TrakCare, as an example of a pan-Ayrshire project with a strong NHS focus, and Blue Badges, as an example of a smaller project. The findings are reported separately. Service Updates 2.10 Health and Community Care • ACH & Ailsa Hospital Inpatient Services Review: A site-wide review is underway to improve efficiency and align spend with budget. Several quick wins have been delivered in HCC Community Wards, with most medium-term actions due to commence between late summer 2025 to March 2026. • Aids & Adaptations Policy Review: Progress is delayed pending SLA agreement with Housing Services (draft paper with Housing for review). An extension to March 2026 is being sought due to this dependency. • Analogue to Digital Telecare Switchover: 4,807 installations have been completed in service users’ homes, including 3,422 in-situ digital units. The call centre has transitioned to a digital platform, and user migration is now underway. • Arran SPOC: Netcall telephony implementation is progressing, with a test system in place. Completion is now expected by August 2025 following delays due to infrastructure challenges on the island. • Care Packages (Lower Level): Project is nearing completion, with approval of final recommendations due by end June and implementation planned during July. Delays were due to staffing and winter pressures. • Community Rehab: Three distinct subgroups have identified the work required to complete this project in a deliberate and considered manner. Given the amount of work identified, a project extension to May 2026 will be sought. • Complex Care Model (Change Fund): This options appraisal project has concluded successfully, and a closure report will be submitted to the 203
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Transformation Board. A new project is being scoped based on the preferred outcome. • Day Service Review: The team are now working to implement the preferred option, as per IJB report in June 2025 (ie. All day services provided by HSCP with an alternative role around carer support and outreach delivered by a third party). • Delayed Discharge & Winter Preparedness: Project has concluded. A performance framework has been introduced to monitor trends and is analysed monthly. An annual action plan will support future winter preparedness and has been embedded in our ‘business as usual’ processes. • Enhanced Intermediate Care Team (eICT): The project has now concluded, pending submission of a closure report to the Transformation Board. Improvements include simplified escalation, refined triage roles, and enhanced documentation and training. A full review of policy and process has also been undertaken, where it has been concluded that current working practices are fit for purpose. • HomeFirst Strategy: Work has commenced, aligned with the Strategic Commissioning Plan. This strategy will utilise the needs assessment data used in that plan, to ensure consistent and joined-up strategic planning across the partnership. • MDTs in Localities: The project has successfully concluded, delivering key outcomes including improved person-centred care through integrated working, enhanced efficiency via shared caseloads, better access to specialist input, and strengthened communication across disciplines—leading to more effective decision-making and streamlined care pathways. • Moving & Handling: The project concluded ahead of schedule, delivering a number of key achievements including enhanced training for staff, improved risk assessment processes, and the introduction of QR-coded instructional videos and RAG-rated user guidance. These initiatives have strengthened staff support, optimised equipment use and extended good practice to wider services including providers and carers. • OT Service Provision: Project concluded with a reduction in Service Access OT waiting lists from 812 (May 2024) to 86 (Feb 2025). • Podiatry: Project concluded with a 40% reduction in waiting lists (433 in Oct 2024 to 263 in May 2025) and improved triage and referral processes. Waiting times for new patients reduced from 58 weeks to 4 weeks. 204
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• Speech & Language Therapy: The project has now commenced, and a staff workshop has established a draft project delivery plan, which is currently in the process of being finalised. • Technology First: Progress continues with plans for a central hub at Castleview, Ardrossan being finalised. Staff training and public engagement are key components of this project. 2.11 Children, Families, and Justice • Brighter Pathways: Strategic Report detailing the outputs from each of the workstreams is in development, weekly meetings with the Director are scheduled to assist with the development of the report. Scheduled to report to IJB and Cabinet in September 2025. • Supported Accommodation Service: Business Case was presented to the PSMT on the 3rd of July to develop step down model of care for young people moving on from care. • Service Access; The 2023 Desktop Review has been updated to reflect the present situation with regards to service delivery. • North Ayrshire Children and Young People’s Neurodevelopmental Specification Implementation Group: The remit of the Group has not been without challenge; however, through dedicate multi-agency and multi-disciplinary working, significant progress has been made in relation to non-clinical aspects of the neurodevelopmental service specification. North Ayrshire benefits from positive working relationships between services and this has facilitated constructive discussions and progress in key areas: • We understand what supports are available to children and families in North Ayrshire in relation to NDD. • Information on supports, including training and advice, has become more accessible to parents and carers via platforms such as NEST. • We have a baseline value for confidence and competence in the children’s services’ workforce in relation to supporting children with known or suspected NDD and their families and have a plan in place to improve this over the next year. • We have proactively sought the views and experiences of parents and carers in relation to aspects of the service specification and will continue to do so. In addition, we have consistently feedback to parents and carers in line with good practice standards for engagement. • We understand the journey of the children “meaningfully redirected” from CAMHS since August 2023 and what supports, if any, these children continue to access. 205
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• NDD Connect Event: Planning meetings have been scheduled into the diary, set dates for the event have not been agreed at the time of writing, further updates will be provided accordingly. 2.12 Mental Health and Learning Disabilities • ACH & Ailsa Hospital Inpatient Services Review: A site-wide review is underway to improve efficiency and align spend with budget. The PID has been agreed and a programme board is meeting regularly to monitor progress and share ideas across Ward groups • MAT Standards: all 10 MAT Standards have been rated green by the national support team. This is the highest level before a final RAG rating of blue achieved only by evidence of two years of sustained delivery. Evaluation and search for permanent funding for MAT Standard 7 (MAT in Primary Care) continues. • Early Intervention in Psychosis Service: development of care pathways, system set ups and data benchmarks continues in anticipation of service launching. Some delays to recruitment have meant a delay to service launch and now working towards a date of September 2025. • Community Wellbeing Services: a third workshop was held to develop recommendations for an additional £100,000 of savings from this area. The recommendations have been drafted and further consultations are ongoing. • Learning Disabilities Intensive Support Team: work continues to identify an alternative solution for the day assessment hub. A Project Initiation Document has been agreed with the Scottish Government and Health Improvement Scotland for the funded test of change. • Complex Care Accommodation Requirements: Work is underway with Housing, Mental Health, CDIS and Learning Disabilities colleagues to accurately reflect the demand for future housing needs including for supported type models. The service are also exploring options within the Ayrshire Central Housing Development. • Review Acute Assessment model (Ward 7A) based at Woodland View: All reports complete including benchmarking and previous admission analysis. Ward has been closed/paused pending review. Consultation, engagement and research underway to develop options appraisal allowing the creation of recommendations for the way forward. 206
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• Implementation of Recommendations to Support people with Learning Disabilities through the entire life course: workplan was approved by the Transformation Board and Social Work Governance Board. Short life Working Groups are being set up to take six pieces of work forward. • West Road: the reconfiguration of West Road was completed and officially opened on 22 May 2025. The re-opened and refurbished facility will serve the Community Eating Disorders and Neuro-CAMHS services. • Community Eating Disorders Service (CEDS): The previous PID has been updated to reflect the current circumstances. Operational solutions have been identified and a business case for permanent funding is being developed. • Digital Transformation: TrakCare Implementation continues with two more teams live on the system. A delivery plan to support the Digital Transformation work in Mental Health is being looked at, this was part of the digital strategy work in 2024 and part of the original scope still to be delivered. The Strata system has is being piloted in a number of areas. • Psychological Therapies Specification: a self-assessment tool has been developed to allow mass collection of information from all teams and a test of the tool is underway with two teams. 2.13 Partnership-wide Eclipse The Eclipse social work case management system went live on the 11th June. This was culmination of a significant effort over many years by the Performance and Information System Team in collaboration with operational colleagues. The team, with service support, undertook a substantial final manual migration process to move all data to the new system and provide the best starting position for all workers. The new system provides the functionality that has been at the core of many reviews, namely reducing system downtime, reducing the bureaucracy of form-filling, providing outputs that are person and service specific, and, having a modern system that can integrate with other systems to meet the future requirements of Partnership services. The team will continue to support all users over the coming few months to bed-in the system processes then ease back into a business-as-usual function moving into a process review, development, reporting, and training cycle. A formal evaluation of the implementation is planned. Workforce Plan The Scottish Government Director of Health Workforce issued a letter on 17 December 2024 which advised that it recognised the workload pressure facing NHS 207
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Boards and HSCPs and difficulty in planning for the workforce in the current environment, and contained a requirement to complete a reporting template regarding information about the current workforce. The Interim return was developed by senior managers and approved by PSMT, and submitted to the Scottish Government on the 17th March. This may mean the Scottish Government is looking at further guidance nationally. We are now in year 3 of the workforce plan, and work to carry out an evaluation of the plan and final year three report will commence over the summer to be completed in October 2024. Work to carry out a revised workforce plan will commence following the development of a new Strategic Plan and will therefore take place in 2026. The Carer Partnership has achieved the following highlights: • North Ayrshire Short Breaks Services Statement published in February 2025 • Carers Champions Board established in January 2025 (monthly meetings in Feb/ March) • Continued work on Bridgit (digital self-help portal for carers) with Young Carer section live in March 2025 • Improved process and pathways for offering/ completion of ACSP and YCS - CGNA completing from March 2025 • Revised YCS engagement and update of assessment paperwork complete (SWGB April 25). • Development of Section 28 – Identifying & Involving Carers in Hospital Discharge. Post recruited in February 2025. • CGNA aim, role and offer embedded across schools in January 2025. • Joint Carer Partnership Action Plan compiled. The following work is ongoing and of priority for future reporting: • Communication and marketing materials - Carer Pack aligned with the self-help resource/ work is ongoing • Revised longer term HSCP Carer Strategy with a draft due in the autumn before submission to the IJB. • Introduction of an Engagement role with Carers Gateway North Ayrshire (CGNA). • Increased variety in breaks from caring and improved process in the distribution of short break funds to carers. Shared Care Short Breaks Funding received has been almost doubled for 25/ 26 to CGNA to distribute. • The second annual carers conference driven by what carers need was held during Carers Week in June at Oscars in Saltcoats. Self-Directed Support In the past twelve months the following has been achieved: • An initial desktop review of all policy relating to SDS. • Several design sessions with a core HSCP project team to identify areas to progress. 208
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• A series of individual interviews with a range of senior staff and practitioners across the Partnership to better understand the future direction of SDS, barriers and current organisational cultures. • Service user interviews to capture the difference choice and control makes to people’s lives as part of the change story for North Ayrshire to be used as case studies for staff training purposes. • Three SDS sessions with Team Managers to share progress to date, refresh on SDS duties and options and ask what improved choice and control could look like in their service. • Creation of an overall design brand kit to help make SDS and the options for choice and control clearer. • Graphic design work to support related work in other areas such as unpaid carers and learning disability. • The design of a new SDS microsite to help people seeking information and support navigate SDS and provide staff with a space to host resources to support their practice in relation to options, choice and control. • Two cohorts of a value-based leadership programme for North Ayrshire staff creating the space to consider culture and behaviours required to bring about system level changes. • Developed the beginnings of a new overarching ethical framework correlating with the digital resource, and comprising a public value proposition, 7 anchors of great practice and visible, local stories to bring choice and control to life. • Drafting of an SDS Policy to advice of duties, local decision making and promote consistency and best practice across all HSCP services. 3. PROPOSALS 3.1 It is proposed that IJB note the progress to date. 3.2 Anticipated Outcomes Informing IJB and the people of North Ayrshire on the progress of the Transformation Plan, and also providing assurance of the governance arrangements and that the Transformation Board has appropriate oversight. 3.3 Measuring Impact Stakeholders are assured of progress. 4. IMPLICATIONS 4.1 Financial A number of the transformation projects will deliver financial savings once they are fully operational; some financial targets have been identified as part of the budget development for 2025/26 (reflected in the Medium-Term Financial Outlook). Identified 209
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savings and overspend reductions are tracked in the online Tracker (screenshot in Appendix I and exported version in Appendix III) and our online dashboard (screenshot in Appendix II). 4.2 Human Resources None. 4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk None. 4.6 Community Wealth Building None. 4.7 Key Priorities None. 5. CONSULTATION 5.1 Consultation has taken place with Planning Managers in the Transformation Team, and with the Transformation Board. Scott Hunter, Chief Social Work Officer scotthunter@north-ayrshire.gov.uk 8th August 2025 Appendix 1 – Online tracker Appendix 2 – Online dashboard 210
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Appendix 1 – Online Tracker (Screenshot) 211
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Appendix 2 - Online Dashboard (Screenshot) 212
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Integration Joint Board 21st August 2025 Subject : North Ayrshire HSCP Clinical and Care Governance Report 2024-25 Purpose : This report is presented to IJB Members for :- • Awareness Recommendation : IJB Members are asked to note the contents of the annual Report 2024-25 Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required √ 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms CAMHS Child & Adolescent Mental Health Services CCGG Clinical Care Governance Group HSCP Health and Social Care Partnership IJB Integration Joint Board NHS AA NHS Ayrshire and Arran MWC Mental Welfare Commission NA North Ayrshire 1. EXECUTIVE SUMMARY 1.1 North Ayrshire HSCP continues to have robust clinical and care governance arrangements in place to provide high quality care and support for the people in North Ayrshire. 1.2 This paper provides an update and overview of governance activity for the period August 2024 – July 2025 for consideration by the Integration Joint Board (IJB). The Annual Report is attached at Appendix 1. 2. BACKGROUND As part of the integration of health and social care services, a National Clinical and Care Governance Framework was developed. Clinical and Care Governance is the system in which the HSCP’s are accountable for continuously improving quality and safeguarding high standards of care. The Partnership has developed Clinical and Care Governance arrangements in line with the commitments and requirements contained in the Integration Scheme. Agenda Item 8 213
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2.1 The Clinical and Care Governance Group (CCGG) provide assurance to the IJB that: • Quality of care, effectiveness and efficiency drives decision-making about the planning, provision, organisation and management of services • The planning and delivery of services take full account of the perspective of patients and service users • Unacceptable clinical and care practice will be detected and addressed The Terms of Reference for the CCGG are included as Appendix 2 of this report. The CCGG has a standing agenda that ensures routine consideration of: • Public Protection • Professional Updates • Heads of Service updates • Adverse Events • Complaints/Enquiries • Inspection Reports/Action Plans/SPSO • Workforce • Consultation and Safety Action Notices • Infection Control and Infection • Operational Risk Register The CCGG has also had specific updates and assurance reports on: • Updates to the Strategic Plan • Ward 7A, Woodland view • Primary and Urgent Care • Front Door Service • Improving Cancer Journey Programme • MWC Young People Monitoring Report • KA Leisure Wellbeing Service • AHP highlight report 2.2 The Clinical and Care Governance Annual Report provides information on governance activity under Safe, Effective and Person centred headings. The paper provides details on how the CGG delivers on its function to review and consider operational risk management and escalation, oversight of reporting and reviewing adverse events within HSCP services including the outcome of significant adverse event reports. The paper highlights examples of key pieces of work during this period including activity on a range engagement activity with local communities. The paper provides an update on external inspection of NA HSCP services by the Mental Welfare Commission Information on services user feedback through engagement, complaints and compliments. 214
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3. PROPOSALS 3.1 Anticipated Outcomes Further meeting dates for the NA HSCP’S CCGG are planned for 2024/25, and future update reports will be provided to the Integration Joint Board. 3.2 Measuring Impact It is anticipated that through continuous quality improvement and enhanced reporting structures, the CCGG will ensure services are safe, effective, person-centred and responsive to the ongoing needs of the population. 4. IMPLICATIONS 4.1 Financial No financial implications as a result of this paper 4.2 Human Resources None as a result of this paper 4.3 Legal None as a result of this paper 4.4 Equality/Socio-Economic None as a result of this paper 4.5 Risk Operational risks are reported to the PSMT and these risks are then remitted to the Clinical and Care Governance Group. The Group consider any High or Very High risks (as defined by the approved risk management strategy) and if required escalate these to the Partnership Senior Management Team (PSMT) for consideration for inclusion on the Strategic Risk Register. 4.6 Community Wealth Building None 4.7 Key Priorities Over the coming 12 months the NA HSCP CCG will: • Review the HIS Clinical Governance standards against local performance and identify areas of good practice and areas for improvement • Continue to develop consistent performance measures for health care services within the partnership to support governance scrutiny and assurance on quality of patient care. • Ensure that the NA HSCP Clinical Governance Group considers quality of care, safety and management of risk as part of discussion on financial recovery over the coming 12 months. 215
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4.4 Equality/Socio-Economic None 5. CONSULTATION None Caroline Cameron, Director For further information please contact Darren Fullarton, Lead Nurse/Associate Nurse Director Appendix 1 – NAHSCP Clinical and Care Governance Group Annual Report 2024/25 Appendix 2 – Clinical and Care Governance Group Terms of Reference 216
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 1. Introduction As part of the integration of Health and Social Care services, a National Clinical and Care Governance Framework was developed. Clinical and Care Governance is the system in which the Health and Social Care Partnership are accountable for continuously improving quality and safeguarding high standards of care. The North Ayrshire Health and Social Care Partnership (HSCP) has developed Clinical and Care Governance arrangements in line with the commitments and requirements contained in the Integration Scheme. The role and function of the North Ayrshire Clinical and Care Governance Group (CCG) is built upon strong partnership and collaboration and North Ayrshire HSCP continue to provide robust arrangements for the clinical and care governance of partnership services and wider relevant provision to deliver on statutory, policy and professional requirements and the achievement of partnership quality ambitions. The CCG is a standing group of the IJB. It is a requirement to submit an annual report on the activity of the CCG within the Partnership to the IJB and an annual report to the Healthcare Governance Committee. Key Messages • The North Ayrshire HSCP continues to have robust clinical and care governance arrangements in place to provide scrutiny and assurance on quality care and support for the people in North Ayrshire. • The partnership continues to face financial challenges in delivering and improving service within the available budget. • The partnership continues to strengthen its approach to engaging with our local communities to ensure that the design and delivery of service is done in collaboration with those that use the service. • The partnership has received positive feedback and learning from independent visits and inspection. • Healthcare Improvement Scotland (HIS) have published and consulted on Clinical Governance draft standards. Once approved we will measure our local performance against these standards. • The increased use of performance measures will support and promote scrutiny and assurance through the governance framework. 217
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 2. Health and Care Governance Arrangements The North Ayrshire Clinical and Care Governance Group Framework: The CCGG has a standing agenda that ensures routine consideration of: • Public Protection • Professional Updates • Heads of Service updates • Adverse Events • Complaints/Enquiries • Inspection Reports/Action Plans/SPSO • Workforce • Consultation and Safety Action Notices • Infection Control and Infection • Operational Risk Register Over the past 12 months the CCGG has also received specific updates and assurance reports on: • Updates to the Strategic Plan • Ward 7A, Woodland view • Primary and Urgent Care • Front Door Service • Improving Cancer Journey Programme • MWC Young People Monitoring Report • KA Leisure Wellbeing Service • AHP highlight report 218
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 The North Ayrshire Clinical and Care Governance group has met on 5 occasions since August 2024 and the meeting was adjourned on 4 occasions as the group was not quorate. The next NA CCGG is scheduled for 29th September 2025. The Terms of Reference is included as Appendix 1. 3. Safe Operational Risk Register Operational risks are reported to the PSMT and these risks are then remitted to the Clinical and Care Governance Group. The Group consider any High or Very High risks (as defined by the approved risk management strategy) and if required escalate these to the Partnership Senior Management Team (PSMT) for consideration for inclusion on the Strategic Risk Register. The CCG received Operational Risk Register (ORR) updates at the October 2024 meeting and no items were escalated. At the January 2025 meeting the risk in relation to Ward7A was escalated to PSMT resulting in a new risk being added to the Strategic Risk Register called ‘Growth and expansion of specialist complex care developments’. This was subsequently reported to the IJB in March 2025. Safety Action Notices Safety Action Notices are issued to alert services of concerns/faults that require review from the area manager for consideration of attention and action: # Received Returns Within Timescale % Returns Within Timescale Returns Outwith Timescale % Returns Outwith Timescale Q4 (Jan-Mar '25) 3 2 67% 1 33% Q1 (Apr-Jun '25) 10 0 0% 6 60% Q2 (Jul-Sept '25) 9 4 44% 1 11% Total 22 6 27% 8 36% 43% 57% Safety Action Notices 2025 Returns within Timeframe Returns outwith Timeframe 0 2 4 6 8 10 12 Equipment (Medical) Equipment (Other) Health & Safety SAN Themes 219
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 Performance in this area will continue to be monitored to ensure improvements in returning “Responsible manager response and assurance sign off” within timeframes (within 14 working days) 3.1 Adverse Events Adverse events are reported and investigated on the NHS Datix system. Each adverse event is reviewed and approved locally with weekly oversight from HSCP and MH Adverse Event review groups. The following chart shows the total number of adverse events reported by all services in North Ayrshire: The total number of adverse events reported in this period was 2979 with incidents of violence and aggression slips, trips and falls and self-harm/suicide being the top three categories. Category Number Violence/Abuse/Harassment 1242 Slip, Trip or Fall 448 Self Harm / Suicide 436 Mental Health Services report the most adverse events following by Helath and Community Care and then Children’s, Families and Justice. The Mental Health Adverse Event Review Group (AERG) meets weekly and the North Ayrshire AERG meets every two weeks to review all incidents reported on Datix within that review period. 0 200 400 600 800 1000 1200 1400 North H&SCP 01/07/2024 -30/06/2025 Adverse Event Category 220
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 MH and North AERG: • ensures that the appropriate level of review are undertaken and that all learning from reviews is shared across appropriate services. • outstanding Adverese Event Datix and LMTR trackers are on the weekly agenda with encouragement to the Senior Managers to review for their service and to udpate with the RMT. Monthly SAER meeting with AND/AMD/RMT and Senior Managers to: • nominate review teams – this is now from locality management teams and has resulted in improved timescales • review outstanding SAER where review team not confirmed • reiew and discuss and make decisions on any other challenges within SAER process The progress of all SAERs is tracked by the AERG coordinator and the review teams attend the AERG to present on draft reports prior to submission for final approval. At all stages efforts are made to ensure families are informed and engaged in the SAER process. 3.2 SAERs and LMTRs Since 2019 the number of Significant Adverse Event Reviews (SAER) commissioned for North Ayrshire HSCP is 85. 15 new SAER were commissioned in 2024/25 with 9 commissioned since April 2026. Of the SAERs commissioned in 2024/25, four of these have been completed with seven overdue and four on target to be completed. The AERG chairs, supported by the NHS Risk Management Team, continue to support review team leads to address challenges and barriers to completing SAERs. There has been significant progress in reducing the number of overdue SAERs over the past 12 – 18 months. The activity on undertaking Significant Adverse Event reviews has increased steadily over the past 10 years. This is welcome evidence of an ongoing commitment by the organisation to learn when things do not go well. 0 2 4 6 8 10 12 14 16 18 19/20 20/21 21/22 22/23 23/24 24/25 25/26 Number of SAERs (year) 221
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 Through the MH AERG it is recognised that the framework around SAERs required to be reviewed and the support in place for senior leads undertaking SAERS considered. Tests of change have been undertaken to improve on roles and responsibilities: lead reviewers have timeous support from subject experts, responsibilities including family and staff contacts are shared equally and time in diary consciously planned to improve capacity to undertake SAER activity. The learning from this has been shared and implemented in our approach to supporting lead reviewers. The Root Cause Analysis Training offered to staff has been reviewed by the NHS Risk Management Team with a revised training programme set to be introduced in 2025. Since 2019 the number of Local Management Team Reviews (LMTRs) commissioned for North Ayrshire HSCP is 170. 19 new LMTRs were commissioned in 2024/25 with 8 commissioned since April 2026 Of the LMTRs commissioned in 2024/25, eight of these have been completed with 11 overdue to be completed. The AERG chairs, supported by the NHS Risk Management Team, continue to support review team leads to address challenges and barriers to completing LMTRs. There has been significant progress in reducing the number of overdue LMTRs over the past 12 – 18 months and work continues to complete overdue LMTRs from 2020/21 (2), 2021/22 (1), 2022/23 (6) and 2023/24 (4). 3.3 Learning and Improvement A review of emerging themes from recommendation and learning from SAERs was undertaken in 2024 and this identified the following three top themes: • Record Keeping • Communication between service/professional groups • Communication with family A further thematic analysis undertaken in 2025 identified five main themes from SAERs: • Care Pathways 0 5 10 15 20 25 30 35 40 45 19/20 20/21 21/22 22/23 23/24 24/25 25/26 Number of LMTR (year) 222
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 • Clarity of roles • Communication • Staff Training • Care Assurance There are currently 16 action plans active within North Ayrshire HSCP (mainly mental health services) as a result of learning and improvements identified within SAERs. 7 Action plans were closed in 2024/25 with evidence of actions undertaken and completed approved through the AERG. This year to strengthen the scrutiny and review of action plans and to ensure that activity to imbed learning in practice, the terms of reference for the Quality and Safe Observation Group (a sub group of the MH Clinical Development and Governance Group) was recently expanded to provide consistent governance oversight of learning and action plans from local reviews and from independent inspections and visits such as HIS and MWC. Learning Summaries are developed for all SAER and LMTR reports where required: # Received Returns Within Timescale % Returns Within Timescale Returns Outwith Timescale % Returns Outwith Timescale Q4 (Jan-Mar '25) 0 0 0% 0 0% Q1 (Apr-Jun '25) 11 3 27% 8 73% Q2 (Jul-Sept '25) 2 1 50% 1 50% Total 13 4 31% 9 69% Performance within this area will continue to be reviewed and monitored to ensure improvement in compliance with timescales. 31% 69% Learning Summaries 2025 Returns Within Timescale Returns Outwith Timescale 0 1 2 3 4 Patient Safety/ Falls Pressure Ulcer Death/ Suicide Documentation/ Communication Issues Referral/ Treatment Delay Medication Issues Learning Summary Themes 223
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 4. Effective 4.1 Key programmes of work Service User Engagement Over the past six months, we have been reviewing our current mental health service engagement and participation mechanisms with the aim of improving and developing them further. During this time, we have created a comprehensive Mental Health Services Framework document. This outlines our vision, roles, and responsibilities in ensuring that the voices of people with lived experience and carers are central to shaping the services we provide. Key developments include: · A new public-facing engagement and participation leaflet, which explains what we mean by engagement and highlights the many ways individuals can get involved and share their views. · A new web page on the NA HSCP website https://www.nahscp.org/mental-health-addiction · The creation of a Mental Health Services Engagement and Participation Network, designed to maintain regular communication with members of the public who are interested in helping shape our services. · A year-round feedback mechanism, allowing people to share their views at any point in their care or experience journey. We are also in the process of establishing carer and lived experience forums and panels. Our first Carers forum will launch on 30th July and will meet monthly, offering essential information on mental health carers’ rights, and available support. In addition, a development group is currently exploring the creation of a permanent Lived Experience Panel, which will serve as an ongoing source of insight and guidance for future service development and review. Broader work is underway with clinical teams to create a consistent approach to the collation of patient and carer experience. Currently this is captured in a variety of ways with no single point of oversight. We are currently working on the development of revised carer and patient experience surveys and where possible will encourage the collaborative use of similar tools to ensure a consistent approach that is aligned with national strategy and mental health standards. A key area in providing this consistency is the use of Smart Survey. The recommendation involves all mental health engagement being located centrally using this tool allowing us to centrally monitor feedback but also for clinical teams to utilise this to create local reports and action plans that feed into governance structures. To support this, we propose to develop engagement oversight groups that will be attended by clinical teams, managers, Planning support and QI to review engagement data quarterly. This new area of development will take 6 – 12 months to embed and provide enough time to evaluate the effectiveness of the changes proposed. 224
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 In addition to the areas of development above, ongoing engagement has continued relating to many areas of service change and review. This has included public consultations, focus groups and 1:1 interviews. Within mental health services engagement we also run regular public Connect events throughout the year and run the North Ayrshire mental health Arts Festival with the Mental Health Foundation every October. Psychological Services Psychological Services remain close to the LDP 90% RTT standard (88% in June 2025) with the LDP being over 90% for 9 months over the last year. Pressures in particular parts of the service (CAMHS Psychology and Adult CMHTs) have impacted upon our ability to meet this threshold in the remaining 3 months over the last year. Requests for Neurodevelopmental Assessments are putting extra pressures on these services. Recruitment to vacancies to psychology posts has become easier over the last year because availability of workforce. Unfortunately, the reason for this is a reduction in available funding from SG across Scotland. Vacancies in the service have been recruited to and have ensured that the LDP 90% RTT has been met the majority of the time over the last year.. Further improvement will require increased capacity in the struggling specialties. Over the last year we have been able to establish a full complement our new leadership structure, with a new Heads of Specialty for Adult services. Psychological services has a new established clinical governance structure with two new Clinical governance groups which have started in June 2024. The Psychological Therapies and Interventions CGG chaired by the Director of Psychological services is supporting the implementation of the National specification for the Delivery of Psychological Therapies and Interventions (SG Sept 2023). The implementation of the PT specification has been further progressed over the last year. Significant work has been undertaken to ensure that Psychological Services have the structure and procedures in place to facilitate the requirements of the Safe Staffing Act across all Psychological Specialties. There remains a substantial focus on improvement of data quality and reporting. Psychological Services is working closely with data analysts and digital systems leads in order to ensure that we have data required for service improvement. Brighter Pathways update - Strategic Recommendations & Implementation Area to be progressed: • Develop a Supported Accommodation resource that will support 6 young people leaving care – April 2026 • Increase the number of foster carers in North Ayrshire, via transformation of digital recruitment strategies – Implemented in November 2024 • Implement new fostering scheme with increased finances to retain current carers and attract new carers – New fostering scheme implementation April 2026 • Develop a revised model to provide intensive support to families and children who are at risk of being accommodated – January 2026 • Develop a Standard Operating Procedure between Education and HSCP to ensure shared understanding and transparency between services, supporting more consistent and equitable funding decisions. September 2025 225
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 • Placement Assurance Forum - scrutiny of all internal and external residential resources. September 2026 • Development of a service that provides psychological interventions, support and direct work to children on edge of care and care experienced young people -TBC Service Improvements already implemented • Revised Supported Care Scheme – revised scheme to support young people over sixteen. • Unaccompanied Asylum-Seeking Children Practice Guidance/Welcome Booklets • Moving on Forum/Tracker – to review and plan transitions for young people moving on from care settings. • Revised Housing Protocol - To ensure a co-ordinated response to the accommodation and support needs of care leavers. • The implementation of a new referral template for intensive support referrals to Rosemount for children in family-based care. • Pilot with Children’s House for psychological consultation to support children and young people. 4.2 Quality Improvement Capacity and Capability There is a focus on increasing QI capacity and capability through several learning opportunities. This includes Quality Improvement NHS Education for Scotland (NES) Modules, Ayrshire and Arran Improvement Foundation Skills Programme (AAIFS) and the national Scottish Improvement Leadership Programme (SCIL). • Over 30 staff have completed the Ayrshire and Arran Improvement Foundation Skills (AAIFS) programme since its inception. • 2 staff within mental health have a lead level qualification (SCIL) • The number of staff who have completed QI NES modules is difficult to identify as the data is reported organisationally. Staff undertaking quality improvement courses are encouraged to present their improvement journey and celebrate success and learning at celebration events which take place twice a year. The Quality Improvement and Innovation Group (QI and I) has witnessed an increased attendance, with staff joining to share their improvement ideas, feedback on tests of change and identify where QI support and education can be offered. Collaboration between the QI Partnership team and Senior Nurses has encouraged a streamlined, consistent and improved approach to the co-ordination and delivery of QI support across Mental Health Services. The QI and I Group are currently looking at whole service projects that can impact the patient journey experience. These include such projects as: • Introducing access to smart devices in a low secure setting to aid patient recovery • Taking therapy to the home within Perinatal MH • Cognitive Stimulation Therapy 226
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 4.3 External Inspections of local service The Mental Welfare Commission (MWC) for Scotland’s mission and purpose is to be a leading and independent voice in promoting a society where people with mental illness, learning disabilities, dementia and related conditions are treated fairly, have their rights respected, and have appropriate support to live the life of their choice. To achieve this mission and purpose the Commission have identified four strategic priorities: • To challenge and to promote change • Focus on the most vulnerable • Increase their impact • Improve their efficiency and effectiveness Each year the MWC normally visits individuals in hospital, other care settings, and in their own homes to find out their views and check on their care and treatment. Where appropriate, they will also speak with friends and relatives. The Commission carries out their statutory duties by focussing on five main areas of work: • Visiting people • Monitoring the Acts • Investigations • Information and advice • Influencing and challenging NHS Ayrshire & Arran alongside their associated Health and Social Care Partnerships are subject to such visits. Between April 2024 and March 2025 the MWC undertook 5 announced visits to services across Ayrshire & Arran. • 3rd July 2024 – Ward 7A, Woodland View • 10th July 21024 – Ward 6, Woodland view • 16th August 2024 – Marchburn Ward, EACH • 25th September 2024 – Wards 9, 10 and 11, Woodland View • 6th March 2025 – Ward 8, Woodland View It is important to note that the structure of the visits are often based on the Commission’s thematic review of pertinent issues throughout the year. During the past year, the MWC have paid particular focus on the circumstances of people with learning disability and complex needs who have been in hospital for 10 years or more and published their thematic report “Hospital is not home” in January 2025. Following each visit ‘hot’ feedback is provided to the clinical site and senior management team. This is then followed up by a formal written report which is ratified and used as the basis for remedial work and improvement, as well as recognising positive practice. Of the 5 announced visits the MWC made recommendations for 3 of these. 227
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 An assurance report was submitted to the NHS Healthcare Governance Committee on the 4th August provide further detail on the MWC visits, recommendations and action plans and is included as appendix 2. Wider inspection activity within the HSCP including reports and recommendations is available through the Care Inspectorate Publications and statistics website. 5. Person-Centred Care 5.1 Patient Experience - Concerns, Compliments, Complaints, and Feedback Gypsy Traveller – Mental Health Literature Engagement Report – August 2024 • participants) • The purpose of this engagement was to gather views on existing mental health and wellbeing resources and explore the communities’ opinions on the content, length and graphics of current mental health resources. • Participants suggested health information should be displayed simple and clear, resembling child like guides. More Infographics on health flyers and guides were strongly suggested to combat illiteracy. Suggestions were also made to include the gypsy traveller flag, and culturally appropriate photos and pictures that respect their lifestyle/ Locality Conversations – September 2024 (206 participants) • The purpose of this engagement was to gather views on service information and accessibility across the HSCP. • Participants noted Insufficient GP and dental services; difficulty getting appointments and long waiting lists. There were frustrations with triage procedures and receptionists seen as “gatekeepers.”. Many complaints about phone system and automated options, and elderly noted as being particularly challenged by these digital methods. Cultural needs (e.g., requesting a same-gender doctor) sometimes unmet, causing frustration and misunderstandings. Difficulty accessing mental health services, and multiple reports of long waiting lists for CAMHS resulting in insufficient support for young people. Claims of inadequate support for non-crisis situations and perceived lack of follow-up care within this service. Lack of continuity in staff across HCC and MH services. • Some positive experiences with certain healthcare practices and pharmacies were noted. NHS AA app beneficial for those who are digitally literate, and described as crucial for some, but hard to navigate for others. • Suggestions to Simplify video triage processes and emails; upgrade phone systems. Increase availability and flexibility of GP appointments (more face-to-face and out-of-hours options). Language line needs to be available at triage stage of GP, not just in appointment, or translate options. Equalities Engagement – September 2024 (206 participants – combines with above locality engagement) • The purpose of this engagement was to collect information from equalities groups across North Ayrshire to inform HSCP equalities outcome plan. Questions were designed to get on their views of accessing and receiving health and social care services, to discover any barriers they may face, and find out their suggested improvements. • Participants noted reduction in women’s health screenings. Long waiting lists for hearing aids were noted multiple times, forcing people to pay for private services. Some noted that 228
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 when hearing aids were handed into Crosshouse, they were left without being able to hear for up to a week whilst they were fixed and returned. patient transport services noted as being unreliable. It was also noted that there is only 1-2 gender clinics in Scotland with long wating lists, and general insufficient resource and health support for trans people in the area. It was felt that Doctors often dismiss health concerns for pregnant women as pregnancy-related, Fear of being misdiagnosed with depression or post-partum issues. Inadequate resources for children with disabilities or neurodevelopmental disorders were noted, particularly difficulty accessing prescriptions and specialised care. Across the engagement many were fearful of understaffing in hospitals and shared experiences of delayed care. Difficulties with referrals for those with substance problems, particularly obtaining a CPN. • There were positive mentions of health visitors and sexual health clinics as they were praised for their reassurance, responsiveness, and support and provide valuable information and referrals. • Suggestions were made to Provide comprehensive information at diagnosis and E ensure consistent care, counselling, and support post-diagnosis. Additionally, suggestions to provide general health checks to the gypsy traveller community and signpost to relevant health services to support identified needs. There was also suggestions to provide training to community groups on suicide risk and low-level support and offer health training sessions, such as defibrillator use. Elderly groups suggested establishing annual well man’s clinics for comprehensive health check-ups, Including tests for diabetes, PSA, blood pressure, and other indicators. Locality Conversations – Young person Engagement – May 2025 (219 participants) • The purpose of this engagement was to gather young people’s views on HSCP services for our Locality Plans and the Children’s services plans. Questions were designed to get local priorities, uncover where young people look for support and any barriers they face, and suggestions of service improvement • Young people noted long waiting lists for mental health support and not being signposted to alternative options. Furthermore, they feel they are often dismissed by adults when raising concerns about their mental health which furthers stigma around the topic. Neurodiversity was largely raised, with concerns around lack of support and diagnosis. Young people noted feeling let down, misunderstood and alone. There were huge concerns of young people accessing substances, without knowledge of lasting health impacts. • Breathing space was noted as being helpful and young people liked being able to access support anonymously, as well as information on NHS website. • Young people suggest school staff need more neurodiversity training to better support their students, as well as updated training on mental health. further suggestions were made to have accessible routes for young people to find health information in their local area, with suggestions of school assembly awareness sessions of pathways as well as youth only clinics/drop in hubs. Young people called for more counsellors and ‘activity based’ mental health support as opposed to just support in clinical settings. Suggestions were also made about having support in localities, with difficulties getting to appointments (CAMHS/ physio) that are based in Irvine when from other localities. 229
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North Ayrshire Health and Social Care Partnership Health and Care Governance Group Annual Report 2024/25 20250609 HSCP CG Reporting Template v1.0 5.2 Complaints themes Final annual report currently being finalised and will be presented to the IJB. This final report will provide analysis of complaints performance and analysis. However, the following table provides high level overview of activity: Indicator Data Complaints received (2025) Stage 1 53 closed 3 ongoing (2 overdue) Stage 2 42 closed 7 ongoing (within timescales) Stage I performance Percentage closed in time 43 (79%) Stage 2 performance Percentage closed in time 31 (74%) 6. Priorities for forthcoming year • Review the HIS Clinical Governance standards against local performance and identify areas of good practice and areas for improvement • Continue to develop consistent performance measures for health care services within the partnership to support governance scrutiny and assurance on quality of patient care. • Ensure that the NA HSCP Clinical Governance Group considers quality of care, safety and management of risk as part of discussion on financial recovery over the coming 12 months. 230
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NORTH AYRSHIRE Health and Social Care Partnership In partnership with Clinical and Care Governance Group Background The main purpose of integration is to improve the wellbeing of people who use our health and social care services, of families, our communities and, in particular, those whose needs are complex and involve support from across health and social care at the same time. The North Ayrshire Health & Social Care Partnership (NAHSCP) Integration Scheme is intended to achieve the National Health and Wellbeing Outcomes prescribed by the Scottish Ministers in Regulations under section 5(1) of the Public Bodies (Joint Working) (Scotland) Act 2014 (hereinafter referred to as “the Act”). In Annex C of ‘Clinical and Care Governance of Integrated Health and Social Care Services’ (A Scottish Government publication) it contains the following description of clinical and care governance. 1. Clinical and care governance is the process by which accountability for the quality of health and social care is monitored and assured. It should create a culture where delivery of the highest quality of care and support is understood to be the responsibility of everyone working in the organisation - built upon partnership and collaboration within teams and between health and social care professionals and managers. 2. It is the way by which structures and processes assure Integration Joint Boards, Health Boards and Local Authorities that this is happening - whilst at the same time empowering clinical and care staff to contribute to the improvement of quality - making sure that there is a strong voice of the people and communities who use services. 3. Clinical and care governance should have a high profile, to ensure that quality of care is given the highest priority at every level within integrated services. Effective clinical and care governance will provide assurance to patients, service users, clinical and care staff and managers, Directors alike that: a. Quality of care, effectiveness and efficiency drives decision-making about the planning, provision, organisation and management of services; b. Unacceptable clinical and care practice will be detected and addressed 4. Effective clinical and care governance is not the sum of all these activities; rather it is the means by which these activities are brought together into this structured framework and linked to the corporate agenda of Integration Authorities, NHS Boards and Local Authorities. 5. A key purpose of clinical and care governance is to support staff in continuously improving the quality and safety of care. However, it will also ensure that wherever possible poor performance is identified and addressed. All health and social care professionals will remain accountable for their individual clinical and care decisions. 6. Many clinical and care governance issues will relate to the organisation and management of services rather than to individual clinical decisions. All aspects of the work of Integration Authorities, Health Boards and local authorities should be driven by and designed to support efforts to deliver the best possible quality of health and social care. Clinical and care governance, however, is principally concerned with those activities which directly affect the care, treatment and support people receive. 231
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NORTH AYRSHIRE Health and Social Care Partnership Page 2 of 4 Terms of Reference 1.0 Introduction The Clinical and Care Governance Group is identified as a sub group of the North Ayrshire Health and Social Care Partnership, Integration Joint Board (IJB). The approved Terms of Reference and information on the composition and frequency of the group will be considered as an integral part of the standing orders of the Integrated Joint Board. The Group will be known as the Clinical and Care Governance Group of the Integration Joint Board and will be a sub group of the Integration Joint Board. 2.0 Remit To provide assurance to the IJB as follows: • On the quality and safety of health and social care partnership services. • That staff across the Partnership are supported to provide quality services and are appropriately skilled and registered to discharge their professional responsibilities. • That proposed changes in practice, within one professional group, do not adversely impact upon another profession, and that there is a whole system approach to improvement. • That services are able to learn and develop from service user and carer experiences and that effective mechanisms are in place to do so. • That self-evaluation and quality assurance mechanisms are in place to inform improvement. • That a systematic and proportionate approach to the review of critical incidents, significant incidents and near misses is embedded in the Partnership; and pan- Ayrshire where this relates to mental health services. • That findings of critical incidents, significant events and near misses, locally and nationally, are considered and used to review and improve practice. • That services commissioned through registered, third and independent sector have appropriate contract monitoring arrangements in place and that those services are delivered to a high standard. • That medical devices (and where required - devices to support care), that are used, are sourced and maintained appropriately. • That appropriate links to Infection Control structures are in place. • That a learning culture is encouraged and that good practice and success is shared widely. • That current Partnership governance structures report into and through the Clinical & Care Governance Group. • That practice improvement plans are delivered, as appropriate. • That all Health and Care arrangements are developed with service users at the centre. 3.0 Group Membership The Clinical and Care Governance Group will be chaired by the Lead Nurse, on behalf of the Chief Officer. The Group will report to the Chief Officer and through the Chief Officer to the Integration Joint Board. 232
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NORTH AYRSHIRE Health and Social Care Partnership Page 3 of 4 The Vice Chair of the Group will be the Clinical Director who will cover the meeting in the Chair’s absence. The group will comprise of the following members: • Lead Nurse • Clinical Director • Lead Allied Health Professional • Chief Social Work Officer • Associate Medical Director, Mental Health Services • Director of Public Health or representative • Head of Children, Families & Justice Services • Head of Health and Community Care • Head of Mental Health • Quality Improvement Lead • Psychology Professional Lead • Carer Representative • Risk Management Representative • Governance Representative (NHS) Service Users and Carers, Third and Independent sector representation will be sought via the IJB. The Chair and members will be appointed by the IJB. Group membership will be reviewed annually and the first meeting of the year. 4.0 Quorum Four members including two of the professional leads will constitute a quorum. The professional leads are: • Clinical Director • Lead Nurse • Lead Allied Health Professional • Chief Social Work Officer • Associate Medical Director, Mental Health Services • Assistant Director of Public Health • Clinical Director for Psychological Services Members will be asked to identify deputies to attend in their absence however they will not be included in quorum numbers. 5.0 Attendance The group may co-opt additional advisors as required. 6.0 Frequency of Meetings The Group will meet every 4 weeks. The Chair may, at any time, convene additional meetings of the group. 7.0 Authority The group is authorised to investigate any matters which fall within its terms of reference and obtain external professional advice. The group may form sub-groups to 233
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NORTH AYRSHIRE Health and Social Care Partnership Page 4 of 4 support its functions. The group is authorised to seek and obtain any information it requires from any employee whilst taking account of policy, legal rights and responsibilities. 8.0 Duties The Group shall be responsible for the oversight of clinical and care governance within North Ayrshire Health and Social Care Partnership and specifically it will: • Consider matters relating to; professional governance relevant to Strategic Plan development, service user feedback and complaints, standards, education, learning, continuous improvement and inspection activity. • Provide advice to the strategic planning group, audit and performance committee and locality groups within the Council area. The strategic planning group, audit and performance committee and locality groups may seek relevant advice directly from the Group. • Provide assurance to IJB on the operation of clinical and care governance within the Health and Social Care Partnership in compliance with relevant national standards, highlighting problems and action being taken where appropriate. • When clinical and care governance issues relating to Lead Partnership Services are being considered, the Clinical and Care Governance Group for the Lead Partner will obtain input from the Clinical and Care Governance Groups of the other Health and Social Care Partnerships. • When Clinical and Care Governance issues relating to Public Health are being considered, the Clinical and Care Governance Group will obtain input from the Public Health Governance Group. • The Integration Joint Board may seek advice on clinical and care governance directly from the Clinical and Care Governance Group. In addition, the Integration Joint Board may directly take into consideration the professional views of the professional leads as outlined previously. • Receive minutes and annual reports from the sub-groups established by the Clinical and Care Governance Group in order to provide assurance and accountability. • The group will monitor and review risks falling within it’s remit. 9.0 Conduct of Business Meetings of the group will be called by the Chair of the group. The agenda and supporting papers will be sent to members five working days prior to the date of the meeting. 10.0 Reporting Arrangements Minutes will be kept of the proceedings of the group and will be circulated in draft within five working days to the Chair of the meeting and within three working days thereafter to group members, prior to consideration at a subsequent meeting of the committee. The Chair of the group shall provide assurance on the work of the group and the approved minutes will be submitted to the IJB for information. The group will conduct an annual review of its role, function and achievements. The group will hold a repository for annual reports from Stakeholder Groups 234
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Integration Joint Board 21 August 2025 Subject : Annual Performance Report 2024-25 Purpose : For Discussion Recommendation : Integration Joint Board (IJB) to note the key achievements during 2024-25 and the publication of the Partnership’s Annual Performance Report Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required x 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms ABI Alcohol Brief Intervention CE4U Care Experience for You CPO Community Payback Order DTTO Drug Treatment and Testing Order HSCP Health and Social Care Partnership IJB Integration Joint Board MAPPA Multi Agency Public Protection Arrangements MINDS Mentoring Individuals for New Destinations and Support MIST Medication Assisted Treatment Implementation Support Team MS Multiple Sclerosis NHS AA NHS Ayrshire and Arran NADARS North Ayrshire Drug and Alcohol Service PAC Performance and Audit Committee PSMT Partnership Senior Management Team UNCRC United Nation’s Convention on the Rights of the Child 1. EXECUTIVE SUMMARY 1.1 Each year the Partnership is required to publish an Annual Performance Report, both to comply with legislative requirements and to demonstrate the progress made in working towards strategic priorities and national outcomes. 1.2 The draft report was provided to the Performance and Audit Committee and the Senior Management Team in July 2025 and has been published on the Partnership’s website. 1.3 This covering report highlights some of the key achievements during 2024-25 which are contained within the Annual Performance Report. Agenda Item 9 235
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2. BACKGROUND 2.1 Section 42 of the Public Bodies (Joint Working) (Scotland) Act 2014 requires Partnerships to publish an annual performance report setting out an assessment of performance in planning and carrying out the integration functions for which they are responsible. 2.2 Guidance for Health and Social Care Integration Partnership Performance Reports (published by the Scottish Government, March 2016) was followed to ensure the content of our performance report met the requirements. 2.3 Following the provision of the report to the Performance and Audit Committee and the Senior Management Team all provided feedback on the report content has been reflected in the preparation of the final document. Performance Highlights 2.4 The Annual Performance Report demonstrates the ongoing progress made by the Partnership in delivering against its vision and strategic priorities, as well as the Scottish Government national health and wellbeing outcomes, children’s and justice service outcomes and a range of local measures. 2.5 The report uses case studies throughout to demonstrate some of the performance highlights. Key highlights against each of the Strategic Priorities are outlined below: Provide Early and Effective Support • North Ayrshire Drug and Alcohol Service (NADARS) has continued to demonstrate high levels of performance by meeting national and local standards and targets. • Individuals were seen within 3 weeks: Target met no less than 96% of the time for Alcohol related intervention, and 99% for Drug related intervention • Individuals were seen within 6 weeks: Target met 100% of the time • Dirrans Centre Collaboration: Partnered with Ayrshire Hospice to support people with life-limiting conditions locally. • Mental Health Unscheduled Care Service: officially launched their new mental health assessment hub on Friday 13th September. This assessment hub, based in Woodland View Hospital provides nurse led assessment for a period of up to 72 hours • Digital Telecare Transition: Achieved Bronze Digital Telecare Implementation Award, with over 50% of users transitioned to digital-ready alarms. • This is the third year of North Ayrshire Primary Care Development Manager working with 11 North Ayrshire GP practices implementing the ‘Providing Welfare Rights in GP Practices’. At the end of 2024-25; there were 536 referrals compared to 646 in the previous year (17% decrease); over £3Million generated for patients and almost £7Million generated within the 3 years. 236
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Tackle Inequalities • Our Learning Disability service delivered its Creative Scotland funded project, ‘What Comes Next’ including sharing the project film and presenting the film as part of the Scottish Mental Health Arts Festival. • The Health and Mind project is a new initiative within Woodland View Hospital funded for 12 months through the Connecting to Care fund (SCVO). The aim of is to support digital inclusion and engagement work connecting people to digital services and supports health care needs • The New Scots ESOL (English for Speakers of Other Languages) Hub provides lessons Monday to Friday 9am to 12.30pm and welcomed 4 new students into the class. The hub provides the opportunity for our young people to be part of a community and also receive ongoing support with any issues and wellbeing. • Input is an organisation based at Towerlands Community Centre in Irvine that provides work preparation for people with additional educational needs. The skills development programme is based on the refurbishment of digital devices, with trainees learning about computers and their components gaining valuable employment skills like communication and teamwork and boosting their confidence. • North Ayrshire Council is one of three Scottish local authorities that are collaborating with health experts on ways to improve health and wellbeing for residents. The partnership will examine ways to strengthen and accelerate actions that will reduce health inequities for people living in North Ayrshire, Aberdeen City and South Lanarkshire. • The Young Carers Covenant was launched by the Carers Trust and the Young Carers Alliance, setting out a series of outcomes for organisations to work towards to ensure the life chances of young carers are improved • Money Matters has had a dedicated Welfare Rights Officer providing advice in North Ayrshire secondary schools since 2021. The service has been a huge success and has put more than £1m into the bank accounts of families during this time Enable Communities • The Family Centred Wellbeing Service (FCWS) this summer devised and facilitated a summer programme that ran twice a week for the full summer for our families. They utilised accessible community resources in every area (for example, Fairlie beach, Low Green Irvine, Dalry Park, Eglinton Park, Ardeer Beach) and did free activities for our families to help build their confidence. • During 2024 to 2025, 171 compliments were received by the Health and Social Care Partnership relating to the services with 22 out of 156 complaints being upheld. • Refugee Festival Scotland is an annual celebration of the contribution refugee communities make to life in Scotland. This year service users involved with our Refugee and Resettlement Team were invited by the Salvation Army in Kilbirnie to prepare a Syrian buffet for an event to celebrate different cultures. 237
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• The ILF (Independent Living Fund) Scotland Fund fully reopened in April, with an initial investment of £9 million from the Scottish Government. North Ayrshire has an allocation of 32 new applications for the first year of reopening, where up to an extra £330 per week can be accessed per applicant. • Anam Cara dementia respite centre in Kilbirnie was officially reopened with a ribbon-cutting ceremony on Tuesday 4th June. The specialist dementia respite centre accommodates up to 9 guests aged 60 years or over, offering critical respite services within single room, en-suite accommodation. • Scottish Breastfeeding Week is an annual event, which ran from Monday 10 June to Sunday 16 June, which aims to enable new mums/parents to consider their breastfeeding journey and how they can be supported • In a groundbreaking achievement, NHS laboratory specimens were successfully delivered from the island of Arran by drone across the Firth of Clyde. This innovation, part of Project CAELUS, reduced delivery times from several hours to just 30 minutes, significantly speeding up diagnostic processes and treatment decisions. • The Scottish Centre for Personal Safety provides empowering personal safety training to vulnerable individuals, organisations and businesses throughout Scotland. Run entirely by volunteers, it offers empowerment-focussed, trauma- informed personal safety training for people in North Ayrshire. Develop and Support our Workforce • The Children and Families Health Team have supported two members of staff to undertake the Postgraduate Certificate in Child Protection at the University of Stirling • As platinum award winners in Investors in People, the Dirrans team were looking for a different challenge so went forward for a new award from Investors in people, the ‘We invest in wellbeing’ framework. • Trindlemoss Day Opportunities was the focus of a recent very positive Care Inspectorate visit. Feedback noted the sector-leading quality of what was happening within the service. • The Health and Social Care Partnership are delighted to advise the launch of a formal model of support for workers in the creation of a Staff Vicarious Trauma Service. The Partnership recognises the secondary trauma, stress and burn out, which can occur when working in a complex human environment with many moving parts. • Our first annual Care at Home Manager Development Day took place this year. This was introduced as a practical support for new and existing managers to enhance both confidence and skills • All employees of NAHSCP and our providers can now enjoy a year’s free access to Holly Health, a mobile app that can support people to make small, achievable changes that could help boost health and wellbeing • The winners of the 2024 Partnership Awards were announced at our ‘Promoting Wellbeing Together’ event at the Redburn Community Centre in Irvine. 238
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• The LiveWell group have partnered with KA leisure to bring free health checks to Council employees. Improving Mental and Physical Health and Wellbeing • The Three Towns Community Shed offers a safe and welcoming space for anyone over the age of 18 to drop in. The community initiative was launched recently after bringing together the existing local Men's Shed and recently formed, She Shed under one banner. • A report produced by NHS Ayrshire & Arran’s Prevention and Service Support Team has highlighted the positive impact of Naloxone distribution and use in North Ayrshire. 1,640 Naloxone kits were handed out in Ayrshire between April 2024 and March 2025 (741 of which were in North Ayrshire), with 73 lives reported to have been saved in that time (18 in North Ayrshire). • The latest inspection report for Montrose House Care Home highlights a number of positive developments and improvements such as the service receiving a "Good" rating for both supporting residents' wellbeing and for leadership. • NHS Ayrshire & Arran, in partnership with Coloplast Ltd, has launched a successful pilot service to improve the lives of people with multiple sclerosis (MS). This innovative service focuses on managing neurogenic bladder and bowel dysfunction • North Ayrshire's first ever Dementia Connect event was held, bringing together those living with dementia and their carers to learn more about dementia care and the supports available. Around 80 people attended the free event at the volunteer rooms in Irvine. • North Ayrshire Health and Social Care Partnership hosted a Mental Health and Wellbeing ‘Connect’ event on Monday 29 April at the Ardeer Community Centre in Stevenston. The public were invited to come along and chat to the many visiting support services, browse the stalls and participate in a variety of workshops focussing on a range of mental health topics Children’s and Justice Outcomes • Our transformation programme to improve outcomes and opportunities for care experienced children and young people in North Ayrshire is now under way. The Brighter Pathways Programme Board was set up to look at how services can be delivered differently to ensure care experienced children and young people have access to the appropriate resources and supports into adulthood. • The annual Promise Conference was held in December and saw 73 young people from across our Secondary Schools join for a day of connection. • In December, the HSCP received notification from the Scottish Government that the Delivering Equally Safe Fund would provide a further 12 months funding to allow us to continue to develop our approach to providing crucial support to survivors of violence against Woman and their children. • This year the United Nation’s Convention on the Rights of the Child (UNCRC) was fully incorporated into Scots Law. Using the Improvement Service’s Getting 239
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Ready for UNCRC Incorporation Framework document, a benchmarking document was developed to support our work within the HSCP. • We saw the launch of a brand-new free mobile app called ‘CE4U’ (Care Experience for You), the mobile app for iPhone and Android has been designed specifically for care experienced young people • Multi Agency Public Protection Arrangements (MAPPA) are a set of statutory arrangements that allow for the assessment and management of the risk posed by people convicted of certain sexual and violent offences. The creation of an effective Risk Management Plan is the key factor in the MAPPA process. To support staff, In June of this year, subject matter experts from the Risk Management Authority Scotland provided training on the best ways to develop risk management plans. • The Drug Treatment and Testing Order (DTTO) Team have been working in partnership with MINDS of Recovery to deliver a bespoke four-week bite-sized recovery group to service users on a DTTO community sentence. Mentoring Individuals for New Destinations and Support (MINDS) recovery group explores the CHIME (Connectedness, Hope and optimism about future, Identity, Meaning in life and Empowerment dimensions) model of recovery, recovery capitals and the language of recovery • Latest Government statistics on Community Payback Orders (CPOs) (2023 to 2024) show that North Ayrshire had the highest of the Ayrshires with 479 CPOs however we have continuously over-achieved against targets for CPO level 1 and level 2. During 2024-25 78 out of 79 (98.7%) level 1 CPO’s completing within timescales and 108 out of 112 (96.4%) level 2 CPO’s completing within timescales. The target for CPO Level 1 is 57% and for CPO Level 2 is 67%. Mental Health Lead Partnership • A new facility at West Road for Neuro CAMHS and Community Eating Disorder Service (CEDS) will result in an improved environment to carry out physical examinations and improve the wellbeing for patients and staff in the facility. Final building works were completed by the end of the year with plans to open during 2025. • The Medication Assisted Treatment Implementation Support Team (MIST) has awarded North Ayrshire HSCP all green and provisional green in their benchmarking report for all partnerships. This is the highest level attainable in the implementation which supports the Scottish Drug Deaths Taskforce’s aim to have no barriers to accessing treatment and care that supports an individual’s recovery. • NHS Ayrshire & Arran has officially opened a new, nurse-led Mental Health Unscheduled Care Assessment Hub. Recognised as the first of its kind in Scotland, the hub aims to deliver a new model of care of a patient-focused, therapeutic space to support the delivery of compassionate care to those individuals with acute mental illness. • The North Ayrshire Wellbeing & Recovery College won the ‘Best Mental Health Support Service’ at the Mental Health and Wellbeing Scotland Awards 2025. The 240
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category celebrates organisations that provide exceptional help to individuals through their daily actions and activities 2.6 The report concludes with information on the important role played by Locality Planning Forums as a key conduit between local communities and the Partnership, the transformation programme and financial performance. Publication 2.7 This annual performance report is part of a suite of partnership public-facing documents. These documents are available from the NAHSCP web site. 3. PROPOSALS 3.1 It is proposed that IJB notes the key achievements during 2024-25 and the publication of the Annual Performance Report on the Partnership’s website. 3.2 Anticipated Outcomes Informing the people of North Ayrshire and wider stakeholders on the progress of health and social care integration, specifically relating to: • Outcomes for local people. • Locality health and social care needs. • Service provision (including lead partnership responsibilities and commissioned services) • Transformational Change. • Budget and financial information 3.3 Measuring Impact With the publication of the Annual Performance Report 2024-25 the Partnership has met its obligations under the Public Bodies (Joint Working) (Scotland) Act 2014. 4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic None 4.5 Risk None 4.6 Community Wealth Building None 241
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4.7 Key Priorities This would ensure we fulfil our obligations in the Integration Scheme. 5. CONSULTATION Consultation has taken place with staff, partnership stakeholders, the Partnership Senior Management Team (PSMT) and the IJB Performance and Audit Committee (PAC). Caroline Cameron, Director Neil McLaughlin, Manager Performance and Information Systems, nmclaughlin@north-ayrshire.gov.uk Appendices North Ayrshire Health and Social Care Partnership Annual Performance Report 2024-25 242
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North Ayrshire Health and Social Care Partnership Annual Performance Report 2024 to 2025 243
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Reflections from the Director Welcome to our Annual Performance Report for 2024 to 2025. This report focusses on the performance of services during another challenging year for our communities and health and social care services. Our services continued to face pressures over the period, with growing demand and individuals requiring more support. Despite these challenges there have been many significant achievements, and these are outlined in this report The year 2024 to 2025 is the third year of our Strategic Plan 2022-2030, ‘Caring Together’. Through delivery of this plan, we continue to strive for a North Ayrshire where everyone can live a safe, healthy, and active life. Working together, we can develop a vibrant and proactive health and social care service, that is adaptable to the changing needs and demands of North Ayrshire and provide our communities with the right service at the right time. Health and Social Care services across Scotland face increasing pressures in a context of resource limitations, we face challenges in North Ayrshire in meeting the specific needs of our population who face acute challenges with poverty and deprivation, poorer healthy life expectancy and with some living in remote and rural areas. The IJB will continue to face significant challenges in being able to resource and finance the services which are required to meet those needs and improve outcomes for our communities. Our North Ayrshire partnership being a key partner in the Collaboration for Health Equity in Scotland pilot for the next two years will ensure partners work together on these challenges to maximise resources and promote and secure better outcomes for residents. We remain ambitious in how we want to change and modernise our services and will focus on the integration of services to deliver real change to the way services are being provided. Our transformation programme will focus on service redesign to align future service models to strategic priorities and our reducing resources, maximising on the opportunities that our highly skilled and experienced workforce and digital opportunities present. In conclusion, I want to acknowledge the tremendous efforts of staff across the Health and Social Care Partnership who have been under immense pressure for a sustained period, whilst continuing to deliver services with professionalism and dedication. I look forward to the next twelve months with optimism and know that we will continue to work with our partners to meet the needs of our communities. 244
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3 Contents Annual Performance Report 2024 to 2025 ........................................................................................... 1 Reflections from the Director ............................................................................................................. 2 Visions, Values and Priorities ............................................................................................................ 4 Our Local Priorities ........................................................................................................................... 5 Structure of this report ...................................................................................................................... 6 Provide Early and Effective Support ................................................................................................. 7 Tackle Inequalities .......................................................................................................................... 15 Enable Communities ....................................................................................................................... 22 Develop and Support Our Workforce .............................................................................................. 31 Improve Mental and Physical Health and Wellbeing ....................................................................... 38 National Health and Wellbeing Indicators ....................................................................................... 47 Performance in relation to the three Children’s Outcomes and three Justice Service Outcomes ... 50 Children’s Outcomes ................................................................................................................... 51 Justice Outcomes ........................................................................................................................ 54 Reporting on localities ..................................................................................................................... 63 Transformation Programme ............................................................................................................ 69 Reporting on lead partnership responsibility ................................................................................... 79 Mental Health Services ................................................................................................................ 80 Child Health Services .................................................................................................................. 84 Inspection of service ....................................................................................................................... 88 Financial performance and best value ............................................................................................ 93 Appendix ......................................................................................................................................... 99 245
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4 Visions, Values and Priorities North Ayrshire Health and Social Care Partnership (NAHSCP/the Partnership) is working towards a vision where: “All people who live in North Ayrshire are able to have a safe, healthy and active life.” Our Partnership includes health and social care services within Health and Community Care Services (H&CC), Mental Health and Learning Disability Services and Children, Families and Justice Services. In this annual performance report, we look back on the progress we have made, share some of our successes and reflect on some areas that have proved challenging. This report aligns with our “Caring Together” Strategic Commissioning Plan 2022-2030. This is the first time the Health and Social Care Partnership has set out such a long-term plan for how we intend to improve services and the health and wellbeing of the local community. The plan set out our pandemic recovery intentions, as well as offering a longer-term vision for local health and social care services. Over the period of this strategic plan, the Health and Social Care Partnership will seek to: We see these priorities as interlinked, and we expect that where we see success against one priority, it’s effect will positively impact against others. People who use our services and North Ayrshire residents will experience our Partnership values in the way our staff and volunteers engage with you and how we behave. We will treat you with: 246
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5 Local Priorities The themes of the strategic plan are how the HSCP will plan services and seek positive outcomes across the whole of North Ayrshire, but each community within North Ayrshire will have unique challenges and different inequalities. As such, the HSCP is required to develop planning in a smaller geographic area for different localities, which in North Ayrshire are: • Arran • Garnock Valley • Irvine • Kilwinning • North Coast and Cumbrae, and • Three Towns The HSCP previously had in place Locality Planning Forums, which brought together officers working in each locality to discuss local issues, however these were interrupted during the pandemic. In 2024, the Locality Planning Process was revised to ensure greater community engagement and participation in the planning process, and a more robust data element, in order to develop Locality Plans. These plans are being developed over a 2-year process, to analyse local data, engagement, and service information, and ensure continued community feedback and leadership to develop robust, informed plans. This process is currently at the halfway point, with two periods of engagement carried out last year and two further periods planned for this year. 247
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6 Structure of this report We have measured and evaluated our performance in relation to: • Partnership Strategic Objectives • Scottish Government National Health and Well-being Outcomes • Children’s and Justice Services Outcomes • Local measures The North Ayrshire Health and Social Care Partnership continues to have lead partnership responsibilities across Ayrshire and Arran for Mental Health and Learning Disability Services as well as Child Health Services (including immunisation and infant feeding). We have reflected on some of the highlights and challenges of leading these services across Ayrshire. We will show that all our services (those provided by our Partnership staff and those provided by other organisations on our behalf) are providing high quality care and support to the people of North Ayrshire. Finally, the partnership continues to face financial challenges in delivering and improving services from within the available budget, during the year we have made significant progress towards achieving financial balance and overall service sustainability. We have detailed our financial position and reflected on how we continue to provide assurance that we are delivering Best Value in North Ayrshire for Health and Social Care services. 248
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7 Provide Early and Effective Support National Outcomes 1 People are able to look after and improve their own health and wellbeing and live in good health for longer. 2 People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. 3 Health and social care services contribute to reducing health inequalities. 249
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8 1.1 The Partnership’s Executive Team with the NHSAA Chief Executive and NHSAA Board members visited the staff and teams on Arran to receive an annual face to face update on progress. They toured the Emergency Department of Arran War Memorial Hospital and met with some of our new Emergency Department Nurse Practitioners. The Team heard about plans to develop the Single Point of Contact on Arran and had a demonstration of the Netcall telephone system in the GP practice. This telephone system allows digital triage of patient requests so they are automatically connected to the right service, at the right time. The IT Infrastructure work to enable the roll out of Netcall across the hospital is currently underway and is anticipated to be completed during 2025. The members also heard about the excellent national primary care survey results for Arran, which showed higher levels of patient satisfaction than other areas of Scotland. The Arran team have recently been joined by a new Activity Coordinator, who is based in the islands Care Home, Montrose House. This role has been developed, in recognition of feedback from staff, residents and from formal regulatory inspection. A key function of the role is to develop person centred activities for residents, to enhance daily outcomes and experiences and to support and maintain both physical and mental wellbeing. The Care Inspectorate commended the implementation of this role at our most recent inspection and noted the boost it has given to the quality of social stimulation and range of activities enjoyed by our residents both inside and outside of the home. 1.2 To enhance our adult support and protection arrangements after a recent North Ayrshire Inspection, an Improvement Plan is in place. This plan describes the strategic response to the Care Inspectorate’s recommendations. The Partnership has prioritised improvements in Advocacy services, commissioning a new Advocacy Service, launched in April 2024. The service is subject to ongoing monitoring particularly around the numbers of referrals being made for adults who have been identified as being at risk of harm. Although not explicitly listed in the improvement plan, the inspection report highlighted additional areas for enhancement which we are actioning in Health and Community Care. These include: • Refining chronologies • Advancing the ASP escalation protocol • Developing ASP training for Team Managers • Informing adults that they have been referred as an ‘adult at risk of harm’ and supported to engage as fully as possible in the process • Documenting reasons when adults do not attend their ASP Case Conference • Extending invitations to police and health officials to case conferences when beneficial • Establishing a multi-agency high-risk screening group 250
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9 We maintain an ongoing collaboration with the Care Inspectorate and convene quarterly meetings to ensure the effectiveness of our improvement initiatives and to jointly monitor the Partnership’s progress. 1.3 The North Ayrshire Drug and Alcohol Service (NADARS) has continued to demonstrate high levels of performance by meeting national and local standards and targets, such as access to treatment waiting times, provision of alcohol brief interventions (ABIs), the roll-out of Naloxone supplies and increasing patient choice regarding Opiate Substitution Therapy (OST) medications. Figures for those seen within 3 weeks for Alcohol were no lower than 96% during any quarter, while those seen within 3 weeks for Drugs were no lower than 99% during any quarter in 2024 to 2025. 100% of referrals for Alcohol and Drugs were seen within 6 weeks. The team continues to identify new ways of working to provide a more agile and streamlined service and further improve performance. This work has been evidenced by the delivery of early intervention services in the delivery of Alcohol Brief Interventions (ABI) in both priority (Primary Care, A&E and Antenatal) and wider settings. 251
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10 1.4 The Dirrans Centre has been participating in a collaboration with the Ayrshire Hospice Living Well Service since June 2024. This collaboration was created to support the development of a Living Well Service within North Ayrshire. North Ayrshire residents looking to access the service previously required to travel to one of the three bases within East and South Ayrshire which presented some difficulties for North Ayrshire residents due to transport difficulties. The Dirrans Centre offered the use of the lounge and multi-purpose space to the Living Well Service with a view to working towards a collaborative approach to supporting individuals with long term, life limiting conditions within North Ayrshire. The Living Well Service in North Ayrshire runs every Tuesday afternoon and has a focus on promoting healthy living and enhancing quality of life. 1.5 The Mental Health Unscheduled Care Service officially launched their new mental health assessment hub on Friday 13th September. This assessment hub, based in Woodland View Hospital provides nurse led assessment for a period of up to 72 hours, allowing intensive input to consider longer term mental health and support needs. 1.6 We are delighted to announce that North Ayrshire Health and Social Care Partnership (HSCP) was awarded the Bronze Digital Telecare Implementation Award in recognition of the progress made on our analogue to digital telecare transition project. To achieve Bronze status, a Telecare Service Provider must have successfully deployed digital-ready alarm devices to at least 50% of all dispersed and group alarm users. This is the first major milestone in the transition to digital telecare and sets the foundations upon which the rest of the digital telecare transition will rest. North Ayrshire HSCP has been preparing for the analogue to digital switchover for a few years now. In 2022, a project board was set up and the project team recruited in early 2023. There have been many challenges along the way including equipment shortages, procurement obstacles and a tender for a call receiving partner to overcome. It is hoped that the remainder of the equipment rollout will be straightforward, with a new aim to achieve Silver status. The team are on course to have the project completed during 2025. Kevin Queenan, TEC Lead, said: “We’re delighted to have achieved our Bronze Award. Our technicians are very knowledgeable and a pleasure to work with, and our fantastic Indicator 2022-23 2023-24 2024-25 Target set by Scottish Government – Priority Settings 3,420 3,420 3,420 Total ABI delivery in Priority Settings (Ayrshire & Arran) 4,933 6,398 5,940 Indicator 2022-23 2023-24 2024-25 Target set by Scottish Government in Wider Settings 855 855 855 Total ABI delivery in Wider Settings (Ayrshire & Arran) 1,207 1,216 1,325 252
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11 management and project board have supported us throughout – keeping us on the right path as digital is new to all of us”. Alan Boyle, Digital Technician, said: “We’re enjoying the role, it’s great to learn new technologies and rewarding to know that we’re keeping our service users safe”. Achieving this Award is a significant achievement and once the rollout of equipment is completed, North Ayrshire HSCP will move towards the first phase of testing with alarms and peripherals. 1.7 North Ayrshire Alcohol & Drug Partnership (ADP) welcomed 70 young people from across our secondary schools to take part in the first ADP Young Person’s event. Two alcohol and drug education days were also facilitated at Arran High School in June 2024 where 250 young people engaged in the events. The aim was to engage young people and listen to them about their experience of alcohol and drugs education and how it can be improved. The event was facilitated by multi- agency partners and included speakers with lived experience and active workshops for young people to develop knowledge and capture their views and voice. Workshops included the Lived Experience Workshop, Stigma Workshop, Myth Busting Workshop and Future Learning Workshop. The ADP tailored separate workshops to Arran as there are different complexities for the island. This included the addition of sessions in smoking/vaping, emergency first aid, and KA Leisure Champions for Change workshops. Young People got a lot out of these sessions, feedback included: “Very interesting to see how others assumed people were taking drugs because of their appearance.” “It was interesting hearing about a real-life story and how it affects someone.” “(Voice of lived experience) made it seem more real as it was someone’s life, not just statistics.” 1.8 In 2022, the Scottish Government created the £500 million Whole Family Wellbeing Fund (WFWF) for the life of the current parliament (2022 to 2026) to facilitate the delivery of holistic family support, with the expectation this will reduce inequalities in family wellbeing, lessen requirements for family crisis intervention and decrease the number of children and young people living away from their families. The Fund is now in year three of the four-year implementation period. There are a total of 16 projects and services in North Ayrshire that have benefitted from WFWF including, Family Centred Wellbeing Service, Dads Worker, Barnardos Stronger Families and Helping Hands. 253
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12 Seven projects are Third Sector projects, six are NAC/HSCP projects while 3 are independent projects. 1.9 Prevent is a strand of the UK Government’s Counter-Terrorist Strategy that aims to reduce the threat to the UK by stopping people from becoming terrorists or supporting terrorism. It is about preventative action and is focused on the early stages where a crime has not yet been committed. Local authorities, Health and Social Care Partnerships, the NHS, colleges/universities, prisons and the Police all have a duty to protect vulnerable individuals and work together to stop them from being exploited and radicalised. The North Ayrshire Prevent group was created several years ago and continues to meet on a monthly basis with regular attendance from representatives from a range of partner agencies including the Health and Social Care Partnership, Housing, Education, Connected Communities, Legal Services, NHS Ayrshire and Arran, Police Scotland and the Prevent Delivery Unit. The North Prevent group in conjunction with The Safeguarding and Vulnerabilities Team, the Prevent Delivery Unit and the Ayrshire Counter Terrorism Liaison Officer, continue to share knowledge and develop best practice to support those vulnerable to being exploited and radicalised. In order to support our workforce, develop their understanding and improve practice in this area, a variety of training was accessed throughout Quarter 3. This included Extreme Ideologies Training which allowed practitioners to broaden their knowledge and understanding of Extreme Right-Wing ideologies, Islamist ideologies and concerns categorised under Emerging Extremist ideologies. This training was delivered by academic experts in these areas. In addition, a training session was also provided in Trauma, Adversity and Violent (TAVE) extremism, this training session focused on the overlap between trauma, experiences of trauma and involvement in violent extremism. 1.10 Recovery Across Mental Health (RAMH) North Ayrshire Wellbeing & Recovery College brought the community together in December to enjoy its latest pop-up pantomime. The performance at South Beach Baptist Church in Saltcoats was the culmination of a five-week project, with Moxie productions supporting students to explore drama and performance skills. Together, they crafted a fresh and meaningful spin on the classic tale Snow White, embedding a thoughtful mental health message with the humour and energy of a traditional panto. What made the event even more special was its ‘pop- up’ nature. Although students participated in designing the story and characters, they only received their scripts and began rehearsing on the morning of the performance! 254
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13 Recovery College Coordinator Lainey McKinlay praised the participants, saying: “The confidence and bravery to stand on the stage, putting themselves out there, is remarkable. The growth in these students since they began with the college is a privilege to witness.” The pop-up pantomime highlights the transformative work of the Recovery College, which focusses on supporting students to self-manage their mental health and wellbeing by blending creativity, self-expression and mental health awareness to provide a powerful platform for growth, recovery and connection. 1.11 Break the Silence is a local charity providing professional counselling support in East and North Ayrshire for those affected by childhood sexual trauma, as well as their partners and family members. Break the Silence has recently secured re-accreditation from the British Association of Counselling and Psychotherapy. This fantastic achievement demonstrates that the service continues to offer an accountable, ethical, professional and responsive service to clients, staff, volunteers and stakeholders. The charity has also recently launched a new self-help tool, which offers advice and resources for service users while they wait to gain access to the counselling service, including an overview of what they can expect from the service, access to a survivor’s guide, relaxing audio and video resources. Referrals can be made for North or East Ayrshire residents of all genders, aged 18 years and over, via the Break the Silence website, where individuals can also self-refer. 1.12 The North Ayrshire Primary Care Development Manager worked successfully with 11 North Ayrshire GP practises, selected by the Scottish Government Improvement Service and HSCP Money Matters team, to implement the ‘Providing Welfare Rights in GP Practices’. The initiative saw Income Advisors based in these practices, who worked with patients and residents to carry out complete benefits checks, help them make claims and support them if they were disputing claims. Year 3 of the pilot resulted in: • 536 referrals to the service (compared to 646 in the second year, 17% decrease) • £3,126,685.18 has been generated for patients and residents of North Ayrshire in the Third year of the Project with a total £6,979,573.24 since project commenced in 2022 to 2023 1.13 Case Study: Dementia Support Service The Partnership’s Dementia Support Service have provided information regarding a recent interaction they had when supporting a lady in North Ayrshire. Mrs Y had no family, had recently lost her husband and was experiencing cognitive impairment. She was referred to Dementia Support for social stimulation as she was feeling isolated. Mrs Y was initially hesitant to accept that support, believing that she “did not need anyone” and noting that she “would not be told what to do”. The team took time to explain the service to her, offering continual reassurance that she would remain in control of her situation. She would receive a full explanation of why the suggested support would be beneficial and thereafter would dictate what, and when, support was delivered. She tentatively agreed to a trial. 255
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14 Our skilled support workers developed a bespoke support plan for Mrs Y. The approach was predicated on engaging Mrs Y in dialogues about her emotions and memories, including the sorrow of losing her husband and the pangs of separation from her extended family due to health constraints. Gradually, Mrs Y’s trust in the support system solidified. Now, she actively and joyfully engages with the support services, often indulging in fond recollections of her formative years and cherished childhood anecdotes. National Indicators Indicator NAHSCP Scotland Adults able to look after their health very well or quite well 89% 91% Adults supported at home who agreed that they are supported to live as independently as possible 67% 72% Adults supported at home who agreed that they had a say in how their help, care or support was provided 51% 60% Rate of Emergency Hospital Admissions for adults (Per 100,000 population) 15,142 11,559 Rate of emergency bed days for adults 155,896 113,627 Falls rate per 1,000 population aged 65+ 23.0 22.5 256
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15 Tackle Inequalities National Outcomes 3 People who use health and social care services have positive experiences of those services, and have their dignity respected. 4 Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. 5 Health and social care services contribute to reducing health inequalities. 6 People who provide unpaid care are supported to look after their own health and wellbeing. Including to reduce any negative impact of their caring role on their own health and wellbeing. 257
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16 2.1 The Learning Disability service has delivered its Creative Scotland funded project, ‘What Comes Next’ including sharing the project film and involving clients in a panel discussion within the Accessible Book and Storytelling Festival in Edinburgh; and presenting the film as part of the Scottish Mental Health Arts Festival. The service has also been identified as a delivery partner by Scottish Commission for Learning Disability (SCLD) with regard to a Scottish Government funded project looking at Digital Inclusion. 2.2 North Ayrshire Council has been awarded by charity ‘The Smallest Things’ with the nationally recognised ‘Employer with a Heart’ charter mark. The change in the Council’s Maternity Scheme has been made to support employees affected by premature birth. Parents – employed by North Ayrshire Council – of babies born at or before 37 weeks will be entitled to receive an extra week’s Premature Baby Leave and Premature Baby Pay for every week until their babies original due date. The leave entitlement will be added to the end of the employee’s agreed Maternity leave period after the Maternity Leave entitlement has elapsed. Once the employee has ended their maternity leave, they will then move to the premature baby leave/pay. This leave will be paid at full pay. Fiona Walker, Head of Service for People and ICT, shares: “I am delighted that the Council has received the ‘Employer with a Heart’ Charter status. “It is vital as one of North Ayrshire’s largest employers that we help employees and local families who may be dealing with the premature birth of their baby. 2.3 This summer, the thought-provoking How We See Ourselves exhibition ran at the Garrison House in Millport, featuring the work of a talented group of customers from Trindlemoss and members of Neighbourhood Networks. ‘How We See Ourselves’ used poetry, visual art and animation to move the lives, interests, talents and challenges of people with learning disabilities – as well as those who support them – from being a marginal conversation within communities to a central focus. The exhibition provided a multi-media invitation for us all to pause and ask ‘how we see ourselves’ as individuals and as a collective, as well as reflecting on inclusion in its broadest sense. 2.4 The Health and Mind project is a new initiative within Woodland View Hospital funded for 12 months through the Connecting to Care fund (SCVO). The aim of this funding is to support digital inclusion and engagement work which aims to connect people to digital services and supports for health care needs. The Health and Mind project has been a collaborative project involving development and support from a number of teams across NHS Ayrshire and Arran, North Ayrshire Health & Social Care Partnership and The Ayrshire Community Trust (TACT). The Health and Mind project involves trained volunteers coordinated and supervised by the TACT team and clinical staff to provide digital support sessions to current in patients within Woodland View on a Tuesday morning and Thursday afternoon. 258
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17 As part of the funding, ward areas have been provided with devices to support the learning of service users in-between sessions using agreed resources built into devices for ease of access. Devices can be provided free of charge to service users if identified as needed to engage with the project. This project has been supported by the National Digital Health and Care team along with training being provided to volunteers and staff through the Mhor Collective. 2.5 The Kilbirnie Family Care team hosted a well-attended community ‘Back to School’ event in August at the Garnock Valley/North Coast locality area centre. As well as enjoying arts and crafts, biscuit making, hotdogs, drinks and snacks, families were able to choose from a range of pre-loved school uniforms, schoolbags, lunchboxes and pencil cases. Stationery supplies and free haircuts were also on offer, with one parent saying: “I haven’t been able to get my girls’ hair cut for a long time.” 2.6 The New Scots ESOL (English for Speakers of Other Languages) Hub provides lessons Monday to Friday 9am to 12.30pm. We have welcomed 4 new students into our class and they have integrated well bringing the number of students to 11. The class is currently working at SQA National 3 ESOL level, which is equivalent to A2 of the Common European Framework of Reference. Students are making excellent progress in all areas of their English skills, reading, writing, listening, and speaking. We plan to achieve a National 3 ESOL qualification for each pupil and support them on to a positive destination while taking into account their asylum status and their ongoing legal proceedings. The New Scots ESOL Hub is more than just English lessons. It provides the opportunity for our young people to be part of a community. They also receive ongoing support with any issues and wellbeing while two sessions of sport are provided per week. 2.7 Teams from across NAHSCP once again helped to spread some festive cheer among service users in the lead up to the holidays. The Three Towns Children and Families team once again had great success in raising funds throughout the year to provide Christmas dinner packs and children’s gifts for families in need throughout the Three Towns locality. The Garnock Valley Family Care Team ran a successful toy appeal and hosted a well-attended open day at the Kilbirnie Area Office, where over fifty of the families they work with came along and received some toys and food to help out over Christmas. The team held its annual movie event the same day, where families enjoyed a screening of The Polar 259
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18 Express, hot food and drinks, and a visit from special guests Santa and the conductor from the Polar Express. Children also took away a book gifted from North Ayrshire Libraries and carrots and reindeer dust for Rudolph on Christmas Eve. And the Care at Home team at Trindlemoss in Irvine - having recognised that there would be a number of service users spending this festive period without their families - organised a three- course Christmas lunch event, bringing everyone together. This was made possible thanks to kind donations from staff, as well as community champions from Tesco and Asda in Irvine and the Spar in Saltcoats, and this generosity also led to special meals being provided on Boxing Day and New Year’s Day for residents to enjoy. 2.8 The rain didn’t dampen spirits at Trindlemoss Day Opportunities as service users and their families, staff, and members of the public came together to enjoy the annual summer fayre. Despite outdoor activities being cancelled due to wet weather, there was plenty to keep everyone entertained indoors, with a range of stalls selling everything from crafts and sweet treats to jewellery, personalised cups, candles and much more. Guests tried their luck at the raffle and bottle stalls, with free hotdogs, burgers and tempting international food on offer, as well as a Tiki bar providing non-alcoholic drinks and the Baristamoss team brewing up teas and coffees. Entertainment was provided by a DJ, human fruit machine and a fantastic magic and balloon art show, with a limbo dancing contest also proving popular. Staff at Trindlemoss would like to thank everyone who came along on the day, as well as the stallholders and those who contributed prizes for the bottle stall and raffle. 2.9 Input are an organisation based at Towerlands Community Centre in Irvine that provides work preparation for people with additional educational needs. This skills development programme is based on the refurbishment of digital devices, with trainees learning about computers, their components, where they go and what they do, gaining valuable employment skills like communication and teamwork and boosting their confidence along the way. The refurbished devices are then distributed throughout the community to those who are digitally isolated, or to local charities. Referral for trainees is usually via a support organisation such as schools, social work or social care services, however prospective trainees can also approach Input directly. In addition, Input holds drop-in tech sessions on Fridays from 1pm to 3pm at the community centre, where members of the public can pop along for some tech advice and support from the trainees. 260
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19 2.10 Pupils from St Bridget’s Primary in Kilbirnie brought some Christmas cheer to Anam Cara on Wednesday, where guests enjoyed a festive sing-along with their ‘Wee Pals’. The Wee Pals project has been running since 2015, with pupils regularly meeting with guests at the facility to interact, share meaningful activities, learn from each other and have fun. Depending on the content, these sessions are also sometimes held at the school, community hub or local library. The aim of this intergenerational work is to help prevent isolation and reduce loneliness for people with dementia in a respite setting. It also helps to create an environment where children feel comfortable around people with dementia and can build in confidence. 2.11 North Ayrshire Council and Carers Gateway North Ayrshire have signed up to a new UK-wide commitment aimed at improving the lives of young carers and young adult carers, with NAC leading the way by being the first local authority in Scotland to sign up for this important initiative. The Young Carers Covenant was launched by the Carers Trust and the Young Carers Alliance, setting out a series of outcomes for organisations to work towards to ensure the life chances of young carers are improved. Caring can have a serious impact on a young person’s education and long-term future, with many young carers missing out on important parts of their childhood. This means it is vitally important that they receive the right support at the right time to enable to them to continue in a caring role while being a child or young person first. By signing up to the Young Carers Covenant, North Ayrshire Council and its partner Carers Gateway North Ayrshire have made the commitment to work towards ten key outcomes that will improve life chances for young carers, ensuring they are identified at the earliest opportunity, receive timely support, are able to thrive in education and employment, have time for themselves, and are able to maintain good physical health and wellbeing. This will involve continuing to work with education services, including colleges and universities, to ensure staff and students know who young carers are, the effects of caring roles and how to identify and support them 261
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20 2.12 North Ayrshire Council is one of three Scottish local authorities that are collaborating with health experts on ways to improve health and wellbeing for residents. The wide-ranging partnership will examine ways to strengthen and accelerate actions that will reduce health inequities for people living in North Ayrshire, Aberdeen City and South Lanarkshire. Health boards in each of the three areas will also work alongside Public Health Scotland (PHS) and University College London’s Institute of Health Equity (IHE), on the two-year-long Collaboration for Health Equity in Scotland. The local partnership was officially launched in February at Saltcoats Town Hall and Councillor Marie Burns, Leader of North Ayrshire Council, welcomed attendees including Professor Sir Michael Marmot, Director of the IHE, as keynote speaker. The partnership approach will see the three councils working with independent experts to receive practical guidance and support to introduce positive change at local level. North Ayrshire Council engaged with partners from the Community Planning Partnership (CPP) and Integration Joint Board (IJB) before submitting an expression of interest to be involved, which was subsequently accepted. The Collaboration will offer guidance that is aligned with the Council’s “wellbeing” priority, which includes helping residents to navigate the continuing Cost-of-Living Crisis and tackling child poverty. 2.13 Harbourside Men’s Shed was established in 2018 to tackle issues of social isolation and mental health by providing support and activities for men in Irvine and the surrounding areas. Aimed at all men over the age of 18, everything that is provided for members is free to use, ensuring that no one is excluded due to poverty. Based at 29 Kyle Road, Kyle Industrial Estate, Irvine, the Men’s Shed is open from 10am to 3pm, Tuesdays to Thursdays, with anyone welcome to go along on a drop-in basis, take part in a range of activities in its well-equipped workshop, and enjoy a cuppa and a chat. Tuesdays and Thursdays cater mainly for woodworkers, with Wednesdays mostly attracting those who are more interested in model making and painting. However, there is nothing to prevent anyone attending any day the shed is open to work on whatever project they wish. The Shed also works closely with other charities, schools and private customers to build and supply garden furniture, planters, and other handmade wooden items. A major study by Glasgow Caledonian University and Age Scotland found that Men’s Sheds are delivering tangible benefits for both physical and mental health in members, with improvements in fitness through participation in physical work, and a reduction in health visits 262
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21 such as GP appointments. Shed visits were also found to give participants a renewed sense of purpose. 2.14 Money Matters has had a dedicated Welfare Rights Officer providing advice in North Ayrshire secondary schools since 2021. The service has been a huge success and has put more than £1 million into the bank accounts of families during this time. The project has now expanded, with an additional two Welfare Rights Officers joining the team. This will enable the team to offer advice to all parents / carers with children in any education establishment, including early years, primary and secondary. The three Welfare Rights Officers will be split across the localities and referrals can be made direct to the officer by phone, email or ‘contact us’ form. In total, across all areas, the Money Matters team accessed benefits across to the incredible sum of £21,530,176.11, an increase of almost £1 million pounds from 2023-24. National Indicators Indicators NAHSCP Scotland Carers who feel supported to continue in their caring role 31.6% 31.2% Adults who are supported at home who agreed they felt safe 67.5% 72.7% Premature mortality rate (Under 75s age-standardised death rates for all causes per 100,000 population 507 (2023) 442 (2023) 263
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22 Enable Communities National Outcomes 3 People who use health and social care services have positive experiences of those services, and have their dignity respected. 7 People who use health and social care services are safe from harm. 264
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23 3.1 The Family Centred Wellbeing Service (FCWS) are a team of 14 wellbeing workers who support families with children between the ages of 5-18. We support over 170 families in North Ayrshire, with sessions provided within the family’s homes, within our offices, community buildings, and schools. We seek to build on existing parenting capacity and provide practical support, advice, and guidance that will enhance family wellbeing and relationships. The team use the facilities in Meadowcroft to bake/cook with our families, giving them an opportunity to connect, bond and learn life skills that can have a positive impact on their wellbeing and finances. We use the garden to develop play-based skills and to encourage positive mental health and wellbeing. Over the summer, the team devised and facilitated a summer programme that ran twice a week for the full summer for our families. They utilised accessible community resources in every area (for example, Fairlie beach, low green Irvine, Dalry Park, Eglinton Park, Ardeer Beach) and did free activities for our families to help build their confidence and show parents and carers how to access outdoor activities that will have a positive impact on their physical and emotional health. It also encouraged families to access local community resources and build further contacts within the community, reducing the impact of social isolation. 3.2 During 2024 to 2025, 171 compliments were received by the Health and Social Care Partnership relating to the services provided and the professionalism demonstrated by partnership staff. Compliments "We are obviously in the very early days following my Dad's passing but I would like to take the opportunity to bring to your attention the absolutely fantastic service and support which we have received from the 3 Towns Social Services in Saltcoats thus far - particularly [name] who attended to carry out the initial assessment for my mum on the same day her needs were brought to her attention, and [name] who has been following up with the arrangements. We acknowledge that there is, as ever, acute pressure on resources but they have gone out of their way to make us feel reassured in relation to my Mum's care needs, particularly while I remain overseas… Theirs are stressful and intensive jobs, and I should be very grateful if you would bring their sterling performance to the attention of the relevant Council executives.” "I wanted to write this email to be passed on to the Crisis Team within North Ayrshire particularly the two ladies that visited my Aunt on the Friday night and then [name] and [name] who became involved over the weekend. As I reflect today, I just want to say such a sincere thank you to the crisis team who were there to care for my Aunt at the most fragile time in her life and for supporting us as a family. The calm approach, values and support of the team are what got us through those early days before she was then moved on to ward 9 for a longer period of assessment. It is not often people pass on compliments, usually people are fast to complain. But on behalf of my Aunt, uncle and two cousins I cannot thank you enough. Thank you from the bottom of our hearts. You are definitely unsung heroes who we will always remember!” 265
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24 "[name] called to advise he was extremely happy with the service he had received from [name] at the Blue Badge clinic last week. Made him feel at ease and received a fantastic service.” “My late wife who passed away last month was a client of the NAC Care at Home Team for the Kilwinning Area. I write to express my deep gratitude for the high quality service provided by this team over many years and particularly as [name] condition worsened. We would not have been able to have [name] at home until the end without the skilful care and compassion of team members at every level.” "My mum was receiving palliative care having being diagnosed with late stage pancreatic cancer. She wanted to be at home at the end of her life which was also my dad’s wish. My sister and I were supported incredibly by the district nursing team, without whom we absolutely would not have managed to care for my mum at home as she wished. The care and attention shown by the team was incredible especially the way they absorbed the time demand required to support my mum seamlessly in response to her changing needs, in addition to the rest of their community caseload, never giving any sense of the time pressures we know they must have been under but always going the extra mile to ensure my mum was comfortable. This often meant several visits a day and it was obvious that at times members of the team were working well beyond the end of their working day to make sure that my mum had what she needed before they went home. The quality of the nursing care they offered was outstanding, as was the care and compassion shown to my parents and us throughout. I was amazed that in spite of services in the community and resources being so stretched, such a quality of service is still being delivered and that is testament only to the very hard work, professionalism and values of the local district team who go the extra mile mile to care for those who depend of their care. What a tremendous asset they are to the local community in Largs." 3.3 A total of 156 complaints were received during the year and were across all service areas, with 22 complaints being upheld. Complaint Topic Number Service provision/delivery 81 Staff behaviour (including alleged or perceived) 34 Communication 17 Other 8 Continuity of staff 4 Community OT 3 Quality of care 3 Waiting times 3 Justice Services 2 Blue Badge 1 3.4 Refugee Festival Scotland is an annual celebration of the contribution refugee communities make to life in Scotland. As part of the Refugee Festival Week in June 2024, service users 266
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25 involved with our Refugee and Resettlement Team were invited by the Salvation Army in Kilbirnie to prepare a Syrian buffet for an event to celebrate different cultures. A Syrian meal for 35 elderly residents was prepared and included traditional Syrian foods as well as traditional Scottish cuisine. The feedback was fantastic, and everyone enjoyed sampling different delicacies. This event created an opportunity for people from different backgrounds to get to know each other and find out what they have in common thus enabling and building bridges across our communities. 3.5 In August, agreement was reached which saw the renewal of the HSCP’s contract with The Notre Dame Centre, Glasgow, to provide intensive, therapeutic counselling support to children (and their families) who have experienced sexual abuse or other forms of complex trauma. The support comprises of a 6-week assessment process followed by up to three blocks of 10- week intensive support tailored to the individual needs of the child. Various therapeutic approaches are available to the children including Talking Therapies, Play Therapy, Art Therapy and Eye Movement Desensitisation and Reprocessing (EMDR) for example. The most appropriate approach is identified through the initial assessment period. The sessions are designed to create opportunities for children and their wider families to reflect on issues which are impacting on the child’s life and to facilitate change and allow for recovery. 3.6 Fullarton ConneXions is a community hub serving the areas of Fullarton and Harbourside in Irvine and beyond. Operating as a social enterprise, the organisation hires out corporate meeting space and provides hospitality to generate income for community interest groups, peer support, a volunteering programme, and a recovery support group. It also runs a low-cost community cafe four days per week that everyone is welcome to use. Most of the groups that run from the hub’s premises at Fullarton Parish Church are organised and delivered by third parties, however, its booking system is structured in such a way as to give discounted rates and priority to activities that meet specific local needs and promote the building of healthy communities. 3.7 The ILF (Independent Living Fund) Scotland Fund fully reopened in April, with an initial investment of £9 million from the Scottish Government. This investment will enable up to 1,000 additional people in Scotland with the most complex needs to access the support they require to live independent lives. ILF Scotland accepts applications from all Local Authorities across Scotland. North Ayrshire has an allocation of 32 new applications for the first year of reopening, where up to an extra £330 per week can be accessed per applicant who meets the following access principles for the fund: • They live in Scotland 267
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26 • They are aged 16 years or over at the time of application • They access SDS (Self Directed Support) • They receive a net weekly budget of at least £800 3.8 The North Ayrshire Dementia Support Service can provide support to those living with dementia, as well as their carers and families. Each individual’s dementia journey is unique, and the service will tailor its support to meet their needs, whether that be at home or in the local community. The service can provide guidance, information and rehabilitation services – including personal care – to help individuals remain in their own home for as long as possible. It can also assist them to attend hearing, eyesight, dental and GP appointments. The team’s specially trained support staff will also work with their carer or family, giving accurate and up to date information on the individual services that can provide the best support to people affected by dementia and those around them, as well as signposting to respite services. Staff can make referrals through the local social work office. The assessment will help to determine their needs and decide how these can best be met. Individuals and families can also self-refer by contacting their local NAHSCP office. If they already have a care manager in place, they can also be referred by them to the service. 3.9 Support for people with dementia in North Ayrshire received a boost after Anam Cara respite centre in Kilbirnie was officially reopened with a ribbon-cutting ceremony on Tuesday 4th June following an extensive refurbishment project. The specialist dementia respite centre accommodates up to 9 guests aged 60 years or over, offering critical respite services within single room, en-suite accommodation. The support service, which is run by North Ayrshire Health and Social Care Partnership, had been temporarily relocated to the vacant Taigh Mor site in Beith to allow the service to continue while works were carried out. The refurbishment project included a complete transformation of the main garden area, including new garden furniture, with a ramp installed from the conservatory to allow better access for guests to enjoy the outdoors. An additional, smaller garden area adjacent to the dining area has also had some landscaping improvements made. A full revamp of the internal areas of the building has also been carried out, with works including wet wall installation in several of the bathrooms, replacement light fittings with energy-efficient LED bulbs and a full upgrade to 268
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27 the reception area. An archway has been created within the dining area to improve the space, allow better access to the outdoors and create an improved flow for staff moving around the area, and a new boiler and generator have been installed. 3.10 Scottish Breastfeeding Week is an annual event, which this year ran from Monday 10 June to Sunday 16 June, which aims to enable new mums/parents to consider their breastfeeding journey and how they can be supported to: • Breastfeed in public • Breastfeed and return to work • Access local and national peer support As part of the celebrations, the Community Infant Feeding Team were at Irvine Library on Tuesday 11 June, where staff and members of the public came along to chat about all things feeding related, with an additional focus on this year’s theme of returning to work whilst breastfeeding and the support available. 3.11 In a groundbreaking achievement, NHS laboratory specimens were successfully delivered from the island of Arran by drone across the Firth of Clyde. This innovation, part of Project CAELUS, reduced delivery times from several hours to just 30 minutes, significantly speeding up diagnostic processes and treatment decisions. This project demonstrates the commitment to leveraging technology to enhance healthcare delivery, particularly benefiting remote and rural communities. The successful trial marks a significant step forward in addressing logistical challenges faced by remote communities. 3.12 Beith Trust supports community development and regeneration projects in North Ayrshire, focusing on creating inclusive, sustainable spaces for learning, culture and wellbeing. At its core, the organisation is dedicated to improving the quality of life of Beith residents, however many of its services and groups impact those outside of the local community, including families, young people, and those seeking personal development, education or community engagement opportunities. Beith Trust’s activities are designed to strengthen local engagement through education, events and social enterprises, with projects including Lend an Ear Befriending Services, Garnock Valley Helping Hands and many more. A variety of volunteer opportunities are also on offer, including project work, children’s events, administration and facilities work. In return, volunteers receive funded training, skills development and networking opportunities to boost their CVs and gain valuable experience. 269
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28 3.13 The Scottish Centre for Personal Safety provides empowering personal safety training to vulnerable individuals, organisations and businesses throughout Scotland. Run entirely by volunteers, it offers empowerment-focussed, trauma-informed personal safety training for people in North Ayrshire, including female survivors of violence/abuse, youths affected by severe bullying, and people with learning disabilities. These sessions can help to increase self- confidence, lower anxiety levels, and can often improve self- esteem. The charity’s base at the Barony St John Centre in Ardrossan is also used as a wellbeing facility, hosting a range of activities including Tai Chi, sound therapy, Reiki, and gym access. A Wellbeing Café, sauna and ice plunge tank will also be available from later this spring, and additional wellbeing activities take place throughout the year, with therapeutic art and creative writing classes planned for summer 2025. The centre is open to any member of the public suffering from low mental health; however, the focus is on female survivors of violence or abuse, children, people who are vision impaired, people with learning disabilities, ethnic minority groups (including refugees), and LGBT groups targeted by hate crime. 3.14 Our Refugee and Resettlement Team recently hosted an afternoon tea to help tackle social isolation among Afghan ladies living in North Ayrshire. During home wellbeing visits to newly arrived families from Afghanistan, the team identified that the ladies often felt socially isolated and would benefit from meeting up with others from our Afghan community to make some new connections. The event, which took place at Towerlands Community Centre in Bourtreehill, offered an opportunity for them to come together, make new friends, share experiences and provide support for each other. The invite was extended to all Afghan ladies living within North Ayrshire, including those who had newly arrived and others who had resettled here over nine years ago. Participants enjoyed having the opportunity to meet up, exchange phone numbers and to discuss other events they would like to take part in to improve their mental health and wellbeing. A WhatsApp group was also created for them to keep in contact and continue to build friendships. The feedback from the afternoon tea was very positive, with the ladies expressing that it had nurtured a sense of belonging and improved their confidence. 3.15 Self-Directed Support (SDS): For the reporting year 2024 to 2025, the following information indicates how people have arranged and directed their support in North Ayrshire. Self-Directed Support offers four options. These are: • Option 1 – a direct payment, which is a payment to you or third party to pay for your own support 270
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29 • Option 2 – you direct the available support • Option 3 – the local council arranges the support • Option 4 – a mix of the above This continues to demonstrate that traditional support options are offered and accessed most with 80% of people receiving Option 3, where little choice and control is exercised and support is chosen, arranged and directed by the Health and Social Care Partnership. 3.16 Peace of Mind is an innovative programme aimed at reducing social exclusion and isolation as a result of a disability, impairment or long-term health condition, with a particular emphasis on people who do not receive statutory services but still need support. Run by social enterprise Peace of Mind Services, the programme has been successfully operating in Fife for the past three years and is now available in North Ayrshire thanks to funding from the National Lottery. Core to the Peace of Mind principle is the ability of individuals to exercise choice and control over how, where and when they are supported to achieve their social outcomes, recognising that engaging and taking part in community-based activities is key to health and wellbeing. As such, the organisation offers tailored experiences for individuals and groups based on their interests and aspirations. This can include independent living skills such as managing money, preparing healthy meals, attending the gym, or a wide range of activities such as going to art galleries and museums. 271
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30 National Indicators Indicators NAHSCP Scotland Adults receiving any care or support who rated it as excellent or good 68.4% 70.0% People with positive experience of the care provided by their GP practice 60.0% 68.5% Proportion of care services graded ‘good’ (4) or better in Care Inspectorate Inspections 86.6% 81.9% 272
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31 Develop and Support Our Workforce National Outcomes 6 People who provide unpaid care are supported to look after their own health and wellbeing. Including to reduce any negative impact of their caring role on their own health and wellbeing. 8 People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. 9 Resources are used effectively and efficiently in the provision of health and social services. 273
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32 4.1 The Children and Families Health Team have supported two members of staff to undertake the Postgraduate Certificate in Child Protection at the University of Stirling. In line with previous Scottish Government investment criteria, we have also supported one school nurse to undertake the Specialist Community Public Health Nurse (SCPHN) course at Robert Gordon University. The Children and Families Health Team are also in the process of concluding the roll out of Trauma Skilled training to all staff within the service following two staff being trained as trainers earlier in the year. Within the HSCP, we also have a very strong reputation for providing high quality student placements to help create a positive learning experience for the social workers of tomorrow. This aligns with our commitment to grow our own workforce as referenced in our learning and development strategy “Be the best you can be.” Recently, a student who finished their placement within the HSCP offered the following feedback. “I have just finished my first placement, which was based in Justice Services. The knowledge and skills I have developed during my time here has been invaluable. To see the value base and work ethic of each and every member of the team and the commitment they have to achieving the best outcomes with the people who use the Service has been such a positive experience and one I will take with me throughout my social work career. The demand on the service is exceptional and I know this can place workers and management under significant pressure but as I fed back to the management team at the end of placement, I hope that they do not lose sight of the invaluable work that they do and the difference they make. Going forward I hope Justice Services continue to take on students as I feel the experience there is unique and I am beyond grateful to have been lucky enough for this to have been part of my student journey.” Placements provide fantastic opportunities for students to develop their knowledge and skills and get a solid grounding in relation to how social work interventions can support people through particularly challenging and distressing times in their lives. 4.2 As platinum award winners in Investors in People, the Dirrans team were looking for a different challenge so went forward for a new award from Investors in people ‘We invest in wellbeing.’ The We invest in wellbeing framework looks for a strategy and approach to the health and wellbeing of staff. This should be measurable and understand the impact of this on staff practice. The team considered and improved practice by evaluating staff wellbeing through surveys and feedback. They created a wellbeing policy and strategy to guide wellbeing goals such as reducing sickness absence, improving job satisfaction and job retention. They also developed subgroups that focussed on physical, psychological, social and financial factors that can affect staff and shared this as a team to be more informed about what supports staff can access to help improve wellbeing. The team reflected that they already felt that they had a strong presence for looking after staff however going through this process it highlighted areas for improvement and how the framework could improve the service. The We invest in Wellbeing framework comprises three indicators, each with three themes. This defines what it takes to reach each level of accreditation standard, silver, gold, and platinum. 274
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33 It was intended to start at the first level of ‘standard’ however when receiving feedback, this had jumped to silver which is an amazing achievement, and the Dirrans Centre were confirmed winners of the silver award in August 2024. We invest in wellbeing silver award means that you have an established wellbeing strategy or plan and that your people feel positive about your strategy, plans and activities. Developing and supporting our workforce ensures employees are more efficient and effective in their roles, helps retain our skilled and qualified staffing resources, and improves morale and job satisfaction. 4.3 The work of staff within Trindlemoss Day Opportunities was the focus of a recent very positive Care Inspectorate visit. Feedback noted the sector-leading quality of what was happening within the service. Ward 7A continues to experience significant pressure, with delayed discharge continuing to be a key issue. The Ward staff and management team are currently working with Healthcare Improvement Scotland to explore the impact of this, and related conversations are also taking place with Scottish Government to promote their understanding of the issue. Regular conversations are taking place with the adult Learning Disabilities Social Work Team and Children and Families with Disabilities team, in support of their planned integration. A service manager is now in post to support this work. The Learning Disabilities Social Work Team is also being supported via the recruitment of a second team manager. 4.4 The Health and Social Care Partnership are delighted to advise the launch of a formal model of support for workers in the creation of a Staff Vicarious Trauma Service. The Partnership recognises the secondary trauma, stress and burn out, which can occur when working in a complex human environment with many moving parts. The purpose of the venture is to support staff who are working within the live space, exposed to complicated human contexts. The service will be delivered by Breaking The Silence, who have significant experience and knowledge in this field and beyond, supporting victims of profound and vicarious trauma. Staff will be able to access therapeutic support to work through the vicarious trauma they have been exposed to. This will provide a safe space to process their experiences, gain therapeutic insights/supports and build on their resilience to move forward. Incorporating coping strategies, wellbeing plans with the purpose of helping staff to continue work responsibilities without any detriment to their mental, emotional and physical health and wellbeing, protecting them from, and reducing the risk of vicarious trauma. The contract will also provide two wider workforce training days each year for approximately 80 staff in total. The aim is to raise awareness of vicarious trauma per se - including learning, development, preventative/promoting self-care responses, sharing experiences and practice- based learning. Overall, the service aims to support staff’s wellbeing, offer protection from the 275
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34 exposure of traumatic human experiences, while building staff resilience and minimising disruption to the overall service through improved sickness absence and higher staff retention rates. 4.5 Our first annual Care at Home Manager Development Day has taken place. This was introduced as a practical support for new and existing managers to enhance both confidence and skills, focusing on key areas such as: 1) Skill enhancement: Managers should continually develop their skills to keep up with best practices. 2) Leadership Improvement: Effective leadership is essential for the managers to motivate and guide their team. 3) Employee Development: Managers play a key role in the growth of their Care at Home Teams, by improving their mentoring, coaching and feedback skills they can better support the Carers whom they line manage. 4) Networking: The development days enable the managers to share experiences and learn from their peers. 5) Wellbeing: Investing in the development of managers supports their wellbeing. The service will continue to support future sessions, engaging in new concepts, continuing to drive success and growth which also supports career progression. 4.6 Following agreement at the Children’s Services Strategic Partnership, a second 0.8WTE Dads Rock worker has been funded by the Whole Family Wellbeing Funding (WFWF) to be employed by Dads Rock. This increase in staffing capacity will have a positive impact on the number of requests for assistance being submitted. A second Dads Support worker will be able to expand support to the Irvine and Kilwinning area. 4.7 Case Study: Community Nursing Connie, Newly Qualified Nurse (NQN), Garnock Valley and Kilwinning Community Nurse Team I was assigned to the Garnock Valley (GV) District Nurse team as a year 3 student on my management placement. During this placement when the NQN recruitment process commenced one of the Staff Nurses had indicated she was going to retire. I was keen to work in community nursing and made this speciality my first choice on my application form. During my placement I was able to take on a small, delegated caseload and was able to plan and assess the care for my patients with support from my Practice Supervisor and also from the other staff in the team. This experience gave me confidence in what I would expect as a Staff Nurse if successful at interview. All students in my cohort were offered interviews and I attended and I was delighted to be informed I was the preferred candidate for the GV post. In the remainder of my placement, I ensured I was exposed to as much of the community staff nurse role and responsibilities as possible. I joined the team in September as a Band 4 Health care Support Worker while my Nursing and Midwifery Council (NMC) pin was processed which came through early October 276
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35 and I transitioned to a Registered Nurse. Working as a NQN is a daunting experience for any individual, however I have only ever felt fully supported and valued. Ongoing induction and mentorship to the role from both the wider District Nurse team and participating in the NQN induction/education sessions has been beneficial to my journey and it also allows me to discuss the NQN pathway with my peers in other specialities and department. Although I’m a Staff nurse within the team I have access to every part of the wider Health and Social Care partnership team in providing high standard of care for our patients and their families. 4.8 All employees of NAHSCP and our providers can now enjoy a year’s free access to Holly Health, a fantastic mobile app that can support you to make small, achievable changes that could help boost your health and wellbeing. Using a compassionate, personalised approach tailored to your own health goals, interests and activities, the app can help you to reduce stress and anxiety, rebuild your relationship with food, increase exercise and movement and improve your sleep. Holly Health will assist you in making small but consistent changes to your daily behaviours, helping you build healthier habits, promoting mindfulness and encouraging you to be more kind to yourself. In-app coaching is available through a supportive chat bot system, with friendly, motivational reminders by text or email to keep you on the right track. The app also contains a wealth of useful articles and videos that you can browse at your leisure. Funded by NAHSCP, you’ll initially enjoy six months’ free access to the app, before being invited to a further six-month subscription for free once that expires. “I feel I have lessened how often I see my GP” “This is a great idea and honestly feel this could help so many people if this is what doctors are able to prescribe! A year’s free subscription to a brilliant self-help app, with no restrictions and no judgement. This has been a godsend during a tough time.“ “The app is a great resource for reliably keeping on track with habits that are healthy and productive. It is also very generous to allow us to have access to this app for the time being. It is appreciated.“ 4.9 The winners of the 2024 Partnership Awards were announced at our ‘Promoting Wellbeing Together’ event at the Redburn Community Centre in Irvine. The event was a fantastic celebration of the staff, teams and individuals who deliver health and social care services in North Ayrshire, as well as the crucial work of those in our communities who support people with their wellbeing, including volunteers, community organisations and charities. 277
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36 4.10 Congratulations to Eileen Welch, manager of Burnlea Care Home in Largs, who won the Care Leadership of the Year Award in the 2024 National Care Home Awards. The awards, hosted by Scottish Care, acknowledge the individuals, teams and organisations within Scotland’s independent care home sector. The winners were announced at a ceremony held at the Hilton Hotel, Glasgow on Friday 15 November. In addition, Burnlea, which is run by Pepperwood Care, made it to the final three in the Care Service of the Year and Meaningful Activity of the Year categories. Abbotsford Care Home in Ardrossan - also run by Pepperwood Care - was also shortlisted in the Care Service of the Year category. Well done to all involved in these fantastic achievements. 4.11 The LiveWell group have partnered with KA leisure to bring free health checks to Council employees. The KA Leisure health check sessions include lifestyle and weight management advice along with cholesterol, blood pressure, blood sugar testing and the Boditrax machine – a clever system that assesses your body and, very quickly, delivers 14 different measurements, such as your ideal weight, your BMI and your metabolic age. Our Chief Executive Craig Hatton booked in to one of the health check sessions and encouraged others to do the same. He said: “It’s been brilliant having the opportunity to have my recent employee health check, thanks to the LiveWell group and our partners at KA Leisure. I think it’s important that colleagues understand just how vital it is to take time for their own health and learn about what they can do proactively to improve it. The reason I booked in to a recent KA Leisure health check was because I am mindful that I’m not getting any younger and I knew – for my own peace of mind – that making time to have the check done was going to be beneficial for me.” 278
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37 National Indicators Indicators NAHSCP Scotland Readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 106 103 Percentage of adults with intensive needs receiving Care at Home (all levels of CAH) 77.0% 64.7% Number of days people aged 75+ spend in hospital when they are ready to be discharged per 1,000 population 1,266 952 279
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38 Improve Mental and Physical Health and Wellbeing National Outcomes 1 People are able to look after and improve their own health and wellbeing and live in good health for longer. 5 Health and social care services contribute to reducing health inequalities. 9 Resources are used effectively and efficiently in the provision of health and social services. 280
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39 5.1 Irvine Camera Club is an enthusiastic group of people from across Ayrshire who share a common interest in photography. The club is open to everyone, with members from all walks of life. Regular activities include photographic competitions, exhibitions, invited lecturers, studio nights, practical evenings, trips and social events - including visits to other clubs. The group has also provided support to the NAC Arts & Culture Team and the Scottish Mental Health Arts Festival, as well as working with NHS Ayrshire & Arran to provide photography workshops. 5.2 The Three Towns Community Shed offers a safe and welcoming space for anyone over the age of 18 to drop in, take part in a wide range of activities, learn some additional skills and enjoy socialising with new friends. This fantastic community initiative was launched recently after bringing together the existing local Men's Shed and recently formed, She Shed under one banner, with a base at 12C Castle Works, Hill Street, Ardrossan. While the two groups learn, create and socialise in their own right, they also enjoy combined experiences and social events. Helping to combat social isolation, the Shed offers local people a chance to go along and take part in arts and crafts, woodworking, 3D printing, model building, bicycle repairs, fixing furniture or small personal items, and even a music group. The Shed has recently been commissioned by both a local care home and primary school to build them memorial benches and has previously built planters for other community groups. 5.3 A report produced by NHS Ayrshire & Arran’s Prevention and Service Support Team has highlighted the positive impact of Naloxone distribution and use in North Ayrshire. This safe and easy-to-administer medication temporarily counteracts the effects of opioids, such as heroin, methadone, codeine, morphine and buprenorphine, and can save lives by reversing an overdose for 20 to 40 minutes until emergency help arrives. 1,640 Naloxone kits were handed out in Ayrshire between April 2024 and March 2025 (741 of which were in North Ayrshire), with 73 lives reported to have been saved in that time (18 in North Ayrshire). However, the true number of lives saved is thought to be higher, with many instances of Naloxone use going unreported. In addition, a total of 1.225 people received overdose awareness training across Ayrshire in the same time period, with a further 428 people attending a virtual or face to face Naloxone awareness course. 5.4 NHS Ayrshire & Arran, in partnership with Coloplast Ltd, has launched a successful pilot service to improve the lives of people with multiple sclerosis (MS). This innovative service 281
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40 focuses on managing neurogenic bladder and bowel dysfunction, a common issue for people living with multiple sclerosis. Key achievements include the introduction of a dedicated bladder and bowel clinical nurse specialist, early detection through patient questionnaires, and significant reductions in urine retention and urinary tract infections. Patients have experienced improved health outcomes, enabling them to engage more fully in work and social activities. This pilot sets a new standard for MS care, demonstrating the benefits of early intervention and integrated care pathways. 5.5 The latest inspection report for Montrose House Care Home, conducted on 29th October 2024, highlights a number of positive developments and improvements. The service has 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. Effective methods for staffing assessment and planning have been implemented, ensuring safe and sufficient staffing levels. The introduction of robust quality assurance processes has led to continuous service improvement, with key tasks delegated to capable staff members. The employment of an activity coordinator has significantly enriched residents' daily lives, and the home has improved its cleanliness and infection prevention measures. 5.6 North Ayrshire's first ever Dementia Connect event was held, bringing together those living with dementia and their carers to learn more about dementia care and the supports available. Around 80 people attended the free event on 13th November at the volunteer rooms in Irvine. Guest speakers included Professor Elaine Hunter, National AHP Consultant for Alzheimer's Scotland, and Susan Holland, NHS Ayrshire and Arran's Nurse Consultant for Dementia. The event featured conversations based on the outcomes of the national strategy, activities highlighting the challenges faced by individuals living with dementia, and a marketplace with representatives from local and national support services. The event was a great success. 5.7 Case Study: Scottish Healthcare Awards 2024 Our Multiple Sclerosis service based at Douglas Grant Rehabilitation Centre in Irvine were shortlisted as finalists in the ‘Developments in the Management of Multiple Sclerosis’ Award in the 2024 Scottish Healthcare Awards. We are delighted to say that they were announced as winners of the category at the awards ceremony, which was held at the Crowne Plaza in Glasgow in November. The team was recognised for its work in involving patients in future developments to better meet their needs, as well as its work in developing a suite of outcome measures to identify changes in patients’ conditions at an earlier stage, allowing earlier intervention and sustaining function and independence for as long as possible. The Scottish Healthcare Awards acknowledge and celebrate those working across NHS Scotland and its partners to deliver high quality health and social care services to the people of Scotland. A huge congratulations go to everyone involved in the care of patients with Multiple Sclerosis in Ayrshire on this wonderful achievement. 282
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41 5.8 Recognised in Scotland’s National Dementia Strategy, post-diagnostic support is crucial for people newly diagnosed with dementia. High-quality support over an extended period helps individuals and their families live well with dementia and prepare for the future. The Scottish Government guarantees a minimum of one year’s support for every newly diagnosed person. Our team of Community Psychiatric Nurses provide timely emotional and practical support, helping individuals understand their illness, manage symptoms, stay connected to their community, and plan for future care. Additional practical help can be accessed via the local social work office. 5.9 North Ayrshire Health and Social Care Partnership hosted a Mental Health and Wellbeing ‘Connect’ event on Monday 29 April at the Ardeer Community Centre in Stevenston. The public were invited to come along and chat to the many visiting support services, browse the stalls and participate in a variety of workshops focussing on a range of mental health topics. Services such as VoiceAbility advocacy, North Ayrshire Carers Gateway, the NHS A&A Health Improvement team, the Primary Care Mental Health team, Community Link Workers, North Ayrshire Alcohol and Drug Partnership, the NHS A&A Suicide Prevention team and North Ayrshire Wellbeing and Recovery College were in attendance. A series of mental health and wellbeing workshops were also held on the day, with attendees having the opportunity to take part in all of these, as well as some creative or active movement taster sessions. The event also offered the chance to share views on mental health services and supports in your area, meet new people and chat to others with lived experience. 5.10 Following extensive engagement work in 2023 around the topic of transition from child to adult services across learning disability and mental health services, a further phase of work was commissioned to support the development of a transition carer peer support group. This has been made possible through the commitment of some of the parents and carers that initially engaged with us over last year and shared their lived experience. The group named its self 'Transition Together - Carer Peer support Group' and launched in summer 2024. These sessions will be carer led but supported by the partnership engagement officers focussing on mental health and strategic planning, the CAMHS participation officer, wider support staff and Unity Carers Gateway team to ensure ongoing engagement is facilitated around this area of support. The purpose of the group is to: • Provide peer support to other parents & carers • Organise visiting expert guidance in order to share advice and resources • Interactive workshops tailored to address specific concerns relating to transition • Create an atmosphere of empowerment and resilience by building a stronger support network for those facing a transition journey from children to adult services 283
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42 5.11 The North Ayrshire Mental Health Arts Festival ran between 1st October – 27th October 2024. We were delighted to offer a number of events, providing us with opportunities to engage with our communities about mental health and wellbeing, whilst challenging stigma. As well as open events available to the public, we also had a range of closed projects, meaning we had one of the biggest programmes in Scotland. 5.12 Staff and customers of Trindlemoss Day Opportunities in Irvine presented a workshop at the Accessible Book & Story Festival, which took place at the Scottish Storytelling Centre in Edinburgh in September. The festival session allowed a group of North Ayrshire adults with learning disabilities to share their experiences of working with ShowWorks Theatre to produce an innovative performance piece around the theme of ‘being and becoming’, an initiative that was funded through Creative Scotland’s Participatory Arts and Mental Health Fund and The Baring Foundation, in partnership with the Mental Health Foundation. The ‘What Comes Next’ project, which also involved members of Neighbourhood Networks, began with a series of weekly sessions exploring the theme of life changes - whether that be transition from child to adult services, transition into employment, transitions into and out of relationships, or the many other changes that can occur throughout life. Over the course of six months, the group was actively involved in the entire creative process – from the initial idea to the music and characters. Those taking part were also supported by visual artist Lynn McNally to produce scenery, props and other responses to the theme. The final performance piece included contributions from over 50 participants, with the project culminating in a vibrant performance at the Harbour Arts Centre in May, allowing those involved to share their aspirations in an imaginative and joyful way with their friends and family. From this performance, and additional footage captured before and after it, an inspiring short film was produced by local film-maker Jim Gibb, which truly captures the energy and spirit of those taking part. The festival workshop in Edinburgh saw customers and staff of Trindlemoss presenting the film to an audience, as well as taking part in a panel discussion afterwards, gaining extremely positive feedback from festival organisers ‘My Kind of Book’. 284
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43 5.13 Harbour Ayrshire provides a comprehensive support package aimed at reducing the effects of drug and alcohol addiction across Ayrshire. As well as one-to-one support, the charity also runs support groups for men, women and their families, offering a safe space to share experiences and help in the formation of positive relationships. These groups also provide support in areas outwith addiction, including mental health, homelessness, education, skills training and bereavement. Groups are open on a drop-in basis, with no appointment required. Or to access one-to-one support, anyone can self-refer by calling 1292 623016. Harbour Ayrshire also offers a community support vehicle, helping those fleeing violence or moving from temporary or otherwise unsuitable accommodation. It also operates a minibus service, assisting those for whom transport is a barrier to accessing support. 5.14 Working for a Healthy Economy is funded by the Ayrshire Growth Deal. It aims to support the residents and work force of Ayrshire with any health and wellbeing difficulties that are impacting on ability to attend / make progress towards work. You qualify for support if you: • Live or work in Ayrshire • Are Unemployed and looking to make progress towards work • Are Self Employed • Work for a company that employs less than 250 people You don’t need a diagnosis from a GP/Health Professional. If you think that support would be beneficial, you can self-refer. All support is free and confidential. If you are motivated to make change but are experiencing difficulties with issues such as anxiety, depression, panic, sleep, self-esteem, pain, mobility, alcohol, drugs or other barriers that are preventing you from reaching your goals, help is available. 5.15 A team from North Ayrshire’s Drum 4UR Life (D4L) community drumming group presented a ‘CHIME to Drum’ workshop at the International Drum Circle Facilitator’s Guild Conference in Myrtle Beach, South Carolina. Drum 4UR Life is a community drum circle that supports positive mental health and wellbeing. It meets weekly in Ardrossan, as well as offering monthly workshops in Irvine and Largs. In addition, it has facilitated music-making experiences for over 100 community events and groups over the past year. The theme of the conference was ‘journeys’, with the team powerfully sharing the evolution of Drum 4UR Life using the framework of the CHIME recovery model, as well as their own experiences around the connections, hope, identity, meaning and empowerment that come from being involved with the group. The workshop went down a storm, receiving a standing ovation lasting several minutes. 285
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44 Drum 4UR Life grew out of the NAHSCP-funded North Ayrshire Wellbeing & Recovery College, one of only five such services in Scotland, which focuses on self-management for mental health and providing a strengths-based approach to learning and recovery. 5.16 Delayed Discharge rates per 1,000 population have continued to increase in North Ayrshire with the rate for 2024 to 2025 being 20.6 per 1,000 population compared to 13.4 per 1,000 population across Scotland. The Health and Community Care Team have now moved into Year 2 of the Delayed Discharge and Winter Improvement Transformation Plan, a dynamic and evolving programme designed to help the Partnership meet the growing and complex needs of our communities. North Ayrshire Health and Community Care representatives continue to work in collaboration with NHS Ayrshire and Arran colleagues, to support effective hospital discharge and delayed discharge plans, alongside plans to support winter resilience. The collaboration includes supporting the newly implemented frailty zones and wards within acute hospitals to promote early intervention and ensure safe ongoing care and support, in a homely setting from the earliest possible opportunity. 5.17 The Community Led Action and Support Project (CLASP) is open to anyone aged 50 and over, with an aim of reducing isolation and loneliness, improving health and wellbeing, improving digital skills, and providing information and advice on issues affecting older people. The Stevenston-based charity offers a wide range of services across multiple venues and localities in North Ayrshire, including home/telephone befriending, social activities, health and wellbeing classes, weekly lunch clubs, and one-to-one/small group digital tuition and support. Through its HOPE in the Community project, CLASP also provides a range of volunteering opportunities including befriending, digital buddies, activity support volunteers, minibus drivers, lunch club helpers and admin support. It is also seeking new trustees to join its Board/Management Committee. Training is provided and out of pocket expenses reimbursed. 286
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45 National Indicators Indicators NAHSCP Scotland Adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life 67.6% 69.8% Proportion of last 6 months of life spent at home or in community setting 87.6% 89.2% 287
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46 MSG Indicators Indicators Value Emergency admissions to acute hospitals* 18,692 Emergency admissions to acute hospitals (Rate per 1,000) 139.9 Admissions from emergency department 8,584 Admissions from emergency department (Rate per 1,000) 64.3 Percentage of people at emergency department who go onto ward stay (conversion rate) 25.5% Unscheduled ‘hospital bed days’ in acute hospital* 145,927 Unscheduled ‘hospital bed days’ in acute hospital (Rate per 1,000) 1092.5 Unscheduled ‘hospital bed days’ in long stay mental health hospital* 25,676 Unscheduled ‘hospital bed days’ in long stay mental health hospital (Rate per 1,000) 192.2 Unscheduled ‘hospital bed days’ in geriatric long stay* 7,533 Unscheduled ‘hospital bed days’ in geriatric long stay (Rate per 1,000) 68.9 Emergency department attendances 33,606 Emergency department attendances (Rate per 1,000) 251.6 Percentage of people seen within 4hrs at emergency department 65.00% MSG Indicators – Delayed Discharges Indicators Value Delayed discharges bed days (all reasons) 27,099 Delayed discharges bed days (all reasons) (rate per 1,000) 247.7 Delayed discharges bed days (code 9) 9,410 Delayed discharges bed days (code 9) (rate per 1,000) 86.0 Delayed discharges H&SC Reasons 17,535 Delayed discharges H&SC Reasons Rates 160.3 * Calendar year 2024 used as a proxy for financial year 2024/25 due to data completeness, following advice from Public Health Scotland. 288
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47 National Health and Wellbeing Indicators The Scottish Government identified 23 (4 remain in development) indicators that were felt evidenced the 9 National Health and Wellbeing Outcomes. Nine indicators come from the biennial Health and Care Experience Survey (see below) and the additional 14 indicators (also below), which evidence the operation of NAHSCP, come from the NHS Information Services Division (ISD) survey. This survey represents a sample of the community and asks about the collective services received whether it be from Social Services, NHS, the collective HSCP, Private or Voluntary organisations. The survey responses do not separate each organisation’s service provision. The information below represents the most up-to-date information with further updates accessible from – Public Health Scotland Health and Social Care Experience Indicators 2015-16 2017-19 2019-20 2021-22 2023-24 Scottish Average % Rank against Family Group Adults able to look after their health very well or quite well 94% 91% 92% 89% 89% 91% 2 Adults supported at home who agreed that they are supported to live as independently as possible 82% 84% 84% 81% 67% 72% 7 Adults supported at home who agreed that they had a say in how their help, care, or support was provided 78% 70% 75% 73% 51% 60% 8 Adults supported at home who agreed that their health and social care services seemed to be well co-ordinated 73% 74% 76% 64% 55% 61% 7 Adults receiving any care or support who rated it as excellent or good 81% 78% 77% 76% 68% 70% 5 People with positive experience of the care provided by their GP practice 83% 80% 73% 61% 60% 69% 6 Adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life 83% 82% 79% 78% 68% 70% 6 289
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48 Health and Social Care Experience Indicators 2015-16 2017-19 2019-20 2021-22 2023-24 Scottish Average % Rank against Family Group Carers who feel supported to continue in their caring role 41% 39% 31% 31% 32% 31% 6 Adults supported at home who agreed they felt safe 80% 80% 85% 83% 67% 73% 7 To support service improvement, the Scottish Government has identified local authority / Partnership benchmarking families. These family groups are made up of eight local authorities that share similar social, demographic and economic characteristics. Comparing our performance information with our family group should provide a more meaningful comparison with similar areas and allow for greater opportunities for shared learning and best practice. Rankings are on a scale of 1–8, where 1= best performing, 8=worst performing. North Ayrshire is partnered in its family group with: East Ayrshire, Dundee, Western Isles, Glasgow, Inverclyde, North Lanarkshire, and West Dunbartonshire. 290
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49 Indicators based on administrative data 2020-21* 2021-22* 2022-23* 2023-24* 2024-25* Scottish Average Rank against Family Group Premature mortality rate. (Under 75s age-standardised death rates for all causes per 100,000 population). 516 568 527 507 Unavailable 442 4 Rate of Emergency Hospital Admissions for adults (per 100,000 population) 13,860 14,269 13,449 14,009 15,142 11,559 8 Rate of emergency bed days for adults. 138,799 155,206 151,553 142,222 155,896 113,627 8 Readmissions to hospital within 28 days of discharge. 122 113 100 101 106 103 5 Proportion of last 6 months of life spent at home or in community setting. 89% 89% 88% 88% 88% 89% 6 Falls rate per 1,000 population aged 65+ 18 20 20 22 23 23 4 Proportion of care services graded ‘good’ (4) or better in Care Inspectorate Inspections. 87% 79% 78% 83% 87% 82% 3 Percentage of adults with intensive needs receiving Care at Home. (All levels of CAH) 73% 77% 77% 78% 77% 65% 1 Number of days people aged 75+ spend in hospital when they are ready to be discharged per 1000 population) 382 805 1,038 1,087 1,266 952 7 *Column contents are the most up to date data information received from Scottish Government statisticians. As well as the National Health and Wellbeing indicators, we regularly report on local measures to help us to evidence performance against the nine National Health and Wellbeing Outcomes and our Strategic Priorities. The list of local indicators can be found in Appendix 1. The full list of indicators can be found in Appendix 2. 291
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50 Performance in relation to the three Children’s Outcomes and three Justice Service Outcomes 292
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51 Children’s Outcomes Outcome 1: Our Children have the best start in life and are ready to succeed. Outcome 2: Our young people are successful learners, confident individuals, effective contributors, and responsible citizens. Outcome 3: We have improved the life chances for children, young people and families at risk. 1.1 A transformation programme to improve outcomes and opportunities for care experienced children and young people in North Ayrshire is now under way, with progress being made since its launch in April 2024. The Brighter Pathways Programme Board was set up to look at how services can be delivered differently to ensure care experienced children and young people have access to the appropriate resources and supports into adulthood. In line with its Promise commitments, North Ayrshire Health and Social Care Partnership (NAHSCP) has a firm focus on providing the right support and intervention to allow children and young people to remain with birth family or wider family wherever possible, preventing them from coming into local authority care - for example, being placed in foster care or in residential children’s houses. To build on this already established early intervention work, the Board is currently looking at the supports available for families to identify if there are any gaps in service provision where additional early help and more intensive support could help more children to remain with their families. An acute challenge in recruiting and retaining foster carers is having an impact nationally, which has been further impacted by the current cost of living crisis and a reduction in the number of potential foster carers having spare bedrooms due to an increase in home working and their own children staying at home for longer. Recruiting foster carers for NAHSCP is further impacted by a number of independent fostering agencies operating in the area and taking on carers. In a bid to boost recruitment, which is a priority for the programme board, an investment in a long-term digital marketing campaign has recently been agreed, working with a provider that has a proven track record in local authority foster care recruitment. 1.2 The Annual Promise Conference 2024 was held on Monday 9th December and saw 73 young people from across our Secondary Schools join for a day of connection. The aims of the Conference were to: 293
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52 • Introduce young people to The Promise Plan 2024 to 2030 • Offer workshops centred around The Promise’s foundation of voice • Allow time for building connections with other young people and Corporate Parents The day was hosted by Donna Anderson, North Ayrshire Council’s Youth Participation and Democracy Officer, and Adam Johnson, local Care Experienced young person and MSYP for Cunninghame North. Young people were involved in the planning of the Conference at all stages. This year’s agenda included interactive workshops delivered by local Corporate Parents nominated by young people. 1.3 In December, the HSCP received notification from the Scottish Government that the Delivering Equally Safe Fund would provide a further 12 months funding to allow us to continue to develop our approach to providing crucial support to survivors of violence against Woman and their children. This funding will be used to recruit a lead officer to further progress activities to embed the Safe and Together Model on a pan Ayrshire basis. The Safe and Together Model is an internationally recognised suite of tools and interventions designed to help Social Workers and other key professionals to engage with families experiencing domestic abuse, in a child centred, strengths-based way. 1.4 This year, the United Nation’s Convention on the Rights of the Child (UNCRC) was fully incorporated into Scots Law - The Children and Young People's Commissioner Scotland. The UNCRC articles provide for every aspect of a child’s life from birth up to the age of 18 years. Guidance around UNCRC is clear that incorporation and adherence to UNCRC is the responsibility of all public sector organisations and services, including those services viewed as “adult services.” To support our work within the HSCP, it was seen as critical to establish a baseline of understanding and preparedness for implementation across all services. As such, in November 2024, using the Improvement Service’s Getting Ready for UNCRC Incorporation Framework document, a benchmarking document was developed with an ask that all services within the HSCP complete to the best of their ability. Responses provided related to current practice within each service. Results have been shared with all services. Moving forward each service will use the benchmarking exercise to identify compliance and any areas that require special attention to ensure implementation. 1.5 Across our Children and Families services, various Christmas toy appeals were organised to support our most vulnerable families during what can be one of the most stressful, difficult and expensive times of year for our families, especially given the levels of child poverty in North Ayrshire, which sits at 29%. Our Health Visiting Services alongside our Children and Families Social Work teams worked hard to fundraise and collect donations of toys and clothes that could be gifted within our local communities. Staff were humbled by the generosity of those who contributed but also moved by the appreciation shown from those receiving support. 294
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53 1.6 February saw the launch of a brand-new mobile app called ‘CE4U’ (Care Experience for You), the mobile app for iPhone and Android has been designed specifically for care experienced young people. Launched as part of National Care Day, an annual awareness day to celebrate care and compassion of children and young people with care experience, the app has been developed with the help of pupils from local secondary schools over the past 18 months. Free to download, its aim is to provide a hub of useful information and helpful advice on everyday topics including housing, travel, mental and physical health, recipes, job opportunities and entitlements. Developed by young people for young people, the collaboration was made possible due to fortnightly Champions Board meetings that take place in our secondary schools. These drop- ins provide a safe space for care experienced pupils to get advice, plan peer events and access scaffolding and support to help them succeed. The launch is part of the Council’s wider Corporate Parenting Strategy to meet its statutory duties to keep The Promise to Scotland’s care experienced community – in this case those living and studying in North Ayrshire. 1.7 The Tea & Tots programme - run by the Breastfeeding Network (BfN) - has secured additional funding from The National Lottery, allowing BfN Ayrshire and Arran to continue offering these free peer support groups across North Ayrshire for all parents/carers with a baby or child under nursery age (open to all feeding types). Tea & Tots infant feeding groups provide a space for emotional and mental wellbeing support, as well as providing information on feeding, starting solid foods, income maximisation and much more - including regular Bookbug sessions, sensory activities, and guests from local organisations like Child Smile and Messy Munchers. The groups are free to attend and offer refreshments, toys, and books for little ones. Siblings and older children are also welcome to join in. 295
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54 Justice Outcomes Outcome 1: Community Safety and Public Protection. Outcome 2: The Reduction of re-offending. Outcome 3: Social inclusion to support desistance from offending. 2.1 The Multi Agency Public Protection Arrangements (MAPPA) are a set of statutory arrangements that allow for the assessment and management of the risk posed by people convicted of certain sexual and violent offences. In Scotland, arrangements were established by Sections 10 and 11 of the Management of offender’s et cetera Scotland act 2005 and became operational in 2007. MAPPA brings together the Police, Local Authority Social Work Justice Services, the NHS and Prison Service. In addition, some other agencies are under a duty to co-operate with the Responsible Authority in respect to the arrangements. These include, local authority housing, the Reporter to the children’s panel, certain registered social landlords and electronic monitoring providers. The creation of an effective Risk Management Plan is the key factor in the MAPPA process. To support staff in this critical task, on 19th and 20th of June 2024, subject matter experts from the Risk Management Authority Scotland , provided training on the best ways to approach this task. The training was attended by over fifty members of staff from both the Police and Justice Services. As a result of the training there has been an immediate improvement in the quality of the important foundation documents produced by Justice social workers with positive feedback received “Your Risk Management Plan was first class, comprehensively detailing the risk factors and the plans in place to mitigate risk and throughout the MAPPA meeting, your role in working with Mr A and the therapeutic relationship you have with him was highlighted by every other service”. 2.2 Case Study: Employability Mentors Employment can contribute significantly towards desistance and the development of a pro- social lifestyle for service users involved in the Justice system. People released from prison without a job are twice as likely to re-offend as those released with employment opportunities lined up. People with convictions may also face stigma and inequality associated with declaring a criminal record, or an unwillingness by some employers to provide those with criminal convictions with job opportunities. The Employability Mentors located within our Unpaid Work team assist service users involved with the Justice system to obtain skills that will enable them to gain employment and training opportunities to support reintegration into the community. The impact of the work of our Employability Mentors is reflected in J’s story. J's Story 296
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55 This is the story of J, who overcame significant personal and professional challenges to rebuild his life. J's journey from a tumultuous background to a promising future is a testament to resilience, support, and determination. Following a court order that mandated 18 months of social work supervision and 180 hours of unpaid work, his life took a difficult turn. This period marked the beginning of numerous challenges, including poor physical and mental health, which necessitated additional support from various departments, including addiction services. Employment History J had a career in His Majesty's Armed Forces but was discharged due to physical and mental health issues. During this time, he picked up charges before transitioning to roles in security and as a bus driver. However, J’s health issues impacted on his ability to sustain employment. J was referred by his Community Payback Officer (CPO) to the Employability Mentor service to help him reassess and explore his employability options. The Employability Mentor Service is a dedicated one-to-one service for individuals who are involved with Justice Service to identify further education, training, volunteering and employment. By tackling the additional barriers service users face, by being involved with the Justice Service, the employability mentors are able to realistically provide support to reach long lasting positive destinations. The CPO Employability Mentor Service offers people information, advice and guidance on disclosure related issues. This includes helping people understand their rights when disclosing an offence, how restrictions can affect their job hunting or how to reskill into a new career. The Challenge Due to his offence, J was forced to reskill and seek new employment opportunities. His physical and mental health further complicated his ability to find and maintain stable employment. Despite these setbacks, J was determined to improve his situation and with the support of the Employability Mentor sought a new career path, enrolling in courses through the Open University and other training programs. Financial Assistance Addressing financial barriers was crucial. Assistance with fuel costs, support from Money Matters and access to food banks provided J with stability and a foundation to start anew. Health and Wellbeing Continuous support from health services helped improve J's physical and mental health, enabling him to focus on his future. Achievements and Progress While pursuing his studies and with ongoing intervention from the Employability Mentor J actively searched for employment and secured a part-time job as a bus driver. This role not only provided financial stability but also boosted his confidence and well-being. With his health improving and life stabilizing, J is now on a more promising path. As his situation improves, J is more motivated and has started studying IT. Conclusion 297
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56 J's story is a powerful example of how targeted support and personal determination can overcome even the most daunting challenges. J’s s progress in both his job and health highlights the importance of comprehensive joined up support systems in facilitating successful rehabilitation and career transitions. It also evidence that access to employment with a criminal history is still possible. 2.3 The Drug Treatment and Testing Order (DTTO) Team have been working in partnership with Minds of Recovery to deliver a bespoke four-week bite-sized recovery group to service users on a DTTO community sentence. A DTTO is a sentence imposed by the Courts. It focuses on drug treatment as the primary means of reducing offending behaviour. Orders last between six months and three years and combine drug treatment and a testing regime with regular court reviews, in addition to supervision. Mentoring Individuals for New Destinations and Support (MINDS) recovery group explores the CHIME (Connectedness, Hope and optimism about future, Identity, Meaning in life and Empowerment dimensions) model of recovery, recovery capitals and the language of recovery. It also looks at the six stages of change and coping mechanisms to help change the narrative of addiction and recovery. Service users were mandated to attend once a week for two hours. The groups are set up as a conversation café, creating a safe space where service users can discuss issues relating to themselves. Roles are created within the group, from setting up the room, making tea and coffee, to helping individuals complete worksheet tasks and tidying up at the end of group sessions. In one of the groups, with the input from one of the DTTO Recovery Development Workers, one individual stepped up to volunteering, which involved connecting with the group by providing input and generating conversation on areas of focus. Feedback received thus far highlights the positive impact that the recovery group has had on participants. Improvements in mental health, anxiety levels and overall, wellbeing have been reported by participants who feel that the provision of this early support in their journey of recovery has been invaluable. Feedback from service users indicate the following: “I have learned that there are different ways to approach recovery, and being around people has improved my confidence.” “Being there and enjoying it made a difference to me.” “Meeting people has made me realise that I can get somewhere in life.” “It has helped me in overcoming anxiety.” “I’ve enjoyed being out of the house and learning new coping mechanisms with people with the same issues as me, and I’m thinking about attending more groups.” 298
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57 2.4 Case Study: Kilwinning Crazy Golf North Ayrshire Justice Services Unpaid Work Team are responsible for the delivery of unpaid work across North Ayrshire and operate from their office and workshop facility in Stevenston. The Unpaid Work Team were approached by Councillor Donald Reid, looking for assistance with repairing some of the crazy golf structures at McGavin Park in Kilwinning. The park consists of a large lawn area and mature trees. It is home to an enhanced play area, outdoor gym, tennis court and crazy golf. The park is also one of the few to have public toilets which open during school holidays (April to October) and by prior arrangement for group visits. The park is managed by North Ayrshire Council although Kilwinning Community Events Group installed and maintain the sports equipment and much of the play equipment in the park. Part of the group’s work is to develop the community asset for the wider community, and they rely on volunteers to help maintain bedding plants, litter picking, to open, close and clean the toilets, as well as with events at the park. Councillor Reid, Chair of Kilwinning Community Events said, “the group struggled for years to get the skill base to renovate the crazy golf and it is part of the park’s history so it was important the original aspects of the crazy golf were maintained with a Rotary and round table links to the original project”. The Unpaid Work Team, led by Supervisor Allan Auld put together a plan to undertake the necessary work, identifying what material would be required, associated costs and timescales. Allan worked with his team to create new structures for those that could not be repaired. Kilwinning Community Events Group were able to provide the materials that allowed the Unpaid Work Teams to begin work on mending some of the existing structures and clearing the area for new structures. There were multiple setbacks due to the weather conditions, which meant concrete could not be mixed and set. During the planning stages Unpaid Work Teams learned how to think creatively with a vision. Following this, teams learned how to lay kerb stones, mix concrete, then to pour and level it off, as well as how to add extra fittings such as pipes, holes, or to create curves and hills. Several of the structures also had artificial grass, so the teams learned how to measure, cut and then secure this to the structure. Tracy Nimmo, Unpaid Work Team Manager said “The benefits projects like these bring to the local community is paramount to reparation and reintegration of our service users completing the works. Service users get a sense of pride completing visible projects in our communities, especially ones that make a difference to the children and families that benefit from them. This crazy golf site has been in disrepair for many a year; to see it restored for families to use in the summer months is at the heart of what we like to see from the Justice Services Unpaid Work Team. A service everyone benefits from equally.” Cllr Reid said “The community feedback has been extremely positive following the works over the last three years to enhance the parks facilities. The crazy golf restoration is now complete, and we are grateful to Justice Services for the support to re-establish this feature in the park for the benefit of visitors. This was one of those projects that simply would not have happened if it were not for the support of the service. The group was keen to see the works as planned complete for the 140th anniversary of the park’s gifting to the community”. 299
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58 2.5 The latest Government statistics on Community Payback Orders (CPOs) (2023 to 2024) show that North Ayrshire had the highest of the Ayrshires with 479 CPOs however was the lowest of the Ayrshires at 52.5 per 10,000 population. In comparison, East Ayrshire had 473 CPOs and sits at 56.7 per 10,000 population and South Ayrshire had 401 CPOs and sits at 53.7 per 10,000 population. The Scottish average is 39.1 per 10,000 population. There has been a reduction in the number of Criminal Justice Social Work Reports (CJSW) since 2020 to 2021 largely thought to be due to the result of COVID-19. 2024 to 2025 sees the highest number of report submissions since this downward turn, albeit not yet at pre-covid numbers. The latest Government statistics on CJSWs for 2023 to 2024 reveal North Ayrshire to have submitted the highest number of reports of the Ayrshires however continue to be the lowest of the Ayrshires at 73.2 per 10,000 population. In comparison, East Ayrshire sits at 79.4 and South Ayrshire sits at 78.8. The Scottish average is 72.1 per 10,000 population. Our Justice Services continue to have a positive impact on the local community through the Community Payback Order (CPO) unpaid work scheme. For over a decade, the twelfth year in fact we have continuously over-achieved against targets for CPO level 1 and level 2. 2024 to 2025 saw 78 out of 79 level 1 CPO’s completing within timescales and 108 out of 112 level 2 CPO’s completing within timescales. The targets set for unpaid work are pan-Ayrshire targets. 300
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59 2.6 There was a marked increase in in Drug Treatment and Testing Order (DTTO) Assessment and Impositions in 2023 to 2024. There has been a slight decrease in 2024 to 2025; however, the volume of assessments and new Orders this year remains high. The last two years figures appear to represent a return to ‘the norm’ following a ‘dip’ attributed to covid. Of the 63 assessments completed in 2024 to 2025, 45 new DTTO’s were imposed across Ayrshire. This incorporates Orders from both Kilmarnock and Ayr Sheriff Courts. DTTO is an intense Order which involves monthly Court reviews, twice weekly contact for the first month and weekly oral drug screens. There are three distinct roles within the team delivering the service and interventions. The Supervising Officer oversees the Order, monitors compliance and compiles the assessment and review reports. The Additions Worker delivers the therapeutic interventions and is primarily responsible for administering the oral drug screens. There are then Recovery Development Workers who provide practical supports, assistance with welfare needs and also build links and connections within the recovery community to help build the persons own recovery capital. A Recovery Care Plan is created with each individual. There are ten domains, including substance use, relationships and offending, which are scored from 1 to 10. These plans are updated at three monthly intervals and allows areas for support/intervention to be identified and progress to be monitored. 301
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60 2.7 Diversion from Prosecution (Diversion) has been available since 1997, within this past year we have experienced a further increase across Ayrshire in assessment referrals from the Procurator Fiscal. Referrals have increased at a significant rate from 2018. Although this disposal is early intervention and low-level offending, the presenting need of service users is extremely high, thus resulting in more staff time being allocated and closer partnership working with other agencies to provide identified services. The number of assessment reports submitted are relatively lower than the number requested due to limited resources, which has resulted in waiting lists within each local authority area. In comparison with last year, 2024 to 2025 notes a decrease in the number of Diversion cases imposed. This is due to delays from the time that the offence was committed until the individual is referred to and assessed by the Diversion team. In this time many positive changes could have taken place and individuals are actively seeking and engaging with services to address any issues which they may have, thus reducing their risk of further offending. In these instances, no interventions are required due to positive reasons. 302
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61 2.8 The Justice Drug Treatment and Testing Order Team worked in partnership with ‘Minds of Recovery’ to deliver a four-week wellbeing programme in North Ayrshire. This intervention focussed upon Models of Recovery, Stages of change and coping strategies. The evaluation highlighted those who participated felt less anxious following the intervention with improvements to mental health due to being able to speak freely about their situation and four of five stated that they would continue to attend Recovery groups throughout North Ayrshire. Participants described recovery as: Being happier, having improved confidence, managing a balanced life and enjoying improved relationships. Participant Testimonials: • "I’ve enjoyed being out of the house and learning new coping mechanisms with people with the same issues as me, and I’m thinking about attending more groups." • "Learned how to manage negative thoughts and situations." • "Gained interaction, knowledge, and confidence in speaking more." After attending Mentoring Individuals for New Destinations & Support [MINDS] participants gained insight into different Recovery Strategies, coping mechanisms, and self-development. Three participants have now engaged with groups/support networks out with the class with a further two contemplating attending other support systems. These insights and testimonials highlight the positive impact of the MINDS Recovery Group, demonstrating significant improvements in mental health, anxiety levels, and overall well-being of the participants. 2.9 MAPPA Level 2 and 3 Chairs came together for a well-received MAPPA training session. The day was packed with valuable takeaways, including a masterclass on how to effectively chair a MAPPA meeting, led by Professor Hazel Kemshall, a world-renowned expert on the subject. The morning session offered a deep dive into the intricacies of chairing these important meetings, with Professor Kemshall sharing her wealth of knowledge and practical tips. The session gave attendees a fresh perspective on best practices and provided an opportunity for everyone to learn from one of the leading experts in the field. In the afternoon, the focus shifted to risk management, with a presentation by Lauren McClintock and Eddie Kotrys from the Risk Management Authority. This covered essential points on what to look for in a solid risk management plan, arming attendees with crucial insights to enhance their work. 303
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62 The feedback has been overwhelmingly positive, with attendees expressing how valuable the sessions were and highlighting the depth of knowledge shared and the opportunity to network with peers. 304
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63 Reporting on localities North Ayrshire is home to approximately 133,570 people, all living in its many towns, villages, and islands. These places are home to many different communities, each with their own characteristics and needs. We recognise that a one – size all approach to services delivery is not appropriate. A blanket service may be of great benefit to one community and of little value to another. That is why we are now designing local services based on local need, identifying the health and social care priorities in communities and developing services that help people access the right services at the right time. 305
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64 Locality Planning Locality Planning is the local mechanism for strategic planning in which local priorities are developed for smaller geographical areas across the local authority. In 2023 it was decided that the framework for carrying out Locality Planning would be revised in order to involve new methods for community engagement and ensuring continued leadership through new Locality Chairs. The HSCP is now halfway through its 2-year process to carry out extensive research in order to develop locality plans with localised priorities and actions for each area. The research process involves: • Engagement: Twice per year, Locality Conversations will be held within each locality in order to collect information from different people within the communities, and feedback what we are doing with the information • Local data: Overall locality data to identify the initial priorities and more in-depth data on specific issues for each area • Local services: Mapping the existing services across each locality • Community Planning: consideration of the existing locality priorities the wider community planning partnership is working towards Progress 2024 to 2025 The first set of locality conversations took place between the 15th and 22nd of April 2024 and were in the form of 2-hour workshops with local staff and members of the public invited to intend. This allowed us to explain a bit about the new process and collect initial community perceptions and challenges. There were five workshops held with 32 participants. In September 2024, local community groups that focussed on people with shared characteristics were contacted and visited by an Engagement Officer to discuss if there were any specific barriers experienced to accessing health and social care services as a result of their shared or protected characteristics. The aim of this was to ensure that the experiences of different equalities groups were captured in the process, and they were visited at their own spaces to ensure attendance, and over the month of September, twenty-three groups were visited with 206 participants. Localities – Initial Insight Garnock Valley Garnock Valley seems to sit around the middle of the localities in terms of performance indicators but is generally still poorer performing when compared to the Scottish figures. In terms of indicators of poverty its levels of deprivation, employment and house prices all indicate the area does not perform as poorly as Three Towns, Kilwinning and Irvine, making it often on the lower side in terms of ranking, but in terms of figures it still shows some higher levels of deprivation. For example, 40.3% of the population lives within the 20% most deprived areas, but this is still lower than the average for the area due to the much higher levels in Three Towns, Kilwinning and Irvine. Child poverty is also higher in North Ayrshire estimated at 29%, and in the Kilbirnie and Beith Ward it is 29.5% All areas within North Ayrshire have a higher over 65 population than Scotland, with Garnock Valley at 21.6% compared to Scotland’s 19.6% and North Ayrshire’s 23.3%, and general health indicators are also around the middle of the other localities, though Garnock Valley does have highest deaths 306
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65 per 100,000 for those aged 15-44. Indicators for Garnock Valley are generally consistent across the majority of outcomes that they perform better than North Ayrshire but worse than Scotland. This is why it is important to recognise that although there are other localities with higher poverty and deprivation, a higher older population, more complex health needs et cetera it still experiences higher issues when compared to other parts of Scotland. So far, 23 people from the Garnock Valley have participated in engagement between the general and targeted equality engagement. Initial issues discussed in the Locality Planning Review groups and engagement have included: • Poor transport links across the area and the impact of accessing appointments and work • Access to GPs and possibility of targeted clinics for key issues in community spaces • Finding information about health and care services • Long waiting lists • Older population and digital accessibility Irvine Irvine is the largest locality in North Ayrshire by population, and one of the more accessible in terms of local services and amenities. According to data it has much higher levels of deprivation compared to nationally but is not as high as some of the other areas in North Ayrshire, for example 45.7% of the population lives within an area that is within the 20% most deprived in Scotland, which is only third highest locally. For many indicators Irvine performs the poorest other than Three Towns, such as for drug related hospital admissions, alcohol specific deaths, psychiatric patient admissions. General health is towards the higher end of the localities but is generally not the worst, though is usually higher than the Scottish rates, however, has the lowest female life expectancy at 78.5. Unemployment is not as high as other areas, the third lowest in the area behind Arran and North Coast and is about average for Scotland, and Health and Social Work is the second highest employment sector behind wholesale and retail, and the GVA per capita is higher than average for the area, possibly due to Irvine being the most populous town in the area. So far, 98 people from Irvine have participated in engagement between the general and targeted equality engagement. Initial issues discussed in the Locality Planning Review groups and engagement have included: • Low-level social interventions and community support groups in promoting mental and physical wellbeing • Affordable leisure options and increased funding and support for community-run initiatives • Increased patient voice in care planning • Difficulty in accessing reliable information about health and social care services. • Outdated or incorrect online information makes it hard to navigate resources 307
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66 Kilwinning Kilwinning performs poorly for economic indicators, with the second highest rate of unemployment and the second highest proportions of people living within the 20% most deprived area in Scotland, behind Three Towns for both. Child poverty in the Kilwinning ward is slightly higher than the North Ayrshire rate, which is higher overall that Scotland, but it increased by 8.3 percentage points between 2021 and 2022. For general health, life expectancy is lower than the Scottish figures and North Ayrshire averages but are again not as low as Three Towns for male and female, and Irvine for female. The 65 plus population is the lowest in Kilwinning of all the localities and it has the lowest rate of delayed discharges of those 65 plus of the localities and the Scottish and North Ayrshire rates, and the lowest unscheduled acute specialty beds. For indicators related to substance use, Kilwinning is around the middle of the localities, but still higher than the Scottish rates, so when comparing the localities to each other it appears as though it’s not as big an issue, but this is due to the elevated rates across North Ayrshire. The averages are also affected by far lower than average numbers for Arran and North Coast and far higher numbers in Three Towns and Irvine. Similarly for prescribed anxiety medication, the rate is the third highest of the localities but Three Towns, Irvine, Garnock Valley and Kilwinning are all above the Scottish proportion. So far, 37 people from Kilwinning have participated in engagement between the general and targeted equality engagement. Initial issues discussed in the Locality Planning Review groups and engagement have included: • Centralised community hubs and improved transport links to enhance service accessibility • Increased investment in self-care resources, clearer pathways, shorter waiting times, and trauma-informed crisis support • Difficulty accessing information about services and accessing appointments • Other barriers were discussed such as financial, language, and digital North Coast and Cumbrae The North Coast and Cumbrae (NC&C) locality is more affluent than other areas of North Ayrshire, with fewer areas of deprivation, lower unemployment, and a higher average house price than the other mainland localities. There is a much higher proportion of older people with 32.3% of the population aged 65 and over, which is 12.7 percentage points more than the Scottish figure of 19.6%. As a result, some of the health inequalities in NC&C are more likely a result of the population age than other areas, for example, the population with long-term conditions is highest in Irvine and NC&C, but for Irvine it is more likely related to the higher rates of deprivation. Despite the older population, overall health indicators are better than other areas, with a high life expectancy and lower rates of cancer registration, low rates of hospital admission and death related to substance use, and lower rates of anxiety medication and psychiatric admissions. These may also be related to the area’s affluence when compared to the other localities. 308
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67 The only health indicator in the initial profiles that is higher in NC&C is unscheduled acute specialty bed days per 100,000 population. Emergency admissions and A&E attendances aren’t particularly different for the area so this may also relate to the older population. So far, 21 people from North Coast have participated in engagement between the general and targeted equality engagement. Initial issues discussed in the Locality Planning Review groups and engagement have included: • Importance of low-level and community-based support, particularly more services around dementia and learning disability • Poor transport links and access to patient transport • HSCP money allocation, and how this is communicated or understood by the public • Care packages and decisions around them Three Towns The Three Towns locality has poorer outcomes in many indicators when compared to the other localities, as well as the national rate. The performance indicates that the Three Towns locality experiences higher rates of poverty and socio-economic disadvantage. The locality has the highest level of people living within the 20% most deprived areas of Scotland at 57%, and also has the highest rates of child poverty, and the highest unemployment rate of the localities, as well as lower house value and more lower council band properties than other areas. Areas with higher levels tend to have poorer health outcomes, which is evident in the general health indicators. Three Towns has the lowest life expectancy rates, as well as high rates of emergency admissions. The Three Towns locality has the highest figures out of all the localities and is much higher than the Scottish and North Ayrshire averages for indicators related to alcohol and drugs, and alongside Irvine has the highest rates for indicators related to mental health care. So far, 19 people from Three Towns have participated in engagement between the general and targeted equality engagement. Initial issues discussed in the Locality Planning Review groups and engagement have included: • Accessibility of primary healthcare services, particularly the challenges in booking appointments, long waiting times, and the difficulties faced by those with mobility issues • The impact of social deprivation on mental health was noted, alongside the necessity for targeted support across various stages of mental health issues, from prevention to post-crisis care • Difficulty accessing information about services or knowing where to go • Discussion of methods to reduce harm from drugs and alcohol, to improve safe drug use and reduce stigma 309
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68 Arran Arran has an established locality planning arrangement which has been in place for many years due to the specific and persistent challenges of the Island. These arrangements have a governance that sits under the Island Plan and the Health and Social Care Partnership will develop health and social care priorities for Arran under this existing governance structure and using engagement that has already been carried out with the islanders. This will occur using the same timescales as our mainland localities. The Key themes of the Arran Island Plan are: • Economy • Community • Environment A Health and Social Care Locality Plan for Arran will be consistent with these existing themes and aim to focus on how health and care needs will be met in Arran. Planned Activity Over 2025 to 2026, the HSCP will carry out engagement with children and young people, and further engagement with services users in September 2025. Collected data will be analysed to inform each locality’s priorities, and the data and engagement will be analysed to identify the key priorities. The Strategic Plan is currently under revision and once complete, Locality Plans will be developed and published for each locality and annual reporting for each will commence. 310
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69 Transformation Programme North Ayrshire HSCP’s Transformation Team support Partnership teams to identify, develop and deliver system wide change to local services and improve outcomes for the people of North Ayrshire 311
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70 Transformation 2024 to 2025 The North Ayrshire HSCP Transformation Plan 2024 to 2027 is an ambitious programme of change consisting of a range of improvement and reform projects across all service areas, each aiming to improve the quality of our services and contribute to the long-term sustainability of health and care in North Ayrshire. The Transformation Plan was approved by IJB in March 2024. Through 2024 to 2025 the financial outlook has deteriorated, and the need for transformation and the redesign of services has become more urgent and more important to the long-term sustainability of the functions for which we are responsible. At the same time our capacity for change is diminishing due to increasing demands on people’s capacity including the short-term actions required to deliver the financial recovery plan, however, progress has been made. There are 79 change projects and programmes on the plan, from across every area of the partnership. Included below are some highlights of key activity and general updates on progress made in 2024 to 2025. This includes £1.7 million overspend reduction. Key Activity In April the Transformation Board agreed governance and approach, including Terms of Reference, format of meetings, and project management methodology (including template documents). It was agreed that each meeting would have a ‘Focus On’ a specific area of the Transformation Plan, but with space on the agenda for raising Risks, Issues, Requests, or Successes from any area of the plan, particularly where a time-critical decision is required. May had a ‘Focus On Transformation’ and the board was updated on Workforce Planning and agreed to the development of a HSCP Digital and Data Plan. Also in May, two members of the transformation team were successful in achieving a fully funded place on Cohort 23 of NES' Digital Health and Care Leadership Programme (DLP). This programme supports Scotland's Digital Health and Care Strategy and Delivery Plan and aims to: maximise the potential of digital solutions to benefit people; and, to support participants to develop the strategic leadership skills required to influence the use of digital solutions in health and social care delivery. In June ‘Focus on Adult Health and Community Care’ had seven new projects being initiated in that area, and an additional project request approved. June also saw the first Ayrshire-wide Innovation Network Event with over 80 attendees and presenters from across Scotland sharing examples of innovation to support transformation of health and social care services across Ayrshire. During August ‘Focus on Mental Health and Learning Disabilities’ had eight new projects initiated. In September a new online Tracker was launched to provide ongoing real time monitoring of projects. The Tracker is linked to a dashboard to provide a visual representation. The second Ayrshire-wide Innovation Event took place on 10th September and had a range of examples of innovation and transformation, including an overview of a new companion robotic device from the 312
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71 National Robotarium, as part of an early intervention and prevention model of care. In October the Transformation Board was updated on the progress of the new Digital and Data Plan which consists of a Landscape Review and a Phase 1 Delivery Plan. The Landscape Review includes: an outward look across the sector, including national digital and data strategies; and inward look incorporating the staff digital experience survey, case studies, and local plans and strategies. The Delivery Plan, informed by the Landscape Review, aims to address immediate priorities and establish a solid foundation for longer term transformative improvements. Priorities for this plan include improving access and supporting the workforce to develop essential digital and data skills. An overview will be presented to the Strategic Planning Group in March. Also, in October the Senior Manager (Strategic Planning and Transformation) was successful in securing a funded place on MSc in Leading Digital Transformation in Health and Social Care in Scotland delivered by the Usher Institute at University of Edinburgh and aims to “enhance the ability of current and future leaders to drive, deliver and embed digital transformation across Scotland’s health and social care services”. In December the Transformation Board focused on some key partnership-wide programmes including an update on the Carers Strategy and an update on the Self-Directed Support Learning Review Implementation, as well as an overview of the initial findings from the Accessing Health and Care Service Review. Also in December, the Service Lead for the Tech First Programme in Health and Community Care was successful in achieving a fully funded place for the Professional Development Award Technology Enabled Care starting in January 2025. The qualification is designed to “empower individuals to evaluate and adopt technologies that support health and care delivery while reflecting on how these could be used to assist people to self-manage and live independently”. The third Ayrshire-wide Innovation Event took place on the 3rd of December and included: an overview of the new Digital Capability Framework and supporting resources from the Digitally Enabled Workforce Team at NHS Education Scotland; a demo of the Seer 2 platform which provides national technology and infrastructure capabilities for data management and analytics for health and social care across Scotland; and an overview of how NearMe is used in South Ayrshire. January had a ‘Focus on Adult Health and Community Care’ with a review of 2024 to 2025 and five new projects initiated, as well as the successful closure of the Blue Badges project. February was a ‘Focus on Children, Families, and Justice’, with a review of 2024 to 2025 and a deep dive into the progress of the Brighter Pathways programme. March saw our fourth Ayrshire-wide Innovation Event with colleagues from Public Health Scotland presenting their Innovation Strategy; the Service Design Academy provided an overview of their approach (which is the Scottish Government approach) to service design. We also had colleagues from South Ayrshire sharing their new Integrated Impact Assessment, as well as a useful recap from the Digital Health and Care Scotland 2025 conference in Edinburgh. The Health and Social Care Transformation conference 2025 was also in March, and North Ayrshire was well represented, learning about the progress of the national Digital Front Door programme as well as other policy and strategy updates, alongside a range world-class industry and health and social care speakers. AI was a key theme with a number of impactful examples from the health sector. 313
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72 March saw a ‘Focus on Mental Health and Learning Disabilities’ with a review of 2024 to 2025, one new project was initiated, and one new project added to the Plan. Updates by Service Children, Families and Justice Housing & Throughcare The biggest challenges facing both the Housing & Throughcare Teams is the growing number of Children & Young People being looked after & accommodated vs the lack of suitable accommodation/placements across our Residential Housing establishments, private residential care providers & our Housing Estate across North Ayrshire. Given the challenges, the workstream acknowledged that action was required to improve communication, in addition to this, integrated processes were required to ensure young people leaving care were both supported & allocated suitable and appropriate housing when they were ready to leave their care setting. The Services indicated that there had been situations where young people in residential care were approaching twenty-one years of age and there was no allocation of housing, or a transition plan, for these young people. Supported Accommodation Workstream members have indicated that they feel there is a need to create more space within our Residential Estate, there have been initial discussions around the proposal of a supported accommodation facility, one that would support young people over sixteen to move on to independent living with twenty-four-hour staffing support. This would be with a view of providing a stepping stone for young people moving on from care, and to equip and prepare them for independent living. The workstream members have expressed a desire to explore this in the future. Fostering & Kinship Workstream Our aspiration is that children who require alternative care are best placed in family-based care, and we require a number of new foster carers to meet the current demand for children of all ages. The biggest challenge facing the fostering sector today is the recruitment and retention of high-quality foster carers who can meet the needs of children in care. A lack of available foster carers, in the right place at the right time, means children are missing out on vital support. Children in need of care are at risk of being moved away from their communities, hobbies, siblings, and are having to change schools and leave behind what is important to them, which has a detrimental impact on their wellbeing, stability and development. The Fostering Service has lost fifty-nine interim carers over the last two years, this is due to resignations, de-registrations and change of role of carers. 314
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73 The service has a target to recruit six new carers per year; however, this has not been achieved in each of the last five years. Within the foster care workstream, recruitment of foster carers was identified as a priority area that required immediate focus. New Fostering Scheme To assist with the recruitment of foster carers, a new scheme has been developed, however, the Scottish Government have indicated that they are reviewing this, it will be discussed at future workstream’s as to whether or not North Ayrshire will pursue a new scheme or await further instruction from the Scottish Government. CAN Digital The programme board and PSMT have approved the funding for the Council Advertising Network to support foster care recruitment. This development will also provide a separate webpage for the fostering service that will improve user experience and journey, alongside targeted digital recruitment strategies that have proven to be successful, with increased recruitment activity and conversions to approved quality foster carers. The Council Advertising Network have developed a fostering webpage for the service and the search engine optimization was started on 11th November 2024. Best Practice Models & Research The focus of this workstream was on residential care and family-based care, data presented indicated that there was a high number of children in internal residential care and external residential care, who had previously been in kinship care and internal foster care provision. Furthermore, there was also a number of children in external residential care who were previously cared for within internal children’s houses. The workstreams focus was on how best we can support foster carers, kinship carers and internal residential houses to better support children and young people with complex needs and behaviours, with an objective to sustain their placement and provide better outcomes and prevent escalation to external high-cost resource. To date the following areas have been progressed: Psychological consultation and clinical support to one of the residential houses as a pilot to support staff to manage specific children’s behaviours. This will be evaluated and considered for other houses and children in foster care. 315
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74 Health and Community Care Care at Home Recruitment: Family Participation Our care at home team remains dedicated to involving service users and their families in recruitment events. Family members can drop into these events, meet the team, and discuss the care provided to their loved ones. During these sessions, the team has received appreciation from families for their compassionate care and efforts to address any concerns. This feedback highlights the team's commitment to delivering high-quality, empathetic care as well as to ensuring that families feel empowered to discuss their concerns openly and fully. New Managers Training A 5-week course was recently offered to Care at Home Managers, covering areas such as HR policies and procedures, budgets, trauma, child protection, adult support and protection, complaint handling, leadership, supervision, transitions, business administration, and evaluation. Attendees rated their knowledge increase from 50% to 86%, and all those who attended noted they would recommend the course to others. This training is crucial for developing and supporting our workforce. Lady Margaret Hospital An executive leadership visit to Lady Margaret Hospital on the Isle of Cumbrae took place on 15th May 2024. It is recognised that working on an island comes with its challenges; however, the visit was extremely positive. Feedback from the visiting team recognised the dedicated and collaborative island-based team who work to ensure that the community is at the heart of everything they do. The Leadership team commended the service for their commitment to continuous improvement by recognising and tackling challenges head-on. Staff found the visit supportive and were pleased with the recognition of the work they do on the island to support the whole community. Care at Home Our commitment to supporting our staff with the necessary skills and resources is central to our service delivery. Recently, our ‘Frontline Event’ for Care at Home Assistants focused on skill enhancement, employee development, networking, and wellbeing. Staff participated in workshops, feedback sessions, and peer interactions. Invited speakers covered essential topics such as tissue viability and stoma care. The event was described as powerful, grateful, and inspiring by attendees. Arran Services: Recruitment Our Arran team has proactively addressed recruitment challenges by working with a recruitment agency, resulting in a significant increase in applications and new appointments. From January to August 2024, we focused on roles such as Advanced Nurse Practitioner, Advanced Pharmacist Practitioner, Social Care Worker, Care at Home Assistants, and more. The recruitment ads received approximately 8,500 clicks, 6,000 revisits, and 636,800 views. Blue Badge Service Review The Blue Badge project successfully established an efficient, technology-driven delivery service model that complies with national standards and enhances the end-user experience. By moving to a fully electronic online application process, the team now processes applications within one working day, with no backlog or waiting list. Payments are handled electronically, and a limited call-back service is available for those unable to access online forms. The team's commitment and innovative 316
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75 approach have led to timely Blue Badge issuance, reduced FOI and councillor enquiries, and improved staff motivation. The refreshed approach aligns with strategic priorities, providing earlier support for those with mobility issues. Performance monitoring ensures any issues are promptly addressed. Transformative Care Pilot (Multiple Sclerosis) NHS Ayrshire & Arran, in partnership with Coloplast Ltd, launched a successful pilot service to improve the lives of people with multiple sclerosis (MS). This innovative service focuses on managing neurogenic bladder and bowel dysfunction, a common issue for people living with MS. Key achievements include the introduction of a dedicated bladder and bowel clinical nurse specialist, early detection through patient questionnaires, and significant reductions in urine retention and urinary tract infections. Patients have experienced improved health outcomes, enabling them to engage more fully in work and social activities. This pilot sets a new standard for MS care, demonstrating the benefits of early intervention and integrated care pathways. Ward 2 Palliative Care Pilot Ward 2 launched an innovative pilot programme to receive direct referrals from North Ayrshire GPs, in collaboration with District Nursing, for patients requiring palliative and complex care. This initiative aims to reduce the need for acute admissions, providing a more seamless and compassionate care pathway for patients. The ward has successfully integrated community referrals and is working to strengthen links with GP practices and District Nurses. Collaboration with Ayrshire Hospice is ongoing to develop comprehensive education and training programmes for staff, focusing on key aspects of palliative care, particularly pain management. Home from Hospital Support (Red Cross) The Home from Hospital Support service, provided by the Red Cross, has achieved significant milestones in offering essential support to individuals during hospital stays and their transition back home. Key achievements include regular check-in calls to ensure safety and well-being, assistance with shopping and financial tasks, and providing companionship. This service has been instrumental in reducing feelings of isolation and ensuring continuous support until no longer needed. The dedication and kindness of the Red Cross staff and volunteers have been widely appreciated, highlighting the positive impact of their efforts on the community. Anam Cara Respite Centre The team at Anam Cara continue to offer outstanding care and support to those in their care. Recently, a social and outgoing service-user, whose primary priority was her family, was resident in the centre. The feedback from her family underlines the difference this service can make to local people and their loved ones. The family were delighted that their loved one had remained settled during the respite period, enabling them to benefit from a break from their caring role (a role which can be emotionally demanding), and giving them the peace of mind to confidently book another period of respite. The family gifted the centre a piece of artwork noting their thanks. Emergency Ambulance Service Our Emergency Ambulance service was also praised by an elderly service user for the prompt attention given when they intervened to support them after they had overdone their daily exercise 317
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76 regime. The team were recognised for their “cheerful competence” which was found to be “truly impressive.”, with the service user concluding “how fortunate we are to have people like this.” Dementia Support The Dementia Support service has made significant strides in providing essential social stimulation and support to individuals experiencing cognitive impairment. Through patient and reassuring communication, the team take time to explain the benefits of the service and ensure service-users feel in control of their care. They develop bespoke support plans and focus on engaging service- users in meaningful conversations about their emotions and memories. This approach helps build trust and leads to active and joyful participation in support services. The success of this initiative highlights the importance of personalized care and the positive impact of early and effective support on mental and emotional well-being. Money Matters The Money Matters team is engaged in a two-year initiative to implement Welfare Rights services within eleven GP practices throughout North Ayrshire. Since the project's inception, three Income Advisers have secured nearly £4 million in benefits for local patients and residents. A notable achievement involved assisting an individual with unrecognized learning challenges who faced escalating mental health issues due to the demands of Universal Credit. The team provided comprehensive support, including overturning a Universal Credit penalty, filing for Adult Disability Payment, navigating the 'unfit for work' designation process, and facilitating a successful bus pass application. As a result, the individual now benefits from an extra £158 weekly and has received back payments exceeding £6,000. This initiative highlights the team's dedication to tackling inequalities and improving the financial well-being of the community. 318
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77 Mental Health and Learning Disabilities Woodland View Models of Care Work on these projects was started within Inpatient teams and the wider partnership. After further thought and review, a wider programme board has recently been established to bring these projects along with transformation work at Ayrshire Central Hospital Community Wards under one Ayrshire Central Hospital Transformation Programme Board. The Project Initiation Document (PID) for this work has been drafted and presented for sign off from the Transformation Board at the meeting on 18 March 2025. It is anticipated that this new structure will generate an integrated approach across all wards and develop the best possible outcomes and savings for the entire site. MAT Standards Medication Assisted Treatment (MAT) Standards continue to be monitored closely by the national MAT Implementation Support Team (MIST). A new RAG rating is expected for North Ayrshire on the Implementation of all MAT Standards. Work continues on how this is implemented in the Justice setting as well as expansion of the programme to stimulants and benzodiazepines. The model of MAT 7 delivery in Primary Care continues to be refined with learnings from the roll out however annual delivery costs of £110,580 remain unfunded as of March 2026. An evaluation of this delivery model will be completed and presented to relevant groups including the Transformation Board by the end of 2025. Child & Adolescent Mental Health (CAMHS) & Community Eating Disorders Service (CEDS) CAMHS in A&A are continuing to engage in and influence West of Scotland CAMHS pathways and service developments such as FCAMHS. West Road in Irvine will be the new Specialist CAMHS Assessment & Treatment Centre for Ayrshire as well as the operational base for the Community Eating Disorders Services by April 2025. Some administration staff are already based at the building and the rest of the staff will be moving in once the staff attack alarms are completed and a few other issues are resolved. Open seven days per week, specialist CAMHS Neuro, ADHD, play Therapy and other Clinical Interventions will be delivered from this re-fitted facility. Hosting flexible working space for staff with five clinic rooms and two large meeting rooms, it is envisaged that the facility will become a centre of excellence in the care and treatment of child and adolescent mental ill-health and eating disorders. A review of the Community Eating Disorder Service is due to be delivered in 2025 to 2026. This project is currently paused until the end of March in order to revisit the PID and agree a way forward. The budget for this service is within the core CAMHS budget and is currently being assessed for reductions to bring spending into alignment. The delay is not anticipated to impact the completion of the project. Digital Transformation The Mental Health Digital Transformation Group is monitoring the implementation of digital transformation projects across Mental Health on a pan-Ayrshire basis. A commissioned review of Mental Health services in alignment with the national strategy has been completed and presented to the group. The implementation of TrakCare Patient Management System continues. This implementation is scheduled for completion by March 2026. Some benefits of this project around the shutdown of 319
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78 access databases are lagging as the development of reports is currently lagging behind the service implementation. Meetings have been taking place to progress this and close the gap however the impact of not closing databases down could impact on the ability for Admin teams from all partnerships being able to free up resources for the Referral Management Service, which is required to get the last large service, Learning Disabilities on to TrakCare. The use of the Strata Health system is being assessed for use in Mental Health. Possibilities exist with Wellbeing services and Community Mental Health Teams. The contract for this system has one more year before prior to optional roll over and a decision will need to be made whether it should continue by May 2025. Alignment to Scottish Government Specifications The introduction of new specifications and strategies since 2023 has given Mental Health services a clearer set of guidelines to work to. Some of the alignment to these standards is being looked at within other transformation projects detailed above, including the Adult Community Mental Health Service and Community Eating Disorders Service. Alignment to the Psychological Therapies Specification is being governed by the Psychological Therapies and Interventions Clinical Governance Group (PT&ICGG) and a workstream has been established to look at scoping and benchmarking all teams that provide psychological therapies across Ayrshire & Arran utilising the newly released self-assessment tool from the Scottish Government. Community Mental Health & Wellbeing Within Adult Community Mental Health and Wellbeing there are a couple ongoing pieces of work. The Adult Community Wellbeing project has developed a conceptual model for the future of wellbeing services in North Ayrshire. Against this future concept, current commissioned and in house services were looked at and prioritised in order to develop a path to delivering Wellbeing services for £100,000 less on an annual basis starting in 2025 to 2026. The project team made the recommendation to PSMT in February to reduce KA Leisure Services by eliminating a separate stream (Mind and Be Active) for people with Mental Health or Wellbeing concerns. This reduction will deliver approximately £90,000 savings in 2025 to 2026 and £121,000 annually from 2026 to 2027. In addition, the project team will be seeking match funding for HARP services with KA Leisure from Acute Services and re- tendering for a combined Wellbeing and Recovery College, Peer Support and exercise provision with the anticipation that this combined scope can provide these services at a reduced cost. A review of the Adult Community Mental Health Service was paused for a short period while work was progressed with the Wellbeing services. This work is now looking to get picked back up following financial discussions which may impact the scope of the service or services directly impacting this one. Engagement with staff and service users has been completed, research around prevalence of mental health conditions and some data analysis has been completed. The project aspired to create a data dashboard for the service on the back of this data analysis which could provide a baseline for any change recommendations coming out of the project and evidence performance against the Core Standards for Secondary Services from the Scottish Government. This has been delayed and a new project request to give this project more visibility has been created. Work has commenced on the creation of a new Early Intervention in Psychosis service. A team leader has started and working with HIS leads to test their implementation guide. The second team member is due to start March 2025 with the service on track to launch June 2025. 320
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79 Reporting on lead partnership responsibility North Ayrshire Health and Social Care Partnership has lead responsibility for: Mental health services (including psychology, CAMHS, learning disability assessment and treatment) Child health services (including child immunisation and infant feeding) East Ayrshire Health and Social Care Partnership has lead responsibility for primary care and urgent care services. Primary care refers to the four independent contractors who provide the first point of contact for the Ayrshire and Arran population. These contractors are General Practitioners (GPs), Community Pharmacists, Optometrists, and General Dental Practitioners. South Ayrshire Health and Social Care Partnership is the lead partnership for the Integrated Continence Service, Community Equipment Store, and the Family Nurse Partnership (FNP). This lead responsibility relates to the delivery of continence care and education across Ayrshire, provision of equipment to people living in the community and supporting first-time mothers aged 19 and under through an intensive preventative home visiting programme delivered by FNP. 321
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80 Mental Health Services 1.1 Trindlemoss Day Opportunities in Irvine has been praised in a report by the Care Inspectorate after an unannounced inspection visit in October, with the majority of areas looked into being rated as ‘very good’ by the national regulatory body. The service, which opened in 2020, provides tailored support for over 100 people with learning disabilities from its base in Tarryholme Drive in Irvine. The inspector identified a number of significant strengths within the service, with customers found to be ‘supported in stable groups by consistent staff who know them well’. The ‘warm, respectful and kind interactions between staff and people supported’ were also highlighted in the report. Support was found to be tailored to each individual’s identified outcomes, with the service maintaining a flexible approach that allows customers to access a range of groups and activities of their choice. Regular project topics also provide multiple opportunities for themed activities and trips to associated places. Health promotion and education is integrated into activities, empowering people to take control of their health and wellbeing, with the service also making use of local facilities such as the swimming pool and gym. These trips also provide a chance to enhance travel and life skills. Trindlemoss Day Opportunities was also praised for its strong links to the local community, providing support for lunch clubs, play groups and dementia support groups, as well as assisting with gardening and litter picking. Additionally, the Baristamoss Café is open to the local community several days a week, providing employment training and boosting the development of social skills for those supported. In terms of staffing, employees were described as enthusiastic and knowledgeable, putting customers at the centre of all they do. Staff reported that they were able to spend quality time with individuals and get to know them well, and support was found to be provided in a timely manner. Good relationships were noted between staff and management, with appropriate checks and audits in place for the service type. The Trindlemoss facility was commended for being clean and well maintained, offering a generous amount of space split into zones allowing multiple activities to take place at the same time. The gardens were described as ‘well maintained’ and used for a number of activities - including growing vegetables - and areas such as the training kitchen and laundry area provide important socialisation and life skill development opportunities. 1.2 The festive season at Trindlemoss was filled with joy and community spirit, thanks to the dedicated efforts of our Care at Home team. On Christmas Eve, service users enjoyed a cosy 322
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81 Christmas-movie afternoon complete with hot chocolate and sweet treats. Christmas Day was a heartwarming experience as our team spent the morning with service users, helping them open presents and providing assistance in their homes. A special Christmas lunch was organised in the Club Room at Trindlemoss Day Opportunities, creating lasting memories for everyone involved. The festive spirit continued on Boxing Day with a two-course meal delivered to each service user's home, and on New Year's Day, our teams prepared and delivered a special steak pie dinner. These efforts ensured that that people felt valued and included throughout the holiday season. 1.3 Collaboration with the Scottish Commission for People with Learning Disabilities around a digital inclusion project now also involves Scottish Care as a key delivery partner, building on their existing implementation of Care Technologist roles in East Ayrshire and elsewhere. The work will involve understanding and connecting existing digital inclusion activity in North Ayrshire and how this benefits people with learning disabilities, with a view to developing frameworks and resources which can be easily sustained locally and replicated elsewhere. While this work is focused around the digital exclusion of people with learning disabilities, it has the potential to benefit others, through its inherent focus on accessibility. 1.4 A new facility at West Road for N-CAMHS (Neuro CAMHS) and CEDS (Community Eating Disorder Service) will result in an improved environment to carry out physical examinations and improve the wellbeing for patients and staff in the facility. Previously physical examinations were being carried out in environments which were must less suitable. The newly refurbished facility will enable a much safer and hygienic environment which the workforce have been involved in designing. The majority of building work was completed by the end of 2024 to 2025 with an official opening hoped to take place during summer 2025. 1.5 The Medication Assisted Treatment Implementation Support Team (MIST) has awarded North Ayrshire HSCP all green and provisional green in their benchmarking report for all partnerships. This is the highest level attainable in the implementation which supports the Scottish Drug Deaths Taskforce’s aim to have no barriers to accessing treatment and care that supports an individual’s recovery. The Medication Assisted Treatment (MAT) Standards project is focused specifically on improving access to these treatments in order to prevent deaths, reduce harms and promote recovery opportunities. 1.6 This April saw the first of our mental health and wellbeing Connect events across North Ayrshire. This was a great success with fifty individuals signing up to join us on the day and a further forty staff and services supporting the event. A range of mental health services and supports such as NHS 24, Penumbra, Money Matters and Voiceability provided stall information for people to explore and workshops were delivered throughout the day allowing the community to find out essential information and new skills around self-care relating to wellbeing. 323
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82 We will run two or three of these Connect events each year around different themes relating to mental health and wellbeing. 1.7 NHS Ayrshire & Arran has officially opened a new, nurse-led Mental Health Unscheduled Care Assessment Hub. Recognised as the first of its kind in Scotland, the hub aims to deliver a new model of care. The Mental Health Unscheduled Care Assessment Hub, based at Woodland View in Irvine, provides a patient-focused, therapeutic space to support the delivery of compassionate care to those individuals with acute mental illness who would be eligible to access an adult acute mental health bed for ongoing intensive assessment. Managed and coordinated by the Mental Health Unscheduled Care Service, the hub provides 24-hour access to mental health assessment and interventions. The service is delivered by experienced Registered Mental Health Nurses within a therapeutic environment for a period of up to 72 hours and will be able to accommodate up to five patients. North Ayrshire Health & Social Care Director, Caroline Cameron explained, “We are delighted to be able to officially open this new service. “We piloted the hub earlier this year for a small number of patients. We are now ready to open at full capacity and provide those living in Ayrshire and who are experiencing acute mental illness with this new way of working.” The hub aims to: • Improve the patient journey through the Mental Health Unscheduled Care Service • Facilitate closer working and a smoother patient journey between community and inpatient services • Reduce the number of unscheduled admissions to acute adult inpatient mental health beds • Reduce the waiting time for planned adult acute admissions • Reduce the number of initial assessments carried out in acute wards releasing resource for treatment • Provide training opportunities in assessment of mental illness for clinical staff 1.8 A huge congratulations to North Ayrshire Wellbeing & Recovery College on winning the ‘Best Mental Health Support Service’ at the Mental Health and Wellbeing Scotland Awards 2025. The category celebrates organisations that provide exceptional help to individuals through their daily actions and activities. 324
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83 In addition, Recovery College manager Jeanette Allan picked up the ‘Inspirational Leader’ award at the event for her dedication to improving the mental health and wellbeing of those who use the service. The awards were presented at an event held in February at Edinburgh International Conference Centre. In what has been a busy time for the Recovery College, the organisation also officially celebrated the move to its new base at Ayrshire College. The event was attended by key figures, including Ayrshire College management, Recovery College leadership, service partners, staff and peers. The move from Ardrossan to Ayrshire College represents a significant step forward for the Recovery College, providing students with an enriched learning environment. Funded by NAHSCP, the Recovery College is one of only five such services in Scotland, focusing on self-management for mental health and providing a strengths-based approach to learning and recovery. 325
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84 Child Health Services 2.1 Following a budget realignment, the Children and Families Health Team have been able to recruit a third Perinatal Mental Health Nurse to the Perinatal Wellbeing Team on a permanent basis. This takes the staff to 2.6WTE. They continue to operate as an integrated part of the health visiting teams providing one to one and group support to expectant and new mums experiencing low level mental health difficulties. The team continues to be a valuable asset to the Children and Families Health Team and to North Ayrshire more widely, meeting a need in the community for mental health support of this nature. 2.2 The Health Visiting service in North Ayrshire continues to fully implement the national Universal Health Visiting Pathway, with all children under 5 and their families offered a minimum of 11 visits from the ante-natal period through to the child starting school. Developmental assessments are undertaken at 13-15 months; 27-30 months and 4-5 years. Since 2020, the percentage of children with one or more developmental concern at these assessments has increased as shown in the table below: A slight improvement in developmental concerns at the 27–30-month assessment has been observed in the last twelve months but a significant increase in concerns at the 4-year review have also been noted, as well as a slight increase in concerns at the 13–15-month review. This trend is not unique to North Ayrshire and the Scottish Government has set out actions to attempt to address this nationally within the recently published Enhancing the Delivery of the Health Visiting Service: Scotland’s Health Visiting Action Plan 2025-2035 (Scottish Government, 2025). Locally, we have undertaken a review of our Early Years Support Team and have established closer working relationships with early years education colleagues to take forward a programme of work that includes improved information sharing about developmental concerns at an earlier stage; enhanced links between the HV service and early years establishments; a focus on communication needs in children as a priority within our Getting it Right for Every Child (GIRFEC) Steering Group; and shared work around supporting more children to be toilet ready in the early years. 326
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85 Our Early Years Support Team works alongside the Health Visiting team to provide support to families when developmental concerns are identified or when a family requests additional support in other areas. During 2024 to 2025, 933 children and their families were supported, an increase of 10.3% from 2023 to 2024, in areas such as communication, sleep, toileting, home conditions, parental mental health and routines. During 2024 to 2025 we expanded our partnership with national charity Dads Rock to bring a second dads’ worker to the area. This has allowed us to offer one to one and group support to dads in the Irvine and Kilwinning areas, as well as the original Three Towns area. During 2024 to 2025, 53 dads have been supported with 81 children being positively impacted. 2.3 Breastfeeding rates have shown the biggest improvement in 20 years in North Ayrshire. The published data for 2023 to 2024 has shown the following improvements in breastfeeding indicators from an NHS Ayrshire and Arran perspective: Indicator 2022/2023 2023/2024 % breastfeeding at initiation 54.6 57.6 % exclusive breastfeeding at first HV contact (10-14 days) 27.4 30.5 % exclusive breastfeeding at 6–8-week HV assessment 22.8 25.6 Similarly, the published data for 2023 to 2024 has shown the following improvements in breastfeeding indicators from a North Ayrshire perspective: Indicator 2022/2023 2023/2024 Variance % breastfeeding at initiation 53.0 59.6 6.6% increase % exclusive breastfeeding at first HV contact (10-14 days) 23.2 30.5 7.3% increase % exclusive breastfeeding at 6–8- week HV assessment 20.3 25.6 5.3% increase The benefits of breastfeeding on the short and long-term health of mothers and babies have been well documented. It promotes optimum nutrition, growth and development for babies, as well as providing comfort and protection from infections. As such, breastfeeding is actively promoted and supported in a wide range of settings across North Ayrshire and Arran. North Ayrshire Health and Social Care Partnership’s Children and Families Health Team has prioritised investment in infant feeding support through local health visiting teams, as well expanding the Scottish Government’s Breastfeeding Friendly Scotland (BFS) scheme in North Ayrshire and providing additional specialist support for families with more complex feeding issues via the Community Infant Feeding Team. 2.4 Child healthy weight is a public health priority. Over the last three decades, obesity levels in children and, indeed, the wider population have increased, with inequalities observed across our communities. Maintaining a healthy weight throughout childhood is associated with many health benefits both in the short-term and the medium term. 327
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86 Child healthy weight is monitored throughout the universal Health Visiting pathway but also when a child moves into Primary 1. The most recent data for 2023 to 2024 was released in December 2024. For North Ayrshire: • 74.8% of P1 children were of a healthy weight • 12.4% of P1 children were at risk of overweight • 11.9% of P1 children were at risk of obesity 2.5 The Human Papillomavirus (HPV) vaccine helps protect people from HPV-related cancers and 90 per cent of genital wart infections. Getting the vaccine protects young people against future risks. An envelope with an information booklet about the vaccine, ingredients and any side effects, as well as a vaccine consent form, was given to all North Ayrshire S1 pupils and any older eligible pupils with incomplete courses in January 2025. During 2023 to 2024, the most recent reporting year, 80.6% of eligible North Ayrshire young people had received the HPV vaccination by S4. 2.6 The School Nursing service in North Ayrshire continues to offer support to school-aged children and young people on a range of areas from emotional wellbeing and substance use to sexual health and relationships and transitions. A significant part of their role in supporting health and wellbeing needs of children on the Child Protection Register or who are looked after either at home or away from home. School nurses also provide support to Unaccompanied Asylum-Seeking Children (UASC). During 2024 to 2025, a new school nursing app was developed to provide evidence-based information to young people on health and wellbeing. 2.7 In November 2024, Health Visiting and Family Nurse Partnership services across Ayrshire were successfully reaccredited at Gold level for the UNICEF Baby Friendly award. The UK- wide UNICEF Baby Friendly Initiative enables public services to better support families with infant feeding and developing close and loving relationships so that all babies get the best possible start in life. 328
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87 This prestigious award has a particular focus on sustainability, providing a framework to ensure that infant feeding care is evidence-based, consistent, and supports staff to deliver a service that provides the best possible care for new families, with a formal revalidation process taking place two years after initial Gold accreditation and every three years thereafter. This is a significant achievement for health visitors, family nurses and support staff across Ayrshire. 329
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88 Inspection of service The Partnership works closely with independent care providers to ensure that the care and support provided is being delivered in line with peoples’ outcomes, offers best value, meets regulatory requirements, and keeps people healthy and well. Care services provided by Partnership teams also undergo external inspections and are subject to rigorous review and inspection. Working together, we ensure that all required standards of quality and safety are met. 330
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89 Independent Care Providers who provide care services on our behalf Where we commission care and support from independent and 3rd sector Providers services based within the North Ayrshire area, we monitor these services via the Contract Management Framework. The Framework focusses on ensuring a joint approach to evaluating the quality of care and where appropriate provides an approach to supporting Providers to progress improvements. We use a range of methods to monitor performance, including: • Formal Contract Management meetings on a 6 monthly basis and an Annual Joint Evaluation of Contract to ensure that services are safe, effective and most of all, that they meet people’s needs. • Review of compliments, complaints and feedback from staff, carers and people who use services. • Information that we collect, before visits, from the provider or from our records. • Local and national information, for example, Care Inspectorate reports • Visits to providers, including observing care and support and looking at records and documents. The information below represents how those services which are registered with Care Inspectorate and are based in North Ayrshire are currently performing. Registered Services – Minimum Grades across all themes Care Service Subtype 2 Weak 3 Adequate 4 Good 5 Very Good 6 Excellent Grand Total Adult Placement Service Not applicable 0 1 0 0 0 1 Care Home Service Older People 0 7 3 1 0 11 Care Home Service Children & Young People 0 2 0 1 0 3 Care Home Service Learning Disabilities 0 1 2 0 0 3 331
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90 Care Service Subtype 2 Weak 3 Adequate 4 Good 5 Very Good 6 Excellent Grand Total Care Home Service Mental Health Problems 0 0 1 0 0 1 Child Minding Not applicable 0 4 5 0 0 9 Day Care of Children Not applicable 0 6 7 2 0 15 Housing Support Service Not applicable 0 0 3 3 0 6 School Care Accommodation Service Not applicable 1 0 0 2 1 4 Support Service Care at Home 1 1 4 2 0 8 Support Service Other than Care at home 0 0 1 0 0 1 Grand Total Not applicable 2 22 26 11 1 62 332
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91 Inspection of Local Services Throughout 2024 to 2025, a total of ten inspections took place by the Care Inspectorate, eight were unannounced. • Health & Community Care - 2 inspections • Children & Families & Justice Services - 6 inspections • Adult Services - 2 inspections The Care Inspectorate use a six-point scale to grade inspections: 1 Unsatisfactory Major weaknesses – urgent remedial action required 2 Weak Important weaknesses – priority action required 3 Adequate Strengths just outweigh weaknesses 4 Good Important strengths, with some areas for improvement 5 Very Good Major strengths 6 Excellent Outstanding or sector leading Gradings for inspections can be found below. Inspection reports can be found on the Care Inspectorate website - Inspection Reports. 333
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92 Inspection Date Service/Unit Wellbeing Leadership Staffing Environment Care & Support 04 - June – 24 The Meadows 3 0 0 0 0 20 - June – 24 Montrose House 3 3 3 4 3 12- August - 24 Canmore 3 0 0 0 0 22 - October - 24 Trindlemoss Day Opportunities 5 5 5 5 4 31 - October – 24 Montrose House 4 4 0 0 0 05 - November – 24 Supported Carers Scheme 5 3 3 0 3 16 - January - 25 Trindlemoss House 4 4 4 3 5 03 - March - 25 Adoption 5 3 0 0 4 26 - March - 25 Achnamara 3 0 0 0 0 28 - March - 25 Fostering 4 3 0 0 4 334
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93 Financial performance and best value Financial information is part of our performance management framework with regular reporting of financial performance to the IJB. This section summarises the main elements of our financial performance for 2024 to 2025. 335
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94 Partnership Revenue Expenditure 2024 to 2025 Strong financial planning and management is paramount to ensure our limited resources are targeted to maximise the contribution to our objectives. Delivery of services in the same way is not financially sustainable. The updated strategic plan approved for 2022 to 2030 is underpinned by the need to learn from the pandemic and ensure opportunities are maximised to transform care models and find new solutions to ensure the future sustainability of high-quality heath and care services. The IJB set a balanced budget for 2024 to 2025 on 14th March 2024. This did not require any draw on reserves but did include the approval of £10.290 million of savings to achieve financial balance. The ability to plan based on the totality of resources across the health and care system to meet the needs of local people is one of the hallmarks of integrated care. Medium term financial planning is key to supporting this process and identifying the transformation and planned shift in resources to provide sustainable services to the local community over the medium term. Financial information is part of the performance management framework with regular reporting of financial performance to the IJB. This included an integrated approach to financial monitoring, reporting on progress with savings delivery, financial risks and any variations and changes to the delegated budget. There were significant financial challenges during the period. The main challenges during the year were residential placements for children, care at home, supplementary staff in wards and Unplanned Activities (UnPACs) within the lead partnership for mental health. From the initial budget monitoring report in month 3 the projected position has been an overspend. The Integration Scheme requires the preparation of a recovery plan if an overspend position is being projected to plan to bring overall service delivery back into line with the available resource. Following the finalisation of the 2023 to 2024 outturn position, the IJB agreed some initial recovery actions for 2024 to 2025 and implemented management actions to reduce the 2024 to 2025 spend. This included: • Review of expenditure authorisation levels across the Partnership and escalation of specific decisions to senior officers. In particular, a new governance group has been introduced, involving the Director and Heads of Service, to oversee the agreement of higher value packages of care (above £40,000 per annum) • Staff communication in relation to discretionary/non-essential spend • Review of temporary posts and robust vacancy management/approval. The vacancy scrutiny group now has representation from all of the Heads of Service and a recruitment freeze will be implemented for all but essential frontline posts • Ongoing review of future year savings or transformation programmes to identify scope for acceleration • Maximise opportunities from the recently reopened Independent Living Fund (ILF) Scotland In order to facilitate greater scrutiny of the financial position and the delivery of the financial recovery plan during 2024 to 2025, the IJB agreed at the June meeting to establish a ‘Finance Working Group’, chaired by the IJB Vice Chair. The Director and Heads of Service are members of the group. This Finance Working Group meets monthly to facilitate increased oversight and scrutiny of the 336
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95 financial position and transformation programme as well as detailed budget planning for future financial years. Since the initial recovery plan was agreed in June 2024 there was a £4.002 million reduction in costs. The outturn is an overall year-end overspend of £1.212 million on an IJB basis, which when adjusted for new earmarked reserves of £2.381 million is increased to £3.593 million (1.1%), which is a favourable movement of £1.387 million from month 10. 2023-24 Budget £000 2023-24 Actual £000 Variance (Fav) / Adv £000 Service 2024-25 Budget £000 2024-25 Actual £000 Variance (Fav) / Adv £000 91,174 95,625 4,451 Health and Community Care 92,549 98,181 5,632 100,990 98,639 (2,351) Mental Health 108,721 107,823 (898) 40,135 43,431 3,296 Children, Families and Justice 43,717 44,294 577 52,865 52,863 (2) Primary Care 53,575 53,662 87 10,098 10,098 0 Allied Health Professionals 10,748 10,749 1 12,740 11,287 (1,453) Management and Support Costs 13,970 10,186 (3,784) Change Programme 1,635 1,725 90 1,852 1,317 (535) Chief Social Work Officer 1,710 1,773 63 1,671 1,630 (41) Financial Inclusion 4 4 0 3 3 0 National Commissioned Service 92,549 98,181 5,632 311,528 314,893 3,365 TOTAL EXPENDITURE 326,629 328,397 1,768 (311,528) (311,528) 0 TOTAL INCOME (326,629) (326,629) 0 0 3,365 3,365 OUTTURN ON A MANAGED BASIS - 1,768 1,768 0 1,117 1,117 Lead Partnership Allocations 0 (556) (556) 0 4,482 4,482 OUTTURN ON AN IJB BASIS - 1,212 1,212 0 2,982 2,982 New Earmarking 0 2,381 2,381 0 (2,000) (2,000) Draw on Reserves 0 0 0 0 5,464 5,464 OUTTURN POSITION PRIOR TO ADDITIONAL FUNDING CONTRIBUTIONS 0 3,593 3,593 0 0 0 Additional funding contributions 3,593 0 (3,593) 0 5,464 5,464 FINAL OUTTURN POSITION 3,593 3,593 - The Integration Scheme describes the required approach where there is a projected overspend on the IJB integrated budget, which includes the requirement to agree a recovery plan to balance the overspending budget. Only if the recovery plan is unsuccessful will the Health Board and Council 337
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96 consider making available interim funds. The Chief Officer wrote formally to North Ayrshire Council and NHS Ayrshire and Arran to request additional in-year funding and at month 12 the following has been agreed: Social Care element – overspend of £2.036 million. North Ayrshire Council considered this at the Council meeting of 3rd June and agreed to fund this with no requirement to repay the funds in future years. Health element – overspend of £1.557 million. NHS Ayrshire and Arran have funded this but clarity is needed on whether this will be repayable in future years or not . Following these additional funding contributions the final position is on-line. The main areas of variance during 2024 to 2025 are noted below: Health and Community Care – overspend of £5.632 million mainly relates to overspends in care at home, agency costs within integrated Island Services, supplementary staffing in wards and district nursing staffing costs and care packages for people with a physical disability. Mental Health – underspend of £0.898 million which relates to underspends in learning disability care packages, community mental health, non-employee costs at Trindlemoss and these are offset by the overspend on the Lead Partnership for mental health (UnPACs, elderly inpatients, psychiatry and mental health pharmacy). There were also underspends in the Lead Partnership to the level of vacant posts and these were taken as payroll turnover. There is also an underspend in the Alcohol and Drugs Partnership which will be earmarked for use in 2025 to 2026. Children, Families and Justice – overspend of £0.577 million which is mainly related to overspends in services for care experienced children (residential care, respite care and employee costs) and services for children with a disability (residential care, respite care). These were partially offset by an underspend in payments for looked after and accommodated children (fostering, adoption and kinship) and the Whole Family Wellbeing Fund which will earmarked for use in 2025 to 2026. Management and Support Costs – underspend of £3.721 million mainly relates to underspends in transition funding, an over-recovery of payroll turnover due to the level of vacant posts being higher than assumed when setting the budget and the draw down of funding from reserves following a review of reserves. Medium Term Financial Outlook A Medium-Term Financial Outlook (MTFO) is a critical part of the strategic planning process. The financial context for public services remains very challenging and so it is vital that the IJB’s strategic ambitions are set against the financial resources which are anticipated to be available. The MTFO provides key information on the possible financial position of the IJB over future years. It identifies the financial challenges which will be faced by the IJB enabling the IJB to see the impact of current and future decisions on its medium-term financial health. The MTFO will also be used to identify pressure points and inform decisions which are required to ensure the Partnership remains financially sustainable. 338
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97 There are a range of factors which influence the financial planning of the IJB. These are considered through the MTFO and include the following: • Demographic changes • Local priorities • Workforce challenges • The UK and Scottish Economy • Policy and Legislation • Cost and demand pressures • Available funding As in previous years, a Medium-Term Financial Outlook has been prepared to identify what the financial position may look like moving into 2026 to 2027 and 2027 to 2028. This has not been published in full at the present time as the Scottish Government indicated in the Scottish Budget that its Medium-Term Financial Strategy will be updated and published in May 2025. Following this, a full update report will be brought to a future IJB covering the period 2026 to 2027 to 2028 to 2029. Reporting on Localities The Partnership has arrangements to consult and involve localities via their Locality Forums. The IJB has established six Locality Planning Forums, reflecting the previously agreed local planning areas. These provide Board Members with the opportunity to be involved in considering the priorities for each area and outline the role for each Community Planning Partner in meeting these priorities in conjunction with the local communities. This spend has been split into localities by initially allocating spend which could be directly identified to a locality, and the remainder which was not locality specific was allocated on a population basis. 68.1% (65.4% in 2023 to 24) of spend was allocated based on population, which means at this stage the spend per locality can only be used as a guide and will not fully reflect actual locality usage of services. The population information used can be seen in the following table and was taken from the 2023 mid-year population statistics (sourced from National Records of Scotland). 339
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98 Allocation Method % Total allocated on population basis 68.1% By Locality 31.9% Total 100% This resulted in the following spend per locality - Expenditure Irvine £000’s Kilwinning £000’s Three Towns £000’s Garnock Valley £000’s North Coast £000’s Arran £000’s Total £000’s 2024-25 Expenditure 100,373 35,085 74,876 46,902 56,041 15,120 328,397 % share of spend 30.6% 10.7% 22.8% 14.3% 17.1% 4.6% 100% % of total population 29.2% 11.8% 23.5% 14.8% 17.3% 3.5% 100% Age Group Irvine Kilwinning Three Towns Garnock Valley North Coast Arran Total % of spend allocated Children aged 0 to 15 31.4% 13.0% 24.5% 14.5% 13.9% 2.6% 100% 11.8% Adults aged 16 to 64 30.0% 12.1% 24.1% 15.3% 15.5% 3.1% 100% 26.6% Older People aged 65+ 25.6% 10.1% 21.4% 13.6% 24.3% 5.0% 100% 18.4% Share of total population 29.2% 11.8% 23.5% 14.8% 17.3% 3.5% 100% 8.6% 340
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99 Appendix 341
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100 Local Indicators – 2024 to 2025 These local indicators are those related to our strategic plan outcomes for 2022 to 2030 Performance Indicator 2024/25 Target Status Number of service users referred to employability service 121 36 Employability mentors - No of service users being supported into employment, training, education. 45 28 Number of PRI sessions which have taken place 8 8 Support 4 formerly cared for young people to move into independent living each year. 15 4 Support 45 children and young people into kinship care placements each year. 39 45 Recruit 6 new foster carers each year. 2 6 People attending the emergency department will be seen within 4 hours from arrival at hospital (Arran) 98.8% 95% Increase the number of Naloxone Kits distributed per annum (387 per year – 97 p/q) 741 387 Deliver 4,275 ABIs each year (pan Ayrshire) 7,265 4,275 CAMHS – Seen within 18 weeks (RTT) 99.6% 90% Psychological Therapies – Seen within 18 weeks (RTT) 89.8% 90% Reduce out of hours admissions for people aged 65 and over (MH) 20 32 No under 18 should be admitted onto the Adult Intensive Psychiatric Care Unit (Ward 8) 0 0 All accepted referrals to the Intensive CPN team from non-mental health referrers will receive contact within 4 hours 94.4% 90% People subject to level 1 Community Payback Order (CPO) Unpaid Work completed within three months 98.7% 57% Individuals subject to level 2 Community Payback Order (CPO) Unpaid Work completed within six months 96.4% 67% 342
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101 MSG Indicators Performance Indicator 2021-22 2022-23 2023-24 2024-25 Target Status Emergency admissions to acute hospitals 1,376 1,560 1,643 1,495 1,836 Emergency admissions to acute hospitals (rate per 1000) 10.28 11.69 12.30 11.19 13.6 Admissions from emergency department 769 699 820 732 1,173 Admissions from emergency department (rate per 1000) 5.74 5.24 6.14 5.48 8.7 % people at emergency department who go onto ward stay (conversion rate) 27.10% 26.70% 27.60% 24.50% 33 Unscheduled ‘hospital bed days’ in acute hospital 11,426 11,686 13,195 7,816 12,320 Unscheduled ‘hospital bed days’ in acute hospital (rate per 1000) 85.36 87.54 98.79 58.52 91 Unscheduled ‘hospital bed days’ in long stay mental health hospital 2,658 2,117 2,191 2,167 6,782 Unscheduled ‘hospital bed days’ in long stay mental health hospital (rate per 1000) 19.86 15.86 16.40 16.22 50.1 Unscheduled ‘hospital bed days’ in geriatric long stay 616 715 702 223 1,772 Unscheduled ‘hospital bed days’ in geriatric long stay (rate per 1000) 5.63 6.55 6.42 2.04 13 Emergency department attendances 2,840 2,620 2,972 2,988 3,292 Emergency department attendances (rate per 1000) 21.22 19.63 22.25 22.37 24.4 % people seen within 4 hrs at emergency department 67.60% 65.50% 59.80% 64.19% 95% Delayed Discharges bed days (all reasons) 1,776 1,852 1,785 2,876 1,515 Delayed Discharges bed days (all reasons) (rate per 1000) 16.22 16.96 16.32 26.29 13.9 Delayed Discharges bed days (code 9) 764 893 548 864 770 Delayed Discharges bed days (Code 9) (rate per 1000) 6.98 8.18 5.01 7.90 7 343
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102 Where to find more information If you would like more information on IJB strategies, plans and policies and our performance and spending, please refer to the following websites. • North Ayrshire Health and Social Care Partnership • NHS Ayrshire & Arran - How we perform • North Ayrshire Council - Strategies, plans, and policies • North Ayrshire Council - Performance and spending Additional financial information for Ayrshire wide services can be found in: • East Ayrshire HSCP – Strategic Plan 2021-31 • South Ayrshire HSCP – Strategic Plan 2021-31 344
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1 North Ayrshire Health and Social Care Partnership Annual Performance Report Summary Report 2024 to 2025 345
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2 Contents Annual Performance Report Summary Report 2024 to 2025 ............................................................... 1 Annual Performance Report 2024 to 2025 – Overview ..................................................................... 3 Tackle Inequalities ............................................................................................................................ 4 Enable Communities ......................................................................................................................... 4 Provide Early and Effective Support ................................................................................................. 5 Developing and Supporting Our Workforce....................................................................................... 6 Improve Mental and Physical Health and Wellbeing ......................................................................... 7 Children’s Outcomes ......................................................................................................................... 8 Justice Outcomes ............................................................................................................................. 9 Transformation ................................................................................................................................ 11 Lead Partnership Responsibility – Mental Health ............................................................................ 12 Lead Partnership Responsibility – Child Health Services ............................................................... 13 More Information ............................................................................................................................. 15 346
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3 Annual Performance Report 2024 to 2025 – Overview This summary of our annual performance report showcases some of the highlights of the excellent work carried out by our services within the North Ayrshire Health and Social Partnership. This report aligns with our “Caring Together” Strategic Commissioning Plan 2022 to 2030. The plan set out our pandemic recovery intentions, as well as offering a longer-term vision for local health and social care services. Below are the five Strategic Objectives of the North Ayrshire Health and Social Care Partnership. Over the period of the Strategic Commissioning Plan, the Health and Social Care Partnership will seek to: We see these priorities as interlinked, and we expect that where we see success against one priority, it’s effect will positively impact against others. People who use our services and North Ayrshire residents will experience our Partnership values in the way our staff and volunteers engage with you and how we behave. We will treat you with: Whilst this document provides a brief overview of performance, the full Annual Performance Report for 2024 to 2025 is also available to view. 347
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4 Tackle Inequalities • North Ayrshire Council has been awarded by charity ‘The Smallest Things’ with the nationally recognised ‘Employer with a Heart’ charter mark. The change in the Council’s Maternity Scheme has been made to support employees affected by premature birth. Parents – employed by North Ayrshire Council – of babies born at or before 37 weeks will be entitled to receive an extra week’s Premature Baby Leave and Premature Baby Pay for every week until their babies original due date. The leave entitlement will be added to the end of the employee’s agreed Maternity leave period after the Maternity Leave entitlement has elapsed. Once the employee has ended their maternity leave, they will then move to the premature baby leave/pay. This leave will be paid at full pay. Fiona Walker, Head of Service for People and ICT, shares: “I am delighted that the Council has received the ‘Employer with a Heart’ Charter status. “It is vital as one of North Ayrshire’s largest employers that we help employees and local families who may be dealing with the premature birth of their baby. • Our Money Matters Team once again supported the most vulnerable people in our communities, accessing entitled benefits to the incredible sum of £21,530,176.11, an increase of almost £1 million pounds from 2023 to 2024. This was achieved against a backdrop of ongoing welfare reform and a complex benefits system. Enable Communities • In a groundbreaking achievement, NHS laboratory specimens were successfully delivered from the island of Arran by drone across the Firth of Clyde. This innovation, part of Project CAELUS, reduced delivery times from several hours to just 30 minutes, significantly speeding up diagnostic processes and treatment decisions. This project demonstrates the commitment to leveraging technology to enhance healthcare delivery, particularly benefiting remote and rural communities. The successful trial marks a significant step forward in addressing logistical challenges faced by remote communities. • Support for people with dementia in North Ayrshire received a boost after Anam Cara respite centre in Kilbirnie was officially reopened with a ribbon-cutting ceremony on Tuesday 4 June following an extensive refurbishment project. 348
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5 The specialist dementia respite centre accommodates up to 9 guests aged 60 years or over, offering critical respite services within single room, en-suite accommodation. The support service, which is run by North Ayrshire Health and Social Care Partnership, had been temporarily relocated to the vacant Taigh Mor site in Beith to allow the service to continue while works were carried out. The refurbishment project included a complete transformation of the main garden area, including new garden furniture, with a ramp installed from the conservatory to allow better access for guests to enjoy the outdoors. An additional, smaller garden area adjacent to the dining area has also had some landscaping improvements made. A full revamp of the internal areas of the building has also been carried out, with works including wet wall installation in several of the bathrooms, replacement light fittings with energy-efficient LED bulbs and a full upgrade to the reception area. An archway has been created within the dining area to improve the space, allow better access to the outdoors and create an improved flow for staff moving around the area, and a new boiler and generator have been installed. Provide Early and Effective Support • We are delighted to announce that North Ayrshire Health and Social Care Partnership (HSCP) was awarded the Bronze Digital Telecare Implementation Award in recognition of the progress made on our analogue to digital telecare transition project. To achieve Bronze status, a Telecare Service Provider must have successfully deployed digital- ready alarm devices to at least 50% of all dispersed and group alarm users. This is the first major milestone in the transition to digital telecare and sets the foundations upon which the rest of the digital telecare transition will rest. North Ayrshire HSCP has been preparing for the analogue to digital switchover for a few years now. In 2022, a project board was set up and the project team recruited in early 2023. There have been many challenges along the way including equipment shortages, procurement obstacles and a tender for a call receiving partner to overcome. It is hoped that the remainder of the equipment rollout will be straightforward, with a new aim to achieve Silver status. The team are on course to have the project completed during 2025. Kevin Queenan, TEC Lead, said: “We’re delighted to have achieved our Bronze Award. Our technicians are very knowledgeable and a pleasure to work with, and our fantastic management and project board have supported us throughout – keeping us on the right path as digital is new to all of us”. Alan Boyle, Digital Technician, said: “We’re enjoying the role, it’s great to learn new technologies and rewarding to know that we’re keeping our service users safe”. 349
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6 Achieving this Award is a significant achievement and once the rollout of equipment is completed, North Ayrshire HSCP will move towards the first phase of testing with alarms and peripherals. • The North Ayrshire Primary Care Development Manager worked successfully with 11 North Ayrshire GP practises, selected by the Scottish Government Improvement Service and HSCP Money Matters team, to implement the ‘Providing Welfare Rights in GP Practices’. The initiative saw Income Advisors based in these practices, who worked with patients and residents to carry out complete benefits checks, help them make claims and support them if they were disputing claims. Year 3 of the pilot resulted in: • 536 referrals to the service (compared to 646 in the second year, 17% decrease). • £3,126,685.18 has been generated for patients and residents of North Ayrshire in the Third year of the Project with a total £6,979,573.24 since project commenced in 2022 to 2023. Developing and Supporting Our Workforce • The LiveWell group have partnered with KA leisure to bring free health checks to Council employees. The KA Leisure health check sessions include lifestyle and weight management advice along with cholesterol, blood pressure, blood sugar testing and the Boditrax machine – a clever system that assesses your body and, very quickly, delivers 14 different measurements, such as your ideal weight, your BMI and your metabolic age. Our Chief Executive Craig Hatton booked in to one of the health check sessions and encouraged others to do the same. He said: “It’s been brilliant having the opportunity to have my recent employee health check, thanks to the LiveWell group and our partners at KA Leisure. I think it’s important that colleagues understand just how vital it is to take time for their own health and learn about what they can do proactively to improve it. The reason I booked in to a recent KA Leisure health check was because I am mindful that I’m not getting any younger and I knew – for my own peace of mind – that making time to have the check done was going to be beneficial for me.” • As platinum award winners in Investors in People, the Dirrans team were looking for a different challenge so went forward for a new award from Investors in people ‘We invest in wellbeing.’ The We invest in wellbeing framework looks for a strategy and approach to the health and wellbeing of staff. This should be measurable and understand the impact of this on staff practice. The team considered and improved practice by evaluating staff wellbeing through surveys and feedback. They created a wellbeing policy and strategy to guide wellbeing goals such as reducing sickness absence, improving job satisfaction and job retention. They also developed subgroups that focussed on physical, psychological, social and financial factors that can affect staff and shared this as a team to be more informed about what supports staff can access to help improve wellbeing. 350
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7 The team reflected that they already felt that they had a strong presence for looking after staff however going through this process it highlighted areas for improvement and how the framework could improve the service. The We invest in Wellbeing framework comprises three indicators, each with three themes. This defines what it takes to reach each level of accreditation standard, silver, gold, and platinum. It was intended to start at the first level of ‘standard’ however when receiving feedback, this had jumped to silver which is an amazing achievement, and the Dirrans Centre were confirmed winners of the silver award in August 2024. We invest in wellbeing silver award means that you have an established wellbeing strategy or plan and that your people feel positive about your strategy, plans and activities. Developing and supporting our workforce ensures employees are more efficient and effective in their roles, helps retain our skilled and qualified staffing resources, and improves morale and job satisfaction. Improve Mental and Physical Health and Wellbeing • A report produced by NHS Ayrshire & Arran’s Prevention and Service Support Team has highlighted the positive impact of Naloxone distribution and use in North Ayrshire. This safe and easy-to-administer medication temporarily counteracts the effects of opioids, such as heroin, methadone, codeine, morphine and buprenorphine, and can save lives by reversing an overdose for 20 to 40 minutes until emergency help arrives. 1,640 Naloxone kits were handed out in Ayrshire between April 2024 and March 2025 (741 of which were in North Ayrshire), with 73 lives reported to have been saved in that time (18 in North Ayrshire). However, the true number of lives saved is thought to be higher, with many instances of Naloxone use going unreported. In addition, a total of 1.225 people received overdose awareness training across Ayrshire in the same time period, with a further 428 people attending a virtual or face to face Naloxone awareness course. • The Three Towns Community Shed offers a safe and welcoming space for anyone over the age of eighteen to drop in, take part in a wide range of activities, learn some additional skills and enjoy socialising with new friends. This fantastic community initiative was launched recently after bringing together the existing local Men's Shed and recently formed, She Shed under one banner, with a base at 12C Castle Works, Hill Street, Ardrossan. While the two groups learn, create and socialise in their own right, they also enjoy combined experiences and social events. 351
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8 Helping to combat social isolation, the Shed offers local people a chance to go along and take part in arts and crafts, woodworking, 3D printing, model building, bicycle repairs, fixing furniture or small personal items, and even a music group. The Shed has recently been commissioned by both a local care home and primary school to build them memorial benches and has previously built planters for other community groups. Children’s Outcomes • February saw the launch of a brand-new mobile app called ‘CE4U’ (Care Experience for You), the mobile app for iPhone and Android has been designed specifically for care experienced young people. Launched as part of National Care Day, an annual awareness day to celebrate care and compassion of children and young people with care experience, the app has been developed with the help of pupils from local secondary schools over the past eighteen months. Free to download, its aim is to provide a hub of useful information and helpful advice on everyday topics including housing, travel, mental and physical health, recipes, job opportunities and entitlements. Android Play Store Link Apple App Store Link Developed by young people for young people, the collaboration was made possible due to fortnightly Champions Board meetings that take place in our secondary schools. These drop-ins provide a safe space for care experienced pupils to get advice, plan peer events and access scaffolding and support to help them succeed. The launch is part of the Council’s wider Corporate Parenting Strategy to meet its statutory duties to keep The Promise to Scotland’s care experienced community – in this case those living and studying in North Ayrshire. • A transformation programme to improve outcomes and opportunities for care experienced children and young people in North Ayrshire is now under way, with progress being made since its launch in April 2024. 352
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9 The Brighter Pathways Programme Board was set up to look at how services can be delivered differently to ensure care experienced children and young people have access to the appropriate resources and supports into adulthood. In line with its Promise commitments, North Ayrshire Health and Social Care Partnership (NAHSCP) has a firm focus on providing the right support and intervention to allow children and young people to remain with birth family or wider family wherever possible, preventing them from coming into local authority care - for example, being placed in foster care or in residential children’s houses. To build on this already established early intervention work, the Board is currently looking at the supports available for families to identify if there are any gaps in service provision where additional early help and more intensive support could help more children to remain with their families. An acute challenge in recruiting and retaining foster carers is having an impact nationally, which has been further impacted by the current cost of living crisis and a reduction in the number of potential foster carers having spare bedrooms due to an increase in home working and their own children staying at home for longer. Recruiting foster carers for NAHSCP is further impacted by a number of independent fostering agencies operating in the area and taking on carers. In a bid to boost recruitment, which is a priority for the programme board, an investment in a long- term digital marketing campaign has recently been agreed, working with a provider that has a proven track record in local authority foster care recruitment. Justice Outcomes • Diversion from Prosecution (Diversion) has been available since 1997, within this past year we have experienced a further increase across Ayrshire in assessment referrals from the Procurator Fiscal. Referrals have increased at a significant rate from 2018. Although this disposal is early intervention and low-level offending, the presenting need of service users is extremely high, thus resulting in more staff time being allocated and closer partnership working with other agencies to provide identified services. The number of assessment reports submitted are relatively lower than the number requested due to limited resources, which has resulted in waiting lists within each local authority area. In comparison with last year, 2024 to 2025 notes a decrease in the number of Diversion cases imposed. This is due to delays from the time that the offence was committed until the individual is referred to and assessed by the Diversion team. In this time many positive changes could have taken place and individuals are actively seeking and engaging with services to address any issues which they may have, thus reducing their risk of further offending. In these instances, no interventions are required due to positive reasons. 353
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10 • There was a marked increase in in Drug Treatment and Testing Order (DTTO) Assessment and Impositions in 2023 to 2024. There has been a slight decrease in 2024 to 2025; however, the volume of assessments and new Orders this year remains high. The last two years figures appear to represent a return to ‘the norm’ following a ‘dip’ attributed to covid. Of the 63 assessments completed in 2024 to 2025, 45 new DTTO’s were imposed across Ayrshire. This incorporates Orders from both Kilmarnock and Ayr Sheriff Courts. DTTO is an intense Order which involves monthly Court reviews, twice weekly contact for the first month and weekly oral drug screens. There are three distinct roles within the team delivering the service and interventions. The Supervising Officer oversees the Order, monitors compliance and compiles the assessment and review reports. The Additions Worker delivers the therapeutic interventions and is primarily responsible for administering the oral drug screens. There are then Recovery Development Workers who provide practical supports, assistance with welfare needs and also build links and connections within the recovery community to help build the persons own recovery capital. A Recovery Care Plan is created with each individual. There are ten domains, including substance use, relationships and offending, which are scored from 1 to 10. These plans are updated at three monthly intervals and allows areas for support/intervention to be identified and progress to be monitored. 354
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11 Transformation • The North Ayrshire HSCP Transformation Plan 2024 to 2027 is an ambitious programme of change consisting of a range of improvement and reform projects across all service areas, each aiming to improve the quality of our services and contribute to the long-term sustainability of health and care in North Ayrshire. The Transformation Plan was approved by IJB in March 2024. • Our aspiration is that children who require alternative care are best placed in family-based care, and we require a number of new foster carers to meet the current demand for children of all ages. The biggest challenge facing the fostering sector today is the recruitment and retention of high- quality foster carers who can meet the needs of children in care. A lack of available foster carers, in the right place at the right time, means children are missing out on vital support. Children in need of care are at risk of being moved away from their communities, hobbies, siblings, and are having to change schools and leave behind what is important to them, which has a detrimental impact on their wellbeing, stability and development. The Fostering Service has lost fifty-nine interim carers over the last two years, this is due to resignations, de-registrations and change of role of carers. The service has a target to recruit six new carers per year; however, this has not been achieved in each of the last five years. Within the foster care workstream, recruitment of foster carers was identified as a priority area that required immediate focus. • NHS Ayrshire & Arran, in partnership with Coloplast Ltd, launched a successful pilot service to improve the lives of people with multiple sclerosis (MS). This innovative service focuses on managing neurogenic bladder and bowel dysfunction, a common issue for people living with MS. Key achievements include the introduction of a dedicated bladder and bowel clinical nurse specialist, early detection through patient questionnaires, and significant reductions in urine retention and urinary tract infections. Patients have experienced improved health outcomes, enabling them to engage more fully in work and social activities. This pilot sets a new standard for MS care, demonstrating the benefits of early intervention and integrated care pathways. • Child & Adolescent Mental Health (CAMHS) in Ayrshire & Arran are continuing to engage in and influence West of Scotland CAMHS pathways and service developments such as Forensic CAMHS. West Road in Irvine will be the new Specialist CAMHS Assessment & Treatment Centre for Ayrshire as well as the operational base for the Community Eating Disorders Services by April 2025. Some administration staff are already based at the building and the rest of the staff will be moving in once the staff attack alarms are completed and a few other issues are resolved. Open seven days per week, specialist CAMHS Neuro, ADHD, play Therapy and other Clinical Interventions will be delivered from this re-fitted facility. Hosting flexible working space for staff with five clinic rooms and two large meeting rooms, it is envisaged that the facility will become a centre of excellence in the care and treatment of child and adolescent mental ill-health and eating disorders. 355
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12 Lead Partnership Responsibility – Mental Health • Trindlemoss Day Opportunities in Irvine has been praised in a report by the Care Inspectorate after an unannounced inspection visit in October, with the majority of areas looked into being rated as ‘very good’ by the national regulatory body. The service, which opened in 2020, provides tailored support for over 100 people with learning disabilities from its base in Tarryholme Drive in Irvine. The inspector identified a number of significant strengths within the service, with customers found to be ‘supported in stable groups by consistent staff who know them well’. The ‘warm, respectful and kind interactions between staff and people supported’ were also highlighted in the report. Support was found to be tailored to each individual’s identified outcomes, with the service maintaining a flexible approach that allows customers to access a range of groups and activities of their choice. Regular project topics also provide multiple opportunities for themed activities and trips to associated places. Health promotion and education is integrated into activities, empowering people to take control of their health and wellbeing, with the service also making use of local facilities such as the swimming pool and gym. These trips also provide a chance to enhance travel and life skills. Trindlemoss Day Opportunities was also praised for its strong links to the local community, providing support for lunch clubs, play groups and dementia support groups, as well as assisting with gardening and litter picking. Additionally, the Baristamoss Café is open to the local community several days a week, providing employment training and boosting the development of social skills for those supported. In terms of staffing, employees were described as enthusiastic and knowledgeable, putting customers at the centre of all they do. Staff reported that they were able to spend quality time with individuals and get to know them well, and support was found to be provided in a timely manner. Good relationships were noted between staff and management, with appropriate checks and audits in place for the service type. The Trindlemoss facility was commended for being clean and well maintained, offering a generous amount of space split into zones allowing multiple activities to take place at the same time. The gardens were described as ‘well maintained’ and used for a number of activities - including growing vegetables - and areas such as the training kitchen and laundry area provide important socialisation and life skill development opportunities. • NHS Ayrshire & Arran has officially opened a new, nurse-led Mental Health Unscheduled Care Assessment Hub. Recognised as the first of its kind in Scotland, the hub aims to deliver a new model of care. 356
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13 The Mental Health Unscheduled Care Assessment Hub, based at Woodland View in Irvine, provides a patient-focused, therapeutic space to support the delivery of compassionate care to those individuals with acute mental illness who would be eligible to access an adult acute mental health bed for ongoing intensive assessment. Managed and coordinated by the Mental Health Unscheduled Care Service, the hub provides 24-hour access to mental health assessment and interventions. The service is delivered by experienced Registered Mental Health Nurses within a therapeutic environment for a period of up to 72 hours and will be able to accommodate up to five patients. North Ayrshire Health & Social Care Director, Caroline Cameron explained, “We are delighted to be able to officially open this new service. “We piloted the hub earlier this year for a small number of patients. We are now ready to open at full capacity and provide those living in Ayrshire and who are experiencing acute mental illness with this new way of working.” The hub aims to: • improve the patient journey through the Mental Health Unscheduled Care Service. • facilitate closer working and a smoother patient journey between community and inpatient services. • reduce the number of unscheduled admissions to acute adult inpatient mental health beds. • reduce the waiting time for planned adult acute admissions. • reduce the number of initial assessments carried out in acute wards releasing resource for treatment. • provide training opportunities in assessment of mental illness for clinical staff. Lead Partnership Responsibility – Child Health Services • Breastfeeding has been a longstanding priority for staff working in North Ayrshire. The integrated community infant feeding team which includes midwives, health visitors, Family Nurses, support staff, Community Infant Feeding Nurse, and Support Nurse, as well as colleagues from the Breastfeeding Network (BfN) work closely with families to help them make an informed choice about feeding. Staff have all received regular high-quality training to ensure they are knowledgeable and skilled in relation to infant feeding. Breastfeeding rates have shown the biggest improvement in 20 years in North Ayrshire. The published data for 2023 to 2024 has shown the following improvements in breastfeeding indicators from a North Ayrshire perspective. 357
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14 Indicator 2022 to 2023 2023 to 2024 Variance % breastfeeding at initiation 53.0 59.6 6.6% increase % exclusive breastfeeding at first HV contact (10 to 14 days) 23.2 30.5 7.3% increase % exclusive breastfeeding at 6 to 8- week HV assessment 20.3 25.6 5.3% increase The benefits of breastfeeding on the short and long-term health of mothers and babies have been well documented. It promotes optimum nutrition, growth and development for babies, as well as providing comfort and protection from infections. As such, breastfeeding is actively promoted and supported in a wide range of settings across North Ayrshire and Arran. • Child healthy weight is a public health priority. Over the last three decades, obesity levels in children and, indeed, the wider population have increased, with inequalities observed across our communities. Maintaining a healthy weight throughout childhood is associated with many health benefits both in the short-term and the medium term. Child healthy weight is monitored throughout the universal Health Visiting pathway but also when a child moves into Primary 1. The most recent data for 2023 to 2024 was released in December 2024. For North Ayrshire: • 74.8% of P1 children were of a healthy weight. • 12.4% of P1 children were at risk of overweight. • 11.9% of P1 children were at risk of obesity. 358
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15 More Information If you would like more information on Integration Joint Board (IJB) strategies, plans and policies and our performance and spending, please refer to the following websites. • North Ayrshire Health and Social Care Partnership • NHS Ayrshire & Arran - How we perform Additional financial information for Ayrshire wide services can be found in: • East Ayrshire HSCP – Strategic Plan 2024 to 2027 • South Ayrshire HSCP – Strategic Plan 2021 2031 359
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NHS AYRSHIRE AND ARRAN DELIVERY PLAN 2025-2026 Agenda Item 10 361
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Contents Chief Executive Summary ............................................................................................................... 3 1. Introduction ................................................................................................................................. 3 2. Population Health and Reducing Health Inequalities ....................................................... 4 3. Quality and Safety .................................................................................................................... 10 4. Value Based Health and Care ............................................................................................... 11 5. Women and Children’s Health .............................................................................................. 13 6. Planned Care ............................................................................................................................. 17 6.1 Cancer ................................................................................................................................. 22 6.2 Musculoskeletal Health .................................................................................................. 22 7. Unscheduled Care ................................................................................................................... 24 7.1 Delayed Discharges ......................................................................................................... 29 8. Urgent Care ................................................................................................................................ 30 9. Primary and Community Care .............................................................................................. 31 10. Mental Health ......................................................................................................................... 34 10.1 CAMHS ................................................................................................................................ 35 10.2 Psychological Therapies ................................................................................................ 37 10.3 Community Mental Health Services ............................................................................ 38 10.4 Unscheduled Care ........................................................................................................... 39 10.5 In Patient............................................................................................................................. 40 10.6 Alcohol and Drug Service .............................................................................................. 41 10.7 Learning Disabilities ....................................................................................................... 43 11. Healthcare in Custody ........................................................................................................ 45 12. Pharmacy ............................................................................................................................... 46 13. Infrastructure ......................................................................................................................... 48 14. Community Wealth Building / Anchor ............................................................................ 49 15. Workforce ............................................................................................................................... 51 16. Digital ...................................................................................................................................... 54 17. Climate .................................................................................................................................... 56 18. Finance ................................................................................................................................... 58 362
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Chief Executive Summary NHS Ayrshire and Arran faces financial challenges in 2025/26 and beyond with a requirement to create and deliver a sustainable health and care service within the envelope of funding available. The financial context for NHS Ayrshire and Arran is challenging with a forecast budgetary gap of £33.1M for 2025/26. The Board will continue to develop a wide range of cash releasing savings through service improvement and collaborations with our Health and Social Care and System partnerships. It is acknowledged by the Board that the route to achieving financial balance will require service reform that will be delivered over the next 2 – 5 years. Our health and social care partners are also experiencing financial challenges, and it is acknowledged that these financial pressures could impact some of the improvements that are forecast within our acute service improvement plans. However, as a system we are committed to working together to mitigate and manage these system pressures as they emerge. The Board continues to have strategic workforce risks in relation to medical, nursing and AHP supply and capacity. This is particularly challenging with regards to the medical workforce and is maintained on the Strategic Risk Register as a very high risk, despite treatment. These risks will require national support and change as they are not unique to our Board but are linked to national supply chains for controlled staff groups and as such constrains our local ability to get traction on some of the prescribed planning priorities for the Delivery Plan. Unscheduled Care and Planned Care demands continue and the Health Board remains committed to achieving high standards of efficiency and productivity while ensuring robust performance management and governance structures are in place to monitor safe delivery. The core aim to our service improvement programme being to enhance care pathways, reduce duplication, and eliminate waste without compromising the quality and safety of our patients and staff. 1. Introduction The Delivery Plan (DP) has been prepared collaboratively with our partners, to provide Scottish Government with confirmation that we have plans in place to demonstrate how our health and care system will continue to stabilise and improve from the incredible pressure which continues to be experienced. The Delivery Plan sets out our strategic context and priorities, and those of our partners in the health and social care sector, which are aligned to the national priorities of the Scottish Government and NHS Scotland as a whole. 363
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We have worked alongside service leads across the health and care system within Ayrshire and Arran to develop the Delivery Plan which focuses on system redesign and improvement, to strengthen our services to meet increasing and more complex demand within a backdrop of significant financial pressures. The Delivery Plan continues to be underpinned by our Caring for Ayrshire Vision, which is driven by the need to rebalance health and care so that it is less acute focussed and there is a stronger emphasis on delivering care in a variety of alternative and more locally based settings. Caring for Ayrshire is a longer term vision which will take a number of years to fully deliver and will require significant service change aligned to investment in infrastructure. The Delivery Plan is informed by appropriate quality, financial and workforce planning, as well as setting the context for more detailed planning for the delivery of specific services and the effective running of the organisation, such as digital, governance, and other corporate functions. Recognising the significant level of reform and redesign required we will maintain robust stakeholder engagement to foster a bottom-up development and delivery process that leverages the expertise of staff, patients, partners and communities, in line with the Planning with People Framework. Detailed actions for the recovery and stabilisation of our services are included in Delivery Plan. The delivery plan will be monitored regularly by the Improvement Programme Steering Group, with each priority championed by the Recovery Director and managed through the Operational Delivery Unit (ODU). 2. Population Health and Reducing Health Inequalities In June 2024, the Cabinet Secretary for Health and Social Care outlined our vision: A Scotland where people live longer, healthier and more fulfilling lives. The vision is supported by four key areas of work: improving population health, a focus on prevention and early intervention, providing quality services and maximising access. Building on the positive and innovative actions already taking place across areas including tobacco and alcohol control to improve population health and reduce health inequalities, a long term Population Health Framework is being developed, which the work we are prioritising will align to. Ayrshire, with an estimated population of 368,549, presents a diverse demographic landscape. The majority of its residents, about 70%, live in urban areas, totaling 257,984 people. The remaining 30%, or 119,565 individuals, reside in rural settings. The age distribution reveals a varied population structure. Young residents aged 0-14 constitute 15.5% (56,992), while those in the 15-29 age bracket make up 16.1% (59,171). The 30-44 age group also represents 16.1% (59,392), indicating a stable young adult population. The largest age group is 45-59, comprising 22% (81,049) of the population, followed by those aged 60-74 at 20.1% (74,105). Seniors aged 75 and above form 10.3% (37,840) of the population, highlighting a significant elderly demographic. 364
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Health inequalities in Ayrshire and Arran are influenced by various socio-economic factors. Here are some key areas of concern: Life Expectancy and Mortality: Life expectancy in Ayrshire and Arran is generally lower than the Scottish average, with notable disparities between different areas. For example, North Ayrshire has some of the lowest life expectancy, whereas South Ayrshire is closer to or above the Scottish average. Chronic Diseases: The region has higher rates of chronic diseases such as chronic heart disease (CHD), chronic obstructive pulmonary disease (COPD), and asthma. These conditions are closely linked to socio-economic deprivation. Mental Health: Mental health issues are prevalent, with higher rates of hospital admissions for mental health conditions compared to the national average. This includes conditions such as depression, anxiety and self-harm. Emergency Hospital Admissions: Ayrshire and Arran have higher rates of emergency admissions, which can be indicative of underlying health inequalities and access to primary care services. Health Behaviors: Behaviors that impact health, such as smoking, alcohol consumption, drug use and poor diet, are more common in deprived areas. These behaviors contribute to the higher prevalence of chronic diseases and lower life expectancy. Access to Services: There are disparities in access to healthcare services, with rural areas facing more significant challenges in accessing timely and adequate care. Getting it Right for Everyone (GIRFE) Getting it right for everyone (GIRFE) is a multi-agency approach to health, social work, and social care support and services from young adulthood to end of life care. As a practice model it intends to shape the culture, design and delivery of health and social care services, providing a more personalised way to access help and support when it is needed. The ambition of GIRFE is to place the person at the centre of all the decision making that affects them, with a joined-up consistent approach regardless of the support needed at any stage of life. GIRFE has been co-designed by the Scottish Government, Health and Social Care Partnerships, and the people of Scotland. A national toolkit has been developed with a focus on a ‘Team Around the Person’ approach, which was developed collaboratively with people with lived experience and those with professional experience. The ‘Team Around the Person’ toolkit provides a starting point and a framework which can support the implementation of a GIRFE approach. East Ayrshire and South Ayrshire Health and Social Partnerships have been pathfinders in this process, along with other HSCP’s, to inform the national toolkit. GIRFE has been and continues to be an ongoing iterative process and we continue to be involved in monthly national meetings focussed around embedding GIRFE and sharing learning with other HSCP’s across Scotland. Good progress has been made in testing GIRFE within our delivery models over the last year and this work will continue to embed the GIRFE Team Around the Person Toolkit to support a person-centred, consistent and individualised 365
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approach to health and social care support, based on multi-disciplinary and inter-agency working, with ongoing learning and feedback within 2025-26. Child Poverty Public Health are progressing a life course approach to mitigating and preventing poverty, internally through a dedicated action plan for tackling child poverty for the organisation, and externally through our work supporting development of Local Authority and Community Planning Partners through the development of Local Child Poverty Action Reports. In the initial stages of the year ahead we will continue to work closely with our partners in terms of developing actions and sharing the evidence base with regards to poverty. We will look across our internal NHS activity with regards to how our actions can support our partners plans and identify what expertise, evidence and knowledge we can provide to support planning and reporting. As an organisation the NHS has little control over the drivers of child poverty, however, through providing assistance to partners and through internal assurance processes we will endeavour to influence local and partnership activity which can. Tobacco Locally, our NHS Ayrshire and Arran Tobacco Action Plan for our smoking cessation service, Quit Your Way, have identified two improvement actions to be included within this Delivery Plan. The first is to increase smoking cessation referrals from other services such as secondary/acute and mental health. The Quit Your Way team can support staff within these services to raise the issue of smoking and referral pathways through the delivery of training and awareness raising sessions. Additionally, the team can support the development and delivery of specific quality improvement projects which aim to increase the identification and offer of support to those who smoke. The second is to skill Quit Your Way staff to support the wider determinants of smoking behaviour by identifying wider supports required and by providing information, signpost or referral in response. These actions also contribute to the wider Public Health, and Healthcare Public Health, agenda by supporting developing “Waiting Well” action, which aims to improve the health of those on our acute services waiting lists and so contribute to more positive outcomes for both patients and services. Cancer Screening In 2023 National Services Scotland (NSS) published the Scottish Equity in Screening Strategy 2023-2026 which provides direction on national and local actions to achieve equity for those eligible for screening. This national plan documents five areas for action and this applies to all six screening programmes. Within Ayrshire and Arran a local screening inequalities plan for 2023-2026 was developed along the themes of: - Communications, engagement and learning - Access to screening - Data collection and monitoring 366
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- Research and evaluation - Overarching issues NHS Ayrshire and Arran have utilised a fund from Scottish Government to tackle screening inequalities, developing projects which aim to improve the uptake of screening. This fund is for the three cancer screening programmes only. This funding stream provides the Health Board opportunities to implement initiatives which are out with core programme delivery. Over the last two years access to the funding has changed and with increasing financial pressures across the whole system it is unclear what funding will be available in 2025/26 and future years. Any reduction to this funding stream will pose substantial challenges to develop and implement projects to tackle inequalities within cancer screening programmes which are out with core programme delivery. If there are no additional monies provided through inequalities funding there may be proposed actions that cannot be met due to workforce. This is due to the fact these projects are in addition to core programme delivery and form pilots which aim to gather evidence to support service improvement and change. These projects require staff to work additional and unsocial hours. Vaccination The delivery of the vaccination programme is based on building and retaining a trained and skilled workforce, investing in the infrastructure to support the programme and an effective and trusted partnership with all key stakeholders, both local and national. There are imminent introductions of further changes to the programme with the potential inclusion of a vaccine for chickenpox as part of wider changes to the routine childhood immunisation schedule which are expected to be delivered in 2025/26. There are currently no strategic risks associated with vaccination programmes in NHS Ayrshire and Arran, however there are a number of operational risks including: • The dependence on substantive staff working additional/extra contracted hours, supported by bank staff, to enable the successful delivery of winter vaccination programmes (COVID-19 and flu); • Funding allocation for vaccinations still to be confirmed for 2025/26; and • Forthcoming changes to the routine childhood immunisation schedule and associated requirement for additional clinic accommodation, workforce; with additional funding as yet still to be agreed. Sustainable Transport In order to support and deliver on the strategic goals set out in the NHS Scotland Climate Emergency and Sustainability Strategy (2022-2026) as well as our own NHS Ayrshire and Arran Climate Change and Sustainability Strategy (2021-2032) and Anchor/ Community Wealth Building Strategy (2023-2026) we have formed an Active Travel and Sustainable Transport sub group of our Climate Emergency and Sustainability Operational Group (CESOG). With the support of Travelknowhow Scotland, the group has prepared an Action Plan for NHS Ayrshire and Arran on Sustainable Travel for the three financial years (2024/25 to 2026/27). The Action Plan sets out how we will implement actions towards the organisation’s overall strategic goals on sustainable travel, and how we will monitor progress. 367
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The action plan is informed by and interfaces with national, regional and local transport policy and strategy which includes the Scottish Governments Transport to Health Delivery Plan. The Action Plan provides a framework for practical measures tailored to the needs of the organisation, individual sites, employees, patients, and visitors. It will be reviewed and updated on a regular basis to ensure its relevance and to maintain progress on strategic goals. Actions are grouped according to six themes: • Governance, monitoring, and reporting • Reducing the need to travel • Enabling active travel • Promoting public, community, and shared transport • Decarbonising our fleet and business travel • Reducing single occupancy car use There continues to be positive engagement and support in both the development and implementation of the action plan from across NHS Ayrshire and Arran and with support from NHS Assure and our partners in Ayrshire Roads Alliance, North Ayrshire Council and Strathclyde Passenger Transport. Although positive progress has been made to date, there remain clear challenges and risks which include our capacity to deliver the actions, the ongoing capacity and engagement of our local transport partners and colleagues and limited funding to take work forward in the manner and at the pace we would like. Antiracism Strategy NHS Ayrshire and Arran The development of an anti-racism strategy is being led by the Organisational and Human Resource Department and Public Health with support from the NHS Ayrshire and Arran Inequalities Lead and will report back to Scottish Government on progress early 2025. Aims/Objectives 2025-2026 (Year 1) KPI Reduce the difference in screening uptake between the most and least deprived quintile for each of the three cancer screening programmes. Improve cervical screening uptake in deprived areas by 20%. Improve breast screening recall appointment uptake by 40%. Improve bowel screening uptake in prison by 40%. Increase HIV prevention, detection and retention in care. 100% of new diagnoses have completed lookback review. Reduce late diagnosis of HIV to zero. Increase testing for HIV by 30% compared to Q4 2024/25. Work towards viral hepatitis elimination goals, including through achieving Board-level HCV treatment initiation targets. Improve HCV treatment uptake by 100% on Q4 2024/25 Improved access of Long-Acting Reversible Contraception (LARC), including post-abortion and postpartum. Improve overall LARC uptake by 40% on Q4 2024/25 Improve population health, with particular focus on smoking cessation and weight management priorities. Smoking Cessation Increase referrals by 5% each quarter Weight Management 368
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Diabetes prevention (including Gestational Diabetes Mellitus (GDM): Aim to offer treatment and support to 200 people Tier 2 weight management: Aim to offer treatment and support to 200 people Tier 3 weight management: Aim to offer treatment and support to 150 people Remission programme: Aim to offer treatment and support to 15 people Actions 2025-2026 (Year 1) By When Cancer Screening Programmes - Widen cervical screening outreach clinics to include more deprived areas with low uptake; - Implement transport initiative for recall breast screening appointments to improve uptake for those women experiencing travel inequalities and low income; and - Improve staff awareness and uptake of bowel screening in the local prison population. March 2026 Blood Borne Virus (BBV) - BBV service review, including review of BBV testing policy; - Management of BBV exposure policy; - Implementation of BBV diagnosis lookback; and - Reducing stigma education campaign. March 2026 HCV treatment initiation targets - Improvements to prison Sexual Health and Blood Borne Virus (SHBBV) pathway, including dedicated testing clinics and NearMe consultations; - Pilot of community treatment; and - Pilot of DBS testing in pharmacies. March 2026 Smoking Cessation Increase number of referrals to smoking quits by the specialist Quit Your Way cessation service from - Acute - Maternity - Mental health services and - From those living in our 40% most deprived communities Develop, deliver and evaluate pilot which utilises QYW staff to address the wider determinants of health, including those which may make it more difficult to stop smoking. March 2026 Diabetes Prevention and Adult Weight Management Services - Provision of care for women at risk of gestational diabetes (GDM) post-natally; - Provision of early intervention and support for those at high risk of type 2 diabetes; - Provision of person-centred weight management support for those with a high BMI; and - Provision of a type 2 diabetes remission programme involving total diet replacement treatment for those recently diagnosed with type 2 diabetes. March 2026 369
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3. Quality and Safety NHS Ayrshire and Arran’s Quality Strategy describes our commitment to deliver quality improvement and high quality care that will enable and support delivery of our strategic objectives, and our ambition for health and care service transformation. The Healthcare Governance Committee proposed that the current Quality Strategy would be extended to include the period 2023-2025 and this was supported by the Board members. An evaluation of the impact of the current Quality Strategy will begin in January 2025, with a report detailing the findings published in July 2025. Consultation and co-design with a range of stakeholders to guide the direction of NHS Ayrshire and Arran’s future Quality Strategy will begin in January 2025 with a revised Quality Strategy published in 2026. Excellence in Care (EiC) is a national approach which aims to ensure people have confidence they will receive a consistent standard of high-quality care no matter where they receive treatment in NHS Scotland. Commissioned by the Scottish Government in response to the Vale of Leven Hospital Inquiry recommendations, Excellence in Care seeks to improve, integrate and coordinate the way quality care services are delivered. The NHS Ayrshire and Arran EiC team conduct data surveillance of all reportable measures on a monthly basis. Additionally, provision of EiC data to senior leadership and healthcare governance team is included in all directorates’ quality and safety papers. Quality data is sent from our local data management system to Senior Charge Nurse’s, Clinical Nurse Manager’s and Senior Management monthly, to give an oversight of compliance with each of their measures. This provides the opportunity for these staff to review compliance and identify any issues/risks and where possible make changes. Aims/Objectives 2025-2026 (Year 1) KPI Deliver quality improvement and high quality care to enable and support delivery of our strategic objectives, and our ambition for health and care service transformation. Delivery of Strategic Objectives Actions 2025-2026 (Year 1) By When Evaluate the impact of the current Quality Strategy with findings published in July 2025. July 2025 Develop and publish revised NHS Ayrshire and Arran Quality Strategy March 2026 Evaluate, re-design and implement Quality and Safety Walkrounds July 2025 Co-design a Quality Improvement Capacity and Capability Strategy August 2025 Develop and publish Duty of Candour Policy June 2025 Develop and implement an improvement plan to reduce overdue Significant Adverse Event Review (SAER) reports and action plans June 2025 370
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Review of Nursing, Midwifery and Allied Health Professionals audit templates and operational definitions to ensure standardisation of reporting December 2025 Launch and implementation of reviewed Care Assurance Boards in in-patient areas December 2025 Increase the number of users accessing the Care Assurance and Improvement Resource (CAIR) Dashboard by 50% October 2025 Implementation of Healthcare Improvement Scotland (HIS) Quality of Care Review Process September 2025 All relevant staff are face fit tested to an FFP3 respirator to support business as usual patient care and in the event of responding to an incident such as Mpox Clade1 and Measles. - Sessions have been established on our Acute sites in rotation for half a day weekly to provide testing to those staff requiring a test. - Upscale of addition sessions is being planned should this be required. March 2026 4. Value Based Health and Care The Realistic Medicine team continue to support the 13 high level actions from the Chief Medical Officer’s Value Based Health and Care Plan (October 2023). This seeks to use the principles of Realistic Medicine as an approach to achieve this. We have set out a delivery plan that aligns to these objectives. The main constraints to this are the limited resources that compose the Realistic Medicine team and of the limited service engagement resulting from a stretched and under-pressure healthcare system. There will be ongoing work within the Realistic Medicine Team to take forward the aims of Value Based Health & Care (VBH&C) whilst we transition to the Realistic Care Improvement Programme. This will enable NHS Ayrshire and Arran’s reform to be viewed through the lens of VBH&C and an opportunity for Realistic Medicine to support embedding VBH&C into the heart of reform and improvement. Going forward the aims and objectives of the Realistic Medicine teams will be advanced in collaboration with the Realistic Care Improvement Programme at a strategic level. The final development plan for year 2025/2026 will be integrated into the existing plan. Aims/Objectives 2025-2026 (Year 1) Increase Awareness: Raise public awareness of Realistic Medicine and the need for NHSScotland to steward its resources well particularly via social media. Encourage Shared Decision-Making (SDM): Ensure all health and care professionals engage in shared decision-making and promote the “It’s OK to Ask” campaign. Service Users to Utilise BRAN Questions and encourage them to ask their health and care professionals the BRAN questions. Improve Communication: Enhance health and care professionals' communication skills, focusing on clear, accessible information and patient preferences, encouraging Shared Decision Making. 371
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Sustainability and Unwarranted Variation: Develop tools that enable health and care colleagues to seek out and eliminate unwarranted variation in access to healthcare, treatment and outcomes. Focus on Resource Management: Prioritise initiatives to reduce waste and harm, including overprescribing and unwarranted tests. Innovation: Empowering the workforce to be improvers and innovators, bringing services closer to our community in line with Caring for Ayrshire. Actions 2025-2026 (Year 1) By When Social Media Promotion of Realistic Medicine externally in collaboration with the Communications Team, including via the organisation's X and Facebook accounts. Use of videos/information available via the national RM website. Communication and engagement plan to be developed by June 2025 BRAN Publicity materials available from NHS 24. Promotion of BRAN internally via Viva Engage, Communication Team and other internal methods of communication. Ensure BRAN questions are included on all outpatient appointment letters. Trial of appointment letter leaflets at Rainbow House Child Development Centre. BRAN information visible in waiting rooms to enhance decision-making via posters and note paper. Show BRAN/RM videos on screens within waiting areas. June 2025 September 2025 September 2025 Continue to evaluate the CollaboRATE SDM measuring tool which is now embedded with Patient Experience Survey across Acute sites. March 2026 Health and Care professionals will be encouraged to complete TURAS training via promotion on Viva Engage, eNews and other methods of internal communication. March 2026 Assist the Right Decision System steering groups to introduce best practice pathways for NHS Ayrshire and Arran. December 2025 Encourage collaborative work that promotes the interface between Primary and Secondary care. Ongoing Enable CDFs to carry out QI work relating to variations in practice and resource management. December 2025 Establish a Primary Care Teams Channel to collate successful QI projects that could inform Steering Groups and enable a learning by doing and economy of scale approach to developing new pathways. June 2025 Engage with QI to determine whether VBH&C can become an educational element of AAIFS. September 2025 Explore use of Demand Optimization Dashboard for Laboratory Diagnostic Tests with in Primary Care. December 2025 Support permanent introduction of Neptune Waste Management System supporting National Green Theatre programme. September 2025 Representation on Pharmacy Effective Prescribing Groups. Ongoing Near Me Projects - Continued support/exploration of Near Me projects within Breast, Preoperative and Cochlear Implant services. Development of trials of Near Me within care home settings, Tissue Viability Nurse service, December 2025 372
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Neurodevelopmental Empowerment and Strategy (NEST) Team and Rainbow House Child Development Centre. 5. Women and Children’s Health Women’s Health Plan NHS Ayrshire and Arran is committed to contributing to the outcomes outlined in the National Women’s Health Plan for Scotland which underpins actions to improve women’s health inequalities by raising awareness around women’s health, improving access to health care and reducing inequalities in health outcomes for girls and women, both for sex-specific conditions and in women’s general health. Actions to achieve this across Ayrshire and Arran requires cross departmental and multi-agency support and action. The two leading directorates for the strategic vision and delivery of this are Women and Children’s Services and Public Health. Building on previous activity, the Women’s Health Plan Strategic Oversight Group (WHP SOG) was established in 2024, to deliver the ambitions of the WHP. The group is co-chaired between Women and Children’s Services and Public Health with representation from across the Board to drive forward actions. The ultimate aim of the women’s health plan is to improve the general health and wellbeing of all women and girls, whilst reducing health related inequalities. The underpinning tenants of Realistic Medicine and Value Based Health and Care will be integral to delivering meaningful change and improvement for the population of Ayrshire and Arran. A new iteration of the plan is expected in the coming years and will feed into the work of the WHP SOG. Moving into 2025/26 the priorities will be to continue to deliver against the NHS Ayrshire and Arran Women’s Health action plan with the currently identified priorities of pre-conception care, endometriosis, and menopause. We will continue to monitor and implement the national Menopause and Menstrual Health Policy within NHS Ayrshire and Arran and improve the support provided to our staff. It is recognised that there are nationally significant challenges for patients accessing gynaecological appointments and laparoscopic surgery for the diagnosis and treatment of endometriosis. NHS Ayrshire and Arran recognise the challenges in providing access to endometriosis care and surgery and the associated risks and recognise that endometriosis is a progressive disease, and the current wait times increase the risk of the disease becoming more complex, requiring more costly and specialist care. Work has been underway in 2024/25 to redevelop a cohesive pathway for Polycystic Ovary Syndrome (PCOS) patients across both primary and secondary care services. It is expected that this pathway will be presented to governance groups for approval in the final quarter of 2024/25 with a launch in early 2025/26 with ongoing monitoring of impact. 373
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Following on from this the next pathway which will be reviewed and improved is the endometriosis pathway, including the creation of dedicated assessment clinics and implementing patient initiated reviews. Waiting times for endometriosis assessment have remained high and this action will seek to address some of the drivers of these long waiting times. The women’s health academy seeks to create better training and competence within primary care staff to be able to diagnose and manage women’s health concerns more robustly at the point of presentation. This will not only improve the service provided to patients, reduce demand on secondary care services but also promote career development for primary care staff to be strong advocates for women’s health within their settings. During the period of time when families are planning a pregnancy they may not be in routine contact with healthcare services, however this is a time when optimal health is important to provide the best possible chance of a successful pregnancy. A board wide Short Life Working Group will explore what information and support families need during this time and how best to deliver this. Cardiovascular disease is often under-recognised and diagnosed in women. Early identification and modification of risk factors can improve long term outcomes. Therefore a test of change based within primary care services will seek to explore how CVD screening can be delivered through routine appointments to begin the journey of early identification and management. As we continue our journey towards supporting staff experiencing challenges associated with menstrual health and the menopause a key priority for 2025/26 will be to establish a network of Women’s Health Champions to provide staff support. The primary remit of this network will be to provide peer based support to understand the support available within the organisation, signpost to and provide training to staff and line managers and continue to create a culture of openness and awareness. Health Visiting and Family Nurse Partnership The universal child health reviews are core to the Universal Health Visiting Pathway. The reviews provide an opportunity to work with parents to assess children's wellbeing, provide age-appropriate health promotion advice, build parenting capacity, identify needs for support, and facilitate early access to effective interventions. Within 2025-26 all eligible children will continue to receive child health reviews at 13-15 months, 27-30 months, and 4- 5 years from a qualified Health Visitor or Family Nurse, with ongoing review and assessment of staffing across children's health services, to ensure assessments continue to be completed by qualified HV/FNs. Continue to work with partners to build on understanding of wider determinants of health with regards to insecurity of income, housing and food across the life course. There is extensive evidence on the benefits of breastfeeding on the short and long term health of mothers and their babies. The percentage of babies who were exclusively breastfed in 2023/24 at NHS Ayrshire and Arran level was 25.6% - that is the highest rate we have achieved since the Pre-School Child Health Surveillance data has been published since 2002/03. Breastfeeding initiation, exclusive breastfeeding rates at 11-14 days (first Health Visitor visit) and at 6-8 weeks has increased at Ayrshire and Arran level and for each 374
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local authority area, with the exception of rates at 6-8 weeks in East Ayrshire. These positive statistics demonstrate that the culmination of work we have been doing collectively across midwifery, health visiting and family nurse services, including our specialist maternity and community infant feeding teams, over the last few years is starting to build momentum. In addition, the significant investment made by the Health and Social Care Partnerships to enable ongoing work with a third sector partner who provides mother to mother breastfeeding peer support, is clearly contributing to this change. Over the last year, the maternity service and neonatal unit at Ayrshire Maternity Unit achieved UNICEF Baby Friendly reaccreditation and the health visiting and family nurse service achieved reaccreditation with Gold Baby Friendly status. Public protection There is a well-established safeguarding team within maternity and neonates. However, it has been identified that there is not a consistent approach throughout women and children’s services as a whole. To ensure a more robust approach a lead for public protection within Women and Children’s Services has been identified to establish a consistent and robust nonperson dependant approach within the women and children’s directorate. Maternity NHS Ayrshire and Arran continue to deliver on recommendations from the Best Start national Policy to ensure women and their families have a positive experience of maternity and neonatal care which takes account of their individual needs and preferences. It is important that all families are aware of the support and choices that are available to them in order that they can be partners in care and achieve the best outcomes for them. Of the 76 Best Start recommendations we have seven remaining as still to meet locally and three of these require Scottish Government input. We require support to progress further with key challenges around lack of recurring funding for midwifery care, lack of community estate to deliver statutory maternity care in community settings, a rise in morbidity for the care model and continuity of carer in the high-risk pregnancies. The non-recurring funding for Best Start has now ceased. This will impact on our ability to continue to implement recommendations, this issue exists for all health boards. Nationally there is a review of the impact on maternity in relation to the implementation of the neonatal Best Start recommendations and locally we have commenced our own data capture. Locally community accommodation has been reviewed with no solutions agreed and this is being further impacted by local distributed working arrangements and further estate reduction. Gynaecology We continue to develop and implement a Gynaecology Outpatient Procedure Unit for patients requiring clinical interventions, which may have previously required a theatre session and subsequent in-patient stay. This has been developed and will be implemented within current estate in Ayrshire Maternity Unit in 2025. Paediatrics 375
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We will look at expansion of direct access to Paediatric Assessment Unit (PAU) for GP referrals, negating any unnecessary time spent in Emergency Department (ED) for triage, unless clinically required. Developing measurable outcomes will evidence compliance on ED attendances after GP referral and 4-hour compliance from attendance at PAU to discharge or admission. To ensure on-going consistent exacting standards of high dependency critical care delivery it is essential to support a planned programme of staff attendance in the recognised critical care education. Neonates Neonatal services, now a recognised local neonatal unit in keeping with Best Start recommendations has well embedded criteria for admission in Ayrshire and transfer to the tertiary unit in Queen Elizabeth University Hospital for delivery and then repatriation here as appropriate. The Unit occupancy remains consistently in keeping with the required number of respiratory care days, high dependency intensive care days and number of exceptionally low birth weight babies cared for in the current recommendations for a local neonatal unit. Support with the on-going succession planning for the Advanced Neonatal Nurse Practitioner team is acknowledged along with the recent approval of a sixth neonatal consultant appointment. These on-going service developments and appointments will continue to enhance safe and effective service delivery and sustainability. Aims/Objectives 2025-2026 (Year 1) KPI Maternity Strategy (Best Start) – National review of continuity of care model and sustainability of service delivery. National driver – local benchmarking assessment will be used to determine our RAG status as we progress. Development of a Gynaecology (Gyn) Outpatient Procedure Unit within Ayrshire Maternity Unit for patients requiring clinical interventions, which may have required a theatre session and subsequent IP stay. Completion of planned moves, and uptake of additional services including new colposcopy suite. Expansion of direct access to Paediatric Assessment Unit (PAU) for GP referrals. Scoping and service definition to be prepared prior to implementation plan. Deliver care in line with expectations for a ‘local’ neonatal unit and in keeping with BAPMM guidance. Data available from Badgernet system. Evaluation of implemented in-utero transfer form. Staffing and competency for high-dependency (critical care) beds. Competency framework completion – determination of staff percentages completing critical care academic training. Ensure a robust approach to safeguarding that is consistent across the Women and Children’s directorate. Placement of Public Protection midwife and associated delivery plan. Actions 2025-2026 (Year 1) By When Maternity - Progress national overview of continuity of care model. March 2026 Maternity - Carry out a review to identify accommodation for community midwives to deliver care. October 2025 376
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Gynaecology - Forecasting of procedures to be transferred from IP theatre list to Gyn OP procedure unit and impact of waiting times. December 2025 Gynaecology - Review of accommodation within Acute Maternity Unit footprint and estates work required to develop Gyn OP procedure unit. August 2025 Paediatrics - Change the service model to negate unnecessary time spent in Emergency Department for triage, unless clinically required. March 2026 Public Protection Establish a lead for Public Protection within the directorate. Expand the approach current in Maternity and Neonates towards consistency across the directorate. June 2025 March 2026 Women’s Health Plan - Launch revised PCOS Pathway; - Review Endometriosis Pathway; - Launch Women’s Health Academy; - Establish a preconception SLWG to provide board wide recommendations; - Implement a test of change in primary care practice to explore cardiovascular screening for women at routine appointments; and - Recruit and train Women’s Health Champions to provide a staff support network. March 2026 East Ayrshire - Implement the East Ayrshire’s Cherishing Our Families Strategy and the Safe and Together model of practice; - Improve holistic family support for children affected by drugs and alcohol; - Implement the Health Visiting Pathway and Breastfeeding Friendly - Early Learning Scheme; - Provide every child with the access dental care and oral health education/support; - Support children and young people to access neurodiversity supports; - Provide access to training in mental health interventions; - Implement Trauma Informed Contact and Care; and - Pilot Equally Safe at School resource (EA Violence Against Women's Partnership). March 2026 Breastfeeding – Pan Ayrshire • To implement the Breastfeeding Friendly Scotland Early Years and Local Authority Schemes across Ayrshire; and • To continue to increase breastfeeding rates across Ayrshire at the first Health Visitor visit and the 6-8 week Health Visitor visit. March 2026 Ongoing 6. Planned Care There is considerable overlap between planned care and cancer services and performance measurement, and so we progress the planning of these two areas together. This plan presents both the planned care and the cancer planning in order to avoid duplication. The Planned Care and Cancer Delivery Plan incorporate the “core” activity which can be delivered by the available funding through the previously agreed Board allocation, in addition 377
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to the additional activity which has been commissioned through additional Scottish Government funding in 2025/26. This additional funding totals £7.04M plus a further £1.65M for mobile MRI scanners. The detailed plan associated with this funding is set out on the Planned care planning template document. The plan assumes that discussions regarding the Board’s financial position do not result in any adjustment to the allocation of planned care funds. Planned Care As we move into 2025/26 we recognise a number of significant challenges to the delivery of planned care. The steady increase in urgent care demands continues to result in planned care capacity being reduced with increasing workforce resources re-assigned to support urgent care needs. The proportion of referrals into planned care being made on an Urgent Suspicion of Cancer and Urgent basis has increased significantly. The result is that much less capacity remains for routine-priority cases which generally represent the longest waiting patients. It also places significant pressure on the cancer pathways which are required to manage much larger volumes of referrals with minimal increase in the number of cancers diagnosed. The Board continues to face significant recruitment challenges. This includes a number of clinical specialties with notable numbers of long standing consultant vacancies, particularly in some of the medical specialties. There remain some facility-based constraints which arose as a result of changes made during the COVID-19 pandemic, which have not since been possible to reverse. In particular the loss of the UHC day surgery unit, and recovery area for endoscopy are notably reducing the operating theatre and endoscopy capacity and productivity. Cancer NHS Ayrshire and Arran’s key priorities reflect the vision and priorities set out in the Scottish Government’s Cancer Action Plan 2023 to 2026 to improve cancer survival and provide excellent, equitably accessible care to all. The aim is to ensure that people living with cancer, their families and carers are at the heart of cancer services, and a focus on reducing inequities in access to cancer care and cancer outcomes, recognising each person’s time of need. However, there are a number of challenges faced in the delivery of cancer services. There has been a sustained increase in demand, with a significant increase in the number of Urgent Suspicion of Cancer referrals. This places significant additional demand on the diagnostic parts of the pathway required to diagnose cancer pathology. The actual number of cancers diagnosed has risen, but by a smaller amount. There is a particular capacity challenge in relation to the prostate cancer pathway, with the most significant shortfall relating to operating theatre capacity for robot assisted surgery. It is also anticipated that there will be a significant increase in demand for both the diagnostic and treatment elements of the prostate cancer pathway during 2025/26 resulting from the impact of a recent high-profile prostate cancer case. 378
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Diagnosis of cancer is becoming an increasingly sub-specialised area. As a result there are capacity based bottlenecks for certain cancer pathways within Pathology and Radiology in particular. Within radiology, there is a capacity constraint impacting the cancer service in relation to MRI and ultrasound. The National Plan for imaging is expected to address the ultrasound aspect, but there will remain a capacity shortfall for MRI. Diagnostic capacity in endoscopy related to the reduced recovery facilities at UHC impact the upper GI and Colorectal pathways. There are significant challenges with West of Scotland oncology capacity, and also capacity for PET scanning. A number of cancer pathways have identified unfunded shortfalls in consultant capacity. Against this backdrop the Board will prioritise work which further progresses the five main areas of focus: 1) Understanding the changing service demand and capacity • Through 2024/25 additional DCAQ analysis has provided further insight into particular areas of pressure. All individual specialties have either completed or are in the process of updating DCAQ analysis; • Consultant job planning, including the use of the Allocate job planning system for the first time in NHS Ayrshire and Arran, will further support this work but allowing a much clearer identification of core capacity and will support development of tools to monitor delivery of clinical activity against the expected levels; • We have also completed a review of theatre (nursing capacity) in order to better understand the capacity and workforce shortfalls in this area, and further discussion will progress consideration of this outcome within the available funding envelope; • We will develop an online referral guidelines portal using the Right Decisions Platform. This tool will be co-produced between primary and secondary care and is expected to positively impact on ensuring that the right patients reach the right service, first time; and • We will review our robot assisted surgery capacity, particularly in relation to capacity for prostate cancer surgery, and will participate in ongoing regional and national work to identify opportunities to increase surgical capacity to improve the prostate cancer pathway. 2) Productivity and Efficiency Opportunities • Close monitoring of theatre utilisation continues to be a feature of “business as usual” within the Board, and this is evidenced through the strong theatre utilisation performance data. We plan to introduce the national theatre scheduling solution in 2025/26 and will closely monitor the impact that this has on both utilisation and productivity; • Through the newly created “outpatient utilisation group” we will review and progress initiatives to further increase efficiency and productivity through setting local targets and action planning to improve DNA rates and reduce Review:New ratios; and 379
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• We will ensure that our waiting lists are up to date with an ongoing in-house programme of outpatient waiting list validation, and through bi-annual validation of the IP/DC waiting list through the established National Elective Coordination Unit (NECU) process. 3) Modernisation • In 2024/25 we held 2 “summit events” which supported our clinical teams to focus on opportunities to modernise their planned care services. Following on from that we will support the teams in the further expansion of Active Clinical Referral Triage (ACRT) and Patient Initiated Review (PIR) through a programme managed approach; • Implementation of the Ophthalmology Open Eyes system is expected to support more patients being managed within the community setting, and a reduction in demand for the acute service; • Implementation of the Digital Dermatology Service is expected to support a reduction in demand through improved referral information. Subject to continuation of funding, we anticipate that this development will run in parallel to a NECU-led campaign using the same technology which will also enable mutual aid support from other NHS Scotland Boards to NHS Ayrshire and Arran in order to reduce the dermatology backlog; • We will develop an online Referral Pathway guidance portal which we anticipate will lead to improved appropriateness of referrals, ensuring that patients reach the right service first time. This may also contribute to reducing the increase in referral demand both for general referrals and for urgent suspicion of cancer referrals. Within the cancer pathways in particular, reducing overall demand and so enabling faster review and diagnosis we anticipate that this will positively impact on cancer stage of diagnosis; • We will work towards implementation of optimal cancer pathways in the lung cancer, head and neck cancer and colorectal cancer pathways subject to the availability of the necessary resources and funding; • We will continue to deliver a Rapid Cancer Diagnostic Service, subject to continuation of funding; and • We will use QPI data to drive further improvement in cancer care and outcomes, coordinated through our new Cancer Management Group. We will focus on specific priority QPIs, namely Upper GI QPI11 by exploring the opportunity to identify cancers at pre-symptomatic endoscopies using available technology, Melanoma QPI6 and QPI7 by reviewing the pathway and improving the process for notification of melanoma diagnosis. 4) Investment in Sustainability • Significant recurring investment of Access funding has already been targeted at orthopaedics, endoscopy and CT scanning services, and additional investment during 2024/25 prioritised Anaesthesia, Urology and Diabetes and Endocrinology. • Additional areas for recurring investment have been agreed and will be implemented in 2025/26 including ENT surgical staffing, Neurology medical staffing, Gastroenterology multidisciplinary team, Breast Radiologist and operating theatre nursing. Additionally additional Orthopaedic surgeon staffing which had previously 380
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been put in place non-recurringly has now been allocated recuring funding by Scottish Government subject to delivery of agreed additional activity. • We will work locally, and with regional colleagues to develop plans for sustainable delivery of oncology and SACT services. This will include development plans for the establishment of safe and appropriately sized oncology ward facilities within the Board, as well as supporting regional development of a Target Operating Model for Oncology. We will continue to further develop local SACT capacity through workforce diversification and expansion where funding allows. 5) Tackling Long Waits • We will continue to target the longest waiting patients, where capacity allows and within the context of relevant clinical prioritisation. The longest waiting TTG patients will be tracked individually with action plans developed for each; • Short term additional capacity to address the longest waiting patients will be put in place in line with agreed Scottish Government funding plans. This includes recruitment to additional fixed term posts in General Surgery and Orthopaedics. This will also include contracting of independent sector capacity and waiting list initiative type approaches; • There has already been considerable investment to reduce waiting times in orthopaedics. The development of a business case for development of a National Treatment Centre outlined the requirement for further investment in service and capacity in order to manage demand, and although this particular project has been paused, we will continue to engage with Scottish Government colleagues to consider how this significant capacity shortfall can be addressed, and we will actively participate in the development of an Orthopaedics National Plan; and • Recognising that ophthalmology and gynaecology are two other areas of national priority, and that we have some waiting list challenges in these areas, we will seek to identify opportunities to establish additional capacity as funding allows but recognising also that NHS Ayrshire & Arran has a number of other waiting times areas of particular high priority, most notably within some outpatient specialties. Prioritisation of resources will reflect the respective level of risk and challenge. Aims/Objectives 2025-2026 (Year 1) KPI Address Long Outpatient waiting times working towards target of no patients >52 weeks by March 2026. WL Size = 42436 >52 Wks = 3713 Address Long Inpatient/Daycase waiting times working towards target of no patients >2yrs by March 2026. WL Size = 6554 >52 Wks = 631 Reduce waiting times for Medical Imaging Investigations working towards maximum 6 week wait by March 2026. WL Size = 2041 >6 Wks = 355 Reduce waiting times for Endoscopy working towards maximum 6 week wait by March 2026. WL Size = 1047 >6 Wks = 613 Actions 2025-2026 (Year 1) By When 381
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Increase planned care productivity in outpatients and inpatients/daycases through a range of different actions. March 2026 Optimise opportunities for regional working and mutual aid through implementing a number of individual initiatives. March 2026 Implement new digital solutions including Ophthalmology Open Eyes, Digital Dermatology and Theatre Scheduling tool. March 2026 Deliver supplemental activity, in line with funding plan March 2026 Implement the initiatives supported by the National Plan for Imaging. March 2026 6.1 Cancer Aims/Objectives 2025-2026 (Year 1) KPI By Dec 2025 82% of all those urgently referred with a suspicion of cancer are to begin treatment within 62 days of receipt of referral. 82% From March 2025 98% of all patients diagnosed with cancer are to begin treatment within 31 days of decision to treat. 98% Identify and address areas of lower performance or clinical concern through representation at WoSCAN Regional Groups and continued engagement with local and regional clinical leads. Identified and addressed areas of lower performance or clinical concern. Support the development of a Target Operating Model for oncology, and work across the region and locally to address shortfalls in oncology capacity. Development of a Target Operating Model for Oncology Ensure earlier and faster diagnosis at stage I and II in line with Cancer Strategy. Earlier and faster diagnosis at stage I and stage II Actions 2025-2026 (Year 1) By When Ensure sufficient diagnostic capacity to support cancer pathways, through implementation of a range of actions. March 2026 Use QPI data to focus on and address particular shortfalls in cancer pathways. March 2026 Support the development of a Target Operating Model for oncology, and work across the region and locally to address shortfalls in oncology capacity March 2026 Ensure focus on achieving faster and earlier diagnosis through implementation of optimum cancer pathways and other actions. March 2026 6.2 Musculoskeletal Health Musculoskeletal (MSK) conditions continue to be one of the leading causes of sickness absence across Scotland and constitutes 30% of the primary care demand. With increasing demand and complexity of presentation there is acknowledgement that the MSK Service needs to develop new models of care to better support citizens to access the right care in 382
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the right place at the right time. A key priority of the service in delivering this goal is development of a digital platform to enable patient initiated access and supported self- management. This would also bring benefit to primary care and unscheduled care services. The development of a digital platform would enhance the existing digital resources already in place within the service with the Ayrshire and Arran MSK website and social media already having good engagement. The community appointment day (CAD) model is another service development which is seen to be key in better supporting patients in a more timely manner while improving access to the service. In delivering new models of care the expectation is that the performance against the 4 week waiting target improves in line with the national average. Aims/Objectives 2025-2026 (Year 1) KPI Increase compliance with national MSK 4 week waiting time target Improve percentage compliance with 4 week waiting time target to 40% by December 2025 across Physiotherapy, Occupational Therapy and Podiatry MSK services. Develop new models of care which support management of demand into MSK Services Increase website engagement by 20% by December 2025. Facilitate recruitment and retention of MSK workforce 100% of staff have a job plan relevant to their job role by June 2025. Introduce and recruit to MSK podiatry development post by December 2025. Actions 2025-2026 (Year 1) By When 4 week waiting time target • Develop MSK Performance Measurement Plan • Test texting patient with invite to treatment to enable patient focussed booking • Review of MSK conditions where Active Clinical Referral Triage (ACRT) has been implemented and expand to other presentations if able • Routinely use MSK HQ outcome measure at entry and exit from service • Review of MSK referral and vetting guidance • Test early intervention clinic within South locality and assess impact on waiting times with a view to replicating in East and North August 2025 August 2025 December 2025 March 2026 June 2025 August 2025 Develop new models of care which support management of demand to MSK Service • Test texting patients with self-management advice while on the waiting list • Review MSK website content and update where clinically required, improve health literacy, fix broken links, inclusion of printable content • Refine and further testing of Community Appointment Day model including hosting events in the North and South • Robust training and education programme developed for referrers to service • Develop digital patient initiated referral platform for MSK Service December 2025 October 2025 August 2025 March 2026 March 2026 383
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• Utilisation of Community Assets including engagement with primary care; and increased targeted education group clinics. December 2025 Facilitate recruitment and retention of MSK workforce • Review current clinical supervision arrangements ensuring all staff have access to clinical supervision to support staff wellbeing • Embed and further develop development roles within service to ensure resilience and succession planning • Review of skill mix within the service including health care support worker role • Embed a robust MSK education programme for all staff with collaborative delivery across all MSK teams • Collaboratively deliver practice education placements to reduce duplication and enable peer support for students • Implement job planning for all staff within the service • Progress a review to understand the factors currently impacting on recruitment and retention of MSK Physiotherapy staff September 2025 March 2026 March 2026 December 2025 March 2026 June 2025 April 2025 7. Unscheduled Care NHS Ayrshire and Arran has taken a ‘People First’ approach to aligning the unscheduled care priorities and operational guidance through a recovery and reset programme of work through Quarter 4 of 2024/2025. This work focussed on immediate, short term and long term plans to drive improvements on: • Unscheduled care performance metrics; • Quality of care; • Patient safety; • Staff safety, morale and engagement; and • Culture. It was acknowledged and recognised throughout the reset programme that we need to ‘break the cycle’ by carrying out a full reset of processes to support empowering staff to deliver high quality care for all of our patients across our front doors and ward areas. The Unscheduled Care Delivery Plan and improvement actions have been written from the perspective of a refreshed approach across the whole patient journey to support the ‘right care right place’ principles. The plan outlines that we need to take forward a radical organisational journey of change which requires high impact changes to support performance and quality of care. This programme of work also includes actions to support culture change and improve staff engagement. These plans fully align to the focussed piece of data and improvement work carried out by the Centre for Sustainable Delivery in 2023 and throughout 2024. The ‘People First’ initiative focused on three areas of change whilst supporting a financial recovery programme and the ambition to drive best practice. These are noted below in more detail. 384
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1. Leadership A senior leadership group was set up, over and above the existing unscheduled care governance structure, to support the reset and recovery plan for Q4. This has ensured executive level commitment along with enhanced oversight and governance arrangements to drive and monitor the unscheduled care remedial actions to support the improvements at both hospital sites. The commitment to an open and transparent leadership approach was critical to support the ‘People First’ reset with a focus on improving culture and performance whilst balancing quality and safety with front door overcrowding and consistent high occupancy on ward areas. The launch of the ‘People First’ reset has focused on zero tolerance to corridor care, improving ambulance offloads and eradicating full capacity utilisation to support the wellbeing of staff and the dignity of our patients. 2. Function Flow The development and governance to oversee the implementation and delivery of operational strategies focused on reducing the front door overcrowding and performance. In depth reviews were undertaken of the overcrowding across both sites. Site wide processes have been fully reviewed which has enabled an evidence based analysis of flow within areas of the emergency care footprint, Scottish Ambulance offload delays, corridor care and flow through the hospitals. The review of the site wide processes and gaps in process have been developed into a detailed action plan across all divisions and areas. These actions will support continuous flow improvement which feeds into the reset and recovery plan for performance with the ambition to improve our patients’ journeys through the acute sites. A series of system-wide Multi-agency Discharge Event (MADE) took place over two weeks followed by a two week recovery cycle with ward sponsors to support optimising discharges and reducing bed occupancy through the Criteria to Reside process. The learning from these events has also informed the current detailed action plans. Frailty Assessment Units The frailty assessment units were mobilised at both hospital sites in November 2024, with capacity to support patient flow, admission avoidance with Multi-disciplinary Team (MDT) led board rounds. The initial 4 weeks evidenced 33%+ same day discharge. However, this has been impacted with 12% same day discharge due to the restricted flow and productivity through the units due to the site wide high occupancy due to the recent Winter unscheduled care demand. Monthly monitoring will continue through the reset and recovery process. SAFER Phase 1 of a SAFER ‘test of change’ - Senior review of all patients, supporting Flow and Early discharge, supported by MDT Review) has been implemented at the University Hospital Crosshouse site. The first phase has evidenced a 2.5 day reduction in the LOS for 385
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two orthopaedic wards. Quarter 4 of 2024/25 will continue with the embedding of the SAFER board rounds. Phase 2 will commence in Quarter 1 of the 2025/2026 where the SAFER boards will be expanded to other wards to support MDT input to reduce Length of Stay (LOS). Phase 2 will also include the replication of the SAFER process to commence at the University Hospital Ayr site which will be initiated with the same training and workshops that took place at the University Hospital Crosshouse site. Length of Stay Site huddles have had a greater focus on LOS in the Emergency Department and initial assessment units which has led to a new huddle process being implemented to support the decompressing of the front doors through continuous flow. Weekly, long length of stay reviews on the wards have commenced at the University Hospital Crosshouse site led by the Associate Medical Director for the site using an MDT approach. The challenge shared across the board is workforce challenges to support patient discharges with higher packages of care and an improvement workstream to focus on patients with delirium in the discharge process. The weekly long length of stay review process will be implemented at the University Hospital Ayr site during Q4 of 2024/25. Measurement The digital development needed to support the flow processes for unscheduled care has been recognised as a priority area to progress to support live/same day data dashboards to measure continuous flow and daily board rounds. This will be delivered in Q4 of 2024/2025. This will be an evolving area with service driven digital developments. This will further support the culture change journey to share progress on performance and quality with all staff evidencing ‘good news stories’ on their hard work. Best Practice The engagement with staff through focus groups, wider engagement and workshops has supported the ‘People First’ process with a refresh of roles, responsibilities and accountability across the acute sites. This includes a review of job planning across the medical workforce and a review of what resource is required to support 7 days working. The education and coaching to support best practice processes, SOPs and board rounds to enable optimal flow across both sites forms part of the enablers needed to deliver the 2025/2026 Delivery Plan to provide a resilient workforce across the acute sites. The narrative outlined above and the delivery plan outcomes and objectives below and in the spreadsheet builds upon the reset and recovery which has been mobilised through 2024/2025 through the ‘People First’ process and plans. Aims/Objectives 2025-2026 (Year 1) KPI 386
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Improve overall ED 4hr compliance (both unscheduled and scheduled attendances) To at least 80% by March 2026 Reduce time in Emergency Department New metric to be measured: Time to Initial Assessment within 15 minutes = 70% compliance by March 2026 Reduce LOS in ED (daily average) = 17 by March 2026 Reduce 12 hour breaches = 10 by March 2026 Improve Ambulance handover times and hours lost 72% within 60 minutes by March 2026 Reduce SAS conveyances using alternative pathways 6% reduction target by March 2026 Increase >65s discharged from CAU : LOS<72 hours 68% Reduce total delayed discharges for all 3 partnerships <95 by March 2026 Frailty assessment and flow Same day discharges 50% by March 2026 Reduce bed occupancy and LOS 20% reduction in geriatric LOS and 20% reduction in acute hospital LOS Reducing length of stay over 14 days No of patients non-delay LOS >14 days Reducing length of stay for those aged over <65 and >85 20% reduction in geriatric LOS and 20% reduction in acute hospital LOS Develop automated digital site sitreps for circulation 3 times a day, 7 days per week To be scoped – Quarter 1 Develop live digital dashboard for ED performance from Symphony and TRAKCARE Quarter 2 Allied Health Professionals Contribute to the delivery of Caring for Ayrshire models of care in relation to reablement, end of life care and frailty. Improve care pathways providing the right care, from the right person at the right time. Funding and targets to be agreed. Increased activity through frailty assessment units at both sites. Reduced LOS for palliative patients and frailty patients across both sites supported by 3 IJBs community provision and access to community beds. Action 2025-2026 (Year 1) By When Identification of further triage space/changes to environmental structures within the Emergency footprint to support timely patient assessment. Quarter 1 Reset of CAU processes and twice daily board rounds Quarter 1 387
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Implement 2 hourly huddles to support list reviews and escalations. Quarter 1 Develop redirection model and pathways Quarter 2 Development of Bed management standard operating procedures with roles and responsibilities redefined. Quarter 1 Refresh of Escalation/OPEL framework and action trigger cards for acute sites and community. Quarter 1 Continuous flow moves to support timely placing of admitted patients. Quarter 1 Proactive planning by emergency department and bed management team to support ambulance activity and expected demand in community through continuous flow. Quarter 2 Embedding of ambulance escalation process and joint responsibility for handovers and Scottish Ambulance Service responsibility for timely handover Quarter 1 Increase weekend discharges from CAU and Medicine Quarter 1 Scope alternative pathways to support patient centric care at home i.e., palliative care pathway, Homefirst pathway. Quarter 2 - Completion Quarter 4 SAFER implementation on both sites to deliver daily MDT board rounds, supported by a digital solution to capture outcome data. Phased through both sites over 2025/26 Completion 2026 MDT Whole system LLOS reviews and CTR meetings. Quarter 1 Medical workforce review to drive 7 day board rounds to optimise discharges and reduce bed occupancy. Quarter 1 Allied Health Professionals - Develop Multidisciplinary Teams and robust care governance arrangements to enable issue identification, escalation and resolution; - Develop practice development tools and techniques to support innovation, change and excellence; - Ensure effective information sharing across systems, to support positive outcomes for supported people; - Develop targeted responses to reduce the need for specialist level interventions; and - Develop points of access for support, advice and requests for assistance, including advice lines, physical, digital drop-ins and clinical. Completion of acute AHP review and proposal for change agreed and enacted by June 2025. Digital solution to support data capture from referral to completion to be scoped and implemented by late Summer/ Autumn 2025 including development of an AHP digital dashboard. (Subject to approval of the Acute AHP review and subsequent proposal, and subject to investment outlined in the Digital Strategy). Review and develop a whole system approach to improve patient care and flow across the acute and community interface by Winter 2025. 388
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7.1 Delayed Discharges Shifting the balance of care is an objective for all of our services and for everyone we support: from childhood to old age. For older people’s services, a key priority that requires concerted effort is bringing down delayed discharges. A delayed discharge is defined by NHS Services Scotland as “a hospital inpatient who is clinically ready for discharge from inpatient hospital care and who continues to occupy a hospital bed beyond the ready for discharge date”. Reducing delays in discharge from hospital matters for many reasons, but most importantly it is almost never an appropriate place for someone to be if they no longer need hospital care. Time spent in hospital when medically fit is an unnecessary risk to health and welfare, involving risks such as hospital acquired infection and loss of mobility. We will continue our focus on bringing down delayed transfers of care, to get people to the right place for their care needs in Ayrshire and Arran with constant oversight of local performance. Improvement actions for 2025/26 include the continuation of Weekly Delayed Transfers of Care (DTOC) meeting, involving all partners in order to ensure services are allocated to areas of priority. There are a number of working groups looking at double handed care packages with a view to increasing capacity in a way that is safe for patients and staff. Ongoing recruitment with a communications plan in place for recruitment and retention of care staff. Aims/Objectives 2025-2026 (Year 1) KPI Delayed Discharges Reduce the daily average number of occupied bed days due to a delayed discharge. By March 2026 East Ayrshire - 27 North Ayrshire - 99 South Ayrshire - 92 Delayed Discharges Reduce the number of people experiencing a delay of any length or reason in discharge from hospital at the monthly census point. By March 2026 East Ayrshire - 33 North Ayrshire - 99 South Ayrshire - 80 Actions 2025-2026 (Year 1) By When East Ayrshire HSCP • Ensuring a Home First approach across services and pathways; • Service-wide implementation of reablement; and • Implement recommendations from IJB Report on East Ayrshire Community Hospital. March 2026 North Ayrshire HSCP • Maximise capacity and ensure efficient utilisation of care at home capacity to support discharge from hospital including the enhancement of reablement supports in the community; • Ensure robust systems are in place for the management and oversight of complex social work assessments; and • Utilise a Homefirst approach and ensure discharge to assess principles are embedded across Health and Social Care Teams to ensure good discharge planning for people leaving hospital. March 2026 389
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South Ayrshire HSCP • Recruit an additional 40 carers despite the financial challenges; • Maintain care home numbers despite the financial challenges; • Reduce the number of double handling care packages to maximise the spread of care at home; • Maximise the use of step up and step down beds in RRICU; and • Further streamline referral and discharge planning processes for both simple and complex discharges including guardianships. March 2026 8. Urgent Care The new pathways introduced through the Redesign of urgent Care (RUC) programme delivered by the Ayrshire Urgent Care Service (AUCS) has continued to help attract and retain the clinical workforce to sustain rotas for the 24/7 urgent care service in NHS Ayrshire and Arran. The Flow Navigation Centre (FNC) provides rapid early triage and clinical assessment of patients to identify the most appropriate pathway for their care which is provided to people closer to home wherever possible and avoid an acute attendance. This includes appointing patients directly to their local Minor Injuries Unit or alternative community based service. Various other pathways are also embedded within AUCS supported by the FNC including a Call before Convey pathway with Scottish Ambulance Service (SAS). This allows SAS crews to liaise with a senior clinician in the FNC for supported decision making on alternative care options to help keep patients within their own home where appropriate. This pathway works alongside our professional to professional lines for Care Home and Community Pharmacy staff to be supported in relation to clinical decision making ensuring the best outcomes for patients. It also enables patients to be treated/managed within care homes and avoids unnecessary presentations within the healthcare system and by utilising the Pharmacy First Scotland pathway. The Ayrshire Palliative Urgent Care Service was introduced in June 2024 as part of the AUCS FNC. This service improves access to District Nursing Services 24/7 for all patients living in Ayrshire and Arran who are approaching the last few weeks of their life and support for their families. Since June, 94% of patients have remained in their preferred place of care. This model will continue to be developed and embedded within the FNC during 2025/26. Aims/Objectives 2025-2026 (Year 1) KPI Ayrshire Urgent Care Service (AUCS) – at least 85% of patients who contact AUCS will not require attendance at the front door and will receive alternative pathways of care in the right place, at the right time. 85% Create a virtual capacity network by developing a SPOC through Ayrshire Urgent Care Service (AUCS) Flow Seamless pathway to all services for patients. 390
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Navigation Centre (FNC) to encompass the Hospital at Home, Community Rapid Respiratory Response (RRR) programme to ensure a seamless pathway to all services for patients. Maintain the FNC community pathways and explore all opportunities as they arise to enhance the service. Enhanced FNC Community Pathways Develop and embed a community nursing based model for specialist care by supporting palliative patients and families who are within their last four weeks of life within Ayrshire and Arran during the Out of Hours period. A community nursing based model for specialist care to support palliative patients and families who are within their last four weeks of life within Ayrshire and Arran during the Out of Hours period. Actions 2025-2026 (Year 1) By When Develop and embed a referral pathway from AUCS FNC to Hospital at Home Team. March 2026 Develop a referral pathway from AUCS FNC to RRR Service. March 2026 Implement organisational change for RRR and Hospital at Home operational staff to bring them under the SPOC model. March 2026 Scope potential for Ayrshire Community Blood Service (ACBS) to be encompassed within the SPOC. March 2026 Maintain and grow AUCS/FNC pathways with Senior Clinical Decision Maker oversight including appointing to MIU. March 2026 Continue to look for reductions in palliative patients being admitted to hospital who have noted home as their preferred place of care through ongoing data collection. Evaluate responses from patient / family questionnaires to provide insight into the service and identify any improvements. March 2026 9. Primary and Community Care Delivery of safe and effective healthcare provision is a priority for all services to ensure our citizens can access the right care in the right place at the right time. Relationships with service providers across the whole of Ayrshire and Arran, including all Primary Care Independent Contractors, SAS, Mental Health teams and acute services, continues to be strengthened to ensure provision of priority care. The efficient handling of demand by in- hours Primary Care services has enabled Urgent Care to be accessible to those with the most urgent need. Delivered by Ayrshire Urgent Care Service (AUCS), delivery of primary urgent care during the out of hours (OOH) period is a robust well embedded service within NHS Ayrshire and Arran. The team continue to utilise and maximise any opportunity to further review and enhance the service linked to activity and patient outcome data. AUCS continues to test new models of delivery using Advanced Nurse Practitioner models and wider MDT services (e.g. District Nursing, Social Work Services, Emergency Mental Health Crisis Team, and Advanced Paramedics). 391
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A programme for annual review of General Medical Services (GMS) Contracts has been developed and due to be implemented by the primary care team to review practice operating models, quality indicators (including chronic disease management) and identify any improvement work. This will enhance oversight of core service delivery by the Board and help to early identify any issues or additional support GP Practices may need to sustain service delivery. A project is underway to enable the set-up of the national Community Glaucoma Scheme in Ayrshire and Arran. This scheme will enable stable Glaucoma patients to be transferred from acute to community optometry practices for their continued care. Meetings are taking place to aid the roll out of the Open Eyes system that will be used to manage the sharing of patient information from secondary care to primary care providers. The local shared care scheme for Glaucoma patients will continue to ensure wait times are minimised for stable glaucoma patients. We are aiming for a full transition by September 2025. NHS Pharmacy First Scotland is a national service delivered from community pharmacies where citizens can access healthcare advice, treatment and/or referral to other healthcare services without an appointment. The number of consultations by community pharmacy through Pharmacy First Scotland increases year on year which otherwise would have occurred in another part of the primary and unscheduled care system. The addition of independent prescribers allows pharmacies to offer the Pharmacy First Plus service which includes assessment and treatment of acute common clinical conditions which is beyond the scope of the standard Pharmacy First service. 53% of 97 community pharmacies across Ayrshire and Arran offer this enhanced service which reduces the need for onward referral of patients to other healthcare providers even further. The pharmacy team are supporting to train additional pharmacies to become independent prescribers which will facilitate expansion of the Pharmacy First Plus network supporting more patients access care from the right professional for their need as close to home as possible. An Urgent Care Test of Change within Ayrshire Urgent Care Service (AUCS) continues to be rolled out and evaluated working alongside General Practice. This supports local practices with home visits between 3.30pm and 5.30pm. This was developed recognising the impact on access within General Practice when patients present late in the afternoon with an urgent care need requiring a house visit. Rolled out on a phased basis, this model now extends to 44 of 53 GP Practices with the aim to extend to all Ayrshire Clusters by April 2025. Feedback from participating practices has been positive reporting that clinicians can focus on planned appointments without the worry or stress they will be required to attend a last minute house call. NHS Ayrshire and Arran were successful in a recent bid to be a Primary Care Phased Investment Programme (PCPIP) Demonstrator site to work with the Scottish Government and NHS Health Improvement Scotland (HIS). Having commenced in April 2024, Demonstrator sites will be supported to work at pace and use improvement methodologies to fully implement elements of the 2018 GMS Contract, focussing on Pharmacotherapy and CTAC services locally. It seeks to understand the impacts for people, the workforce and the healthcare system with the key aims to improve patient outcomes. Data will be collected and utilised to model full national implementation of priority areas of the GMS 2018 Contract. Development work will also continue alongside this to further embed MDT teams into 392
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practice through the GMS Contract, which would continue in tandem with the focussed work on Pharmacotherapy and CTAC. An Oral Health Needs Assessment was undertaken by Public Health alongside scoping on the vision and strategy for dental services across Ayrshire and Arran. A delivery plan will be presented to NHS Ayrshire and Arran Corporate Management Team for endorsement which sets out the short, medium and long term goals to improve access to dentistry. Oral Health Improvement is a key priority across Ayrshire and Arran. The Oral Health Improvement Team continue to strengthen links within the community, delivering local training programmes, educating the population on good oral health practice, with a priority on prevention and providing support for local groups and events. The team deliver training and interventions for priority groups following recognised national oral health improvement programmes such as Childsmile. The OHI programmes are tailored to individual needs of the population within each of the priority groups. Aims/Objectives 2025-2026 (Year 1) KPI Ensure GMS Enhanced Services meet the needs of the patient population. Review, develop and identify priority enhanced service specifications. Enhance digital telephony within General Practice and move to a single resilient digital telephony platform to enable telephone queuing systems and increase the number of lines into practices. All interested practices surveyed and costed up with 90% of these practices transferred over onto the HB system by the end of year 2025-26. = 40 practices complete. Deliver the Primary Care Phased Investment Programme (PCPIP) to demonstrate what a model of full implementation of the MDT can look like, focussing on CTAC and Pharmacotherapy Services. Continue to progress actions towards the key deliverables. Further embed and explore all opportunities to expand the wider MDT roles aligned to the GMS 2018 Contract which are not included within the Phased Investment Demonstrator Site programme. Expansion of the wider MDT roles aligned to the GMS 2018 Contract. Improve access to NHS dentistry to ensure a sustainable and equitable delivery model which supports the oral health needs of the local population. Improved access to NHS Dentistry. Increased shared care, access to service and patient experience within community Optometry. Community Glaucoma Service (CGS) and Juvenile Idiopathic Arthritis (JIA) service to community optometry implemented within NHS Ayrshire and Arran. Continue to roll out and embed an urgent care pathway for General Practice to refer patients for clinical care and treatment during the out of hours period. Fully deliver the model and embed within AUCS as Business as Usual. Actions 2025-2026 (Year 1) By When Embed a programme of annual reviews for GP Practices to review: - Practice operating models; - Quality Indicators; and - Identify any improvement work March 2026 Programme of review of Enhanced Services and work with wider clinical services to ensure joint up approach within Caring for Ayrshire agenda. March 2026 393
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Phased transfer of GP Practices onto new Board platform. Digital team to link with line providers to progress timeous transfer of lines from practices. 40 practices complete by the end of year 2025- 26. Primary Care Phased Investment Programme (PCPIP) - Expansion/development of the CTAC resilience model and Pharmacy Support Worker team; - Continuation and further development of the Primary Care Practice Educator role; - Audit of demand and activity to capture reliable, ongoing data around CTAC activity at both GP practice and HSCP level; - Undertake a review of the CTAC skill mix and practice allocation and define roles in both CTAC and Pharmacotherapy; - Ensure standardised processes; - Expansion of pharmacy hub; - Test of concept/impact - Advanced Pharmacist Practitioner; and - Evaluate impact of a preceptorship programme. End date for programme is December 2025. NHS Dentistry:- - Improve access to services with the aim to reduce waiting times with a specific focus on emergency and unscheduled care, improving access for people in our most vulnerable groups through; - Support patients to manage their oral health for better health outcomes; - Implement priorities and objectives identified from the programme of work to develop the vision and strategy for dental services; - Invest in the development of dental workforce to improve retention and capacity; and - Review of current care within practices with the aim to provide a greater range of services within General Dental Practices. March 2026 Community Optometry:- - Implementation of the Community Glaucoma Service (CGS) within NHS Ayrshire and Arran; and - Roll out the Juvenile Idiopathic Arthritis (JIA) service to community optometry. March 2026 June 2025 Urgent Care Pathway for General Practice:- - Extend the urgent care General Practice model to cover all GP Clusters across Ayrshire; and - Extend to a model for pre-bookable appointments at an AUCS primary care treatment centre following a referral from General Practice. September 2025 December 2025 10. Mental Health The Mental Health and Wellbeing Strategy MHWBS published in September 2023, sets out a vision of a Scotland, free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible. Locally we will take a life-course approach to understanding mental health and will endeavour to develop a programme of work, with partners, over the coming year to identify and align actions in Ayrshire and Arran to the national delivery plans. Also published in September 2023, The Core Mental Health Quality Standards (CMHQS), sets out the expectations for what services will provide and are structured around the themes that emerged from engagement with people with lived 394
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experience of using mental health and psychological services and the workforce. Along with the Core Mental Health Quality Standards, 4 service specifications have been published in the past 24 months and are being implemented across NHS Ayrshire and Arran: • National Specification for Psychological Therapies and Interventions; • National Specification for Eating Disorder Care and treatment in Scotland; • CAMHS Service Specification; and • Children and Young People – National Neuro-developmental specification. Since the publication of the new strategy and delivery plan in 2023, Mental Health Services have undertaken a mapping exercise of the existing local priorities and outcomes as set out in the Ayrshire Mental Health Conversation against the Mental Health and Wellbeing Strategy Delivery Plan. We are assured that local priorities and outcomes in place and The Ayrshire Mental Health Conversation: Priorities and Outcomes (2019 -2027) continue to be reflective of the three areas of focus and 9 outcomes set out in the Mental Health and Wellbeing Strategy. A Mental Health and Wellbeing Workforce Plan was published in November 2023 in recognition that delivering on the Mental Health and Wellbeing Strategy can only be achieved with the right workforce, supported to have the right skills, in the right place at the right time. As in other service areas, there are significant workforce challenges facing Mental Health services. The Community Mental Health Team (CMHT) have not seen the same levels of investment as other Mental Health services in recent years. This has led to a significant gap in service demand and capacity. Recognising recruitment challenges for qualified Mental Health workers (with many posts expected to take up to a year to fill), the service will consider new advanced/enhanced roles and different ways of working. In CAMHS, recruitment challenges are particularly around Psychiatry, Nursing and Psychology. The service will continue to look at the skill mix required for the service, based on these challenges, recruit more Allied Health Professionals (AHP’s) and look at innovative ways to encourage Psychiatrists to work in Ayrshire. Psychological Services are also experiencing challenges in recruiting to specific priority posts, including Child and Adult Mental Health in the Community. Although training places are increasing year on year, there is currently an insufficient specialist workforce to fill all vacant posts across Scotland so there is currently a competitive workforce context. Within 2025-26 we continue work to ensure the mental health built estate enables the delivery of high quality, person centred and safe care, with a focus on implementing the national Mental Health Built Environment Quality and Safety toolkit. In addition to work on the building toolkit, we continue to utilise the Scottish Government infrastructure budget to support digital pilots. The newly refurbished West Road CAMHS/CEDS unit will launch early in 2025 following circa £600k investment and we plan to refurbish Kilne Walk in Irvine for our Perinatal Mental Health service. Early stage improvement work is being assessed for Ward 7a at Woodland View and the Mental Health Assessment Hub opened in 2024 all with infrastructure investment. 10.1 CAMHS 395
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Within Ayrshire and Arran, CAMHS services are provided by multi-disciplinary teams that provide assessment and treatment/interventions in the context of emotional, developmental, environmental and social factors for children and young people experiencing mental health problems. This is provided through three distinct teams to ensure that children and young people are on the correct pathway at a much earlier stage: Specialist Community CAMHS (SCAMHS), CAMHS Urgent Assessment and Intensive Treatment (CUAIT) and Neurodiverse CAMHS (N-CAMHS). Whilst transforming and developing our services we will continue to learn from children, young people, families and Carers with ‘Lived Experience’ of the service and continue to work to gain feedback through KIDSCREEN which is a health related quality of life questionnaire for children, young people and their parents. Within 2025/26 CAMHS will continue to work towards the waiting time targets set out in the CAMHS NHS Scotland National Service Specification. Already CAMHS has met the 4-week first appointment response time in alignment with the national specification through a redesign of the service and implementation of the three pathways and by fully implementing the revised service access criteria of accepting only those referrals where there are underlying mental health needs in alignment with the national specification. This has enabled meaningful redirection of referrals to wider whole system supports and services to more appropriately meet the needs of children and young people who do not have an underlying mental health condition. Focus is now on providing interventions and treatments, where required and agreed with children, young people and families/carers, as soon as possible, and no later than 18 weeks from first referral, with the median experienced wait for treatment being no longer than 12 weeks. Within 2024/25 NHS Ayrshire and Arran worked in partnership with North Ayrshire Council to create a specialist centre for CAMHS, as well as the all-age Community Eating Disorder Service (CEDS) in Ayrshire and Arran. With building works completed in 2025, the centre at West Road, Irvine will aim to change the way the residents of Ayrshire and Arran access and receive mental health care. It will also provide a base for outpatient services for the CEDS and Neuro-CAMHS team. In addition, we will continue to work with our IT systems and through a programme of wider transformation linked to the Mental Health Digital Transformation Board, will endeavour to develop effective data collection systems that provide robust data and reports to inform service improvement, redesign and monitoring of performance. This will also prepare the service for reporting on delivery of the forthcoming Mental Health Standards. Aims/Objectives 2025-2026 (Year 1) KPI Improve access to mental health service and build capacity and sustainable delivery to maintain the CAMHS 18 week RTT and work towards the 4 week target within National Specification. 18 week RTT and 4 week SG Target Improve service delivery and resilience with the recruitment and retention to CAMHS workforce. % staff retention in key disciplines Improving mental health environment and patient safety. Feedback from young people, parents/carers through QR codes to Microsoft questionnaires, Care Opinion and verbal feedback through CAMHS Participation Officer. 396
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CAMHS will continue to learn from children, young people, families and Carers with ‘Lived Experience’ of the service. Feedback from young people, parents/carers through QR codes to Microsoft questionnaires, Care Opinion and verbal feedback through CAMHS Participation Officer. N-CAMHS will continue to see young people who are currently on the N-CAMHS waiting list. The N-CAMHS waiting list will be reduced and young people will be seen more timeously. Actions 2025-2026 (Year 1) By When Using Trakcare and CAMHS Benson Wintere DCAQ Model to identify ways to meet the additional contact at 4 weeks. March 2026 Further develop and expand on the skill mix of the workforce in particular encouraging Psychiatry and Psychology posts to CAMHS. March 2026 CAMHS business case will have been developed for CAMHS Inpatient beds in Ayrshire on the Woodland View Site. Recent communications regarding capital spend whilst remaining a key objective will result in a delay, whilst potential funding streams are sourced. Start discussions for Inpatient facility 2025/26 Access qualitative feedback through Kidscreen as well as quantitative data. Ongoing Commission external providers to assess children and young people. March 2026 10.2 Psychological Therapies The latest published data, November 2024, indicates that compliance for Psychological Therapies (92.8%) remains higher than the Scotland average. Developments over the next 12 months will address the requirements and standards dictated by the Psychological Therapies Service Specification with a specific program of work, linked to Scottish Government timescales, for implementation. The Self-Assessment tool to consider compliance with the Psychological Therapies Service Specification will be available from January 2025. Some parts of Psychological Services have already started with mapping their service delivery against the service specification and improvement work is underway. This work is led by the Senior Psychology Leadership team and will involve cross discipline and specialty engagement to ensure adequate outcomes. Dedicated clinical governance routes have now been established with the start of the Psychological Therapies and Interventions Clinical Governance Group and the Psychological Services Clinical Governance Group. Both groups are chaired by the Director of Psychological services. Patient centred areas of focus will continue to address issues of longest waits, matched- stepped care within services for children and young people, neurodevelopmental service provision (both Children and Adults) and whole board alignment to the updated Matrix Treatment Recommendation for Psychological Therapies (2023) and the implementation of the National Specification for the delivery of Psychological Therapies and Interventions (Scottish Government, September 2023). This will sit alongside continued work in ensuring a Trauma informed approach is embedded within all directorates of the organisation. 397
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Working with partners in acute/ neurological services to increase workforce capacity of the psychological therapy provision is a key objective. Specific gaps in Cancer Care and Stroke need to be considered as a priority. Ayrshire and Arran has been successful in obtaining funding to be a pilot site for Early Intervention in Psychosis. Recruitment is underway and establishment of Early Intervention in Psychosis service is planned for Quarter 1 2025/26. Risks over the coming financial year are the reduction in Scottish Government funding streams and savings targets. Reduction of these streams of funding risks a significant impact on core mental health services. The lack of allocation to Primary Care funding also adversely impacts on demands upon secondary care and our ability to meet waiting times targets. Implementation of the National Specifications relating to children and young people with neurodevelopmental conditions, and the Community Wellbeing Framework for Children and Young people, are considered important to specialist secondary mental health services being able to meet waiting times targets. These specifications sit outside specialist mental health, but any failure will directly affect the pressures upon our service. Recent work within the areas of Child and Adult Neurodevelopmental Assessment has concluded that development of sustainable assessment services will necessitate specific, additional funding requests to meet the increasing demand for neurodevelopmental condition assessment and treatment. Aims/Objectives 2025-2026 (Year 1) KPI Improve overall 18 week RTT to consistently comply with standard across all specialisms. RTT 92% Implementation of Psychological Therapies and Interventions (PT&I) Standards. Psychological Therapies and Interventions (PT&I) Standards implementation Improve service delivery and resilience with the recruitment and retention of Psychological workforce. Improved service delivery and resilience Actions 2025-2026 (Year 1) By When RTT - Detailed Trajectory work in different specialisms - DCAQ; - Further analysis and formulation of data to create better understanding of reasons behind access in struggling specialisms; and - Redesign of service delivery model where needed. March 2026 - Assessment Tool for PT Spec implementation will be rolled out. - Assessment to commence for all Psychological Therapy specialties/teams. - Engagement with wider services delivering Psychological therapies needed. September 2025 - Through data and trajectory analysis gain more clarity on workforce gaps and skill mix/safe staffing levels; and - Develop workforce plan for overall service. March 2026 10.3 Community Mental Health Services 398
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Adult Community Mental Health Services are devolved in Ayrshire and Arran to their respective Health and Social Care Partnerships (HSCP). Although they might work and look slightly different in each area, the fundamental service delivery is the same. As such the following aims/ objectives have been agreed collectively by all three HSCP’s. Aims/Objectives 2025-2026 (Year 1) KPI To implement the Core Mental Health Standards into Adult Community Mental Health services. Implementation of the Core Mental Health Standards To ensure that individuals have access to mental health services within primary care in order to ensure we are supporting prevention and early intervention agenda. Access to mental health services within primary care. Ensure service delivery aligns to and contributes towards national strategies relating to mental health. When needed, provide complex or specialist treatment quickly, effectively and to the highest standard. Minimise average (median) wait for initial assessment (Community Mental Health Team). Maximise % of people subject to Mental Health Act supported via care programme. Actions 2025-2026 (Year 1) By When Benchmark current service against Core Mental Health Standards. Identify gaps in attainment, what controls and supports are required to attain them. Seek appropriate help to attain controls and supports required. Re-evaluate impact and efficiency of implementation. March 2026 Deliver the integration of the primary care mental health workforce into wider primary care multi-disciplinary teams and community and secondary care. March 2026 10.4 Unscheduled Care The Unscheduled Care Mental Health Service is delivered Pan Ayrshire, managed operationally by the North Ayrshire HSCP. The service has seen many developments and opportunities for growth over the past number of years. The main aim is to embed service changes, and this year to ensure local delivery is in attainment or excel of national standards. Aims/Objectives 2025-2026 (Year 1) KPI Reviewing local Psychiatric Emergency Plans to align them to the national template. Alignment of local Psychiatric Emergency Plans to national template. Actions 2025-2026 (Year 1) By When Psychiatric Emergency Plans - Identify national template; - Benchmark local planning against national template; - Identify gaps and adaptations required of local plan; and - Update and ensure appropriate engagement with stakeholders. March 2026 399
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10.5 In Patient Within the Mental Health Inpatient Service key priorities for 2025/26 will be to improve patient flow, reduce the average length of stay and number/duration of delayed discharges. To support these improvements and deliver a more coherent system of forensic mental health services, we will work to: • Improve referral pathways and increase expectation of ‘pace’/throughput; • Implement more robust bed projection processes; • Continue to develop relationships with the West of Scotland Forensic Network, being part of wider bed capacity solutions; • Continue to review impact of recently opened Unscheduled Care Assessment Hub and opportunities for Adult Mental Health Admission wards; • Review persons subject to unplanned (UNPACs) placement and repatriate locally as clinically appropriate; • Seek support to develop a Data Dashboard to provide robust data on service performance against key measures to inform service delivery and improvement; and • Utilise the new Band 4 Assistant Practitioners to enhance service delivery, reducing supplementary staffing spend. Aims/Objectives 2025-2026 (Year 1) KPI Improve patient flow by reducing ALOS from Q1 Baseline. By March 2026 Average Length of Stay AMH Acute = tbc days EMH Acute = tbc days Improve patient flow by reducing duration of delayed discharges from Q1 Baseline. By March 2026 Delayed Discharges AMH Days = EMH Acute days = Deliver a more effective system of Forensic Inpatient Services. . Referral Pathways agreed/implemented. Ongoing participation in West of Scotland Forensic Network meetings. Increased scrutiny around UNPACs referrals to exhaust all local solutions. Themed analysis of persons subject to UNPACs to consider generation of local options. Reduce supplementary staffing spend. Q3 – reduction of 5% Q4 – further 5% reduction Actions 2025-2026 (Year 1) By When Reducing LOS March 2026 400
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Robust bed management processes including use of traffic light system to monitor progress against PDD. Analyse impact on admission patterns of unscheduled care assessment hub opening and activity for AMH Acute beds. Reducing Duration of Delayed Discharges Monitoring/escalation of delayed discharges via Discharge Liaison Groups. Participate in HIS supported workstream to review Delayed Discharges and identify improvement actions. Ongoing Initial engagement September 2024. Scoping programme currently with expectation of recommendations April 2026. Forensic Inpatient Services Generate and implement referral pathways to increase ‘pace’/throughput. More robust bed projection processes. Continue to develop relationships with WoS Forensic Network, part of wider bed capacity solutions. Look to repatriate persons on UNPACs placement as soon as possible. March 2026 Reduction of use of supplementary registered staff from Q3 2025/26 on Band 4 APs taking up post. March 2026 10.6 Alcohol and Drug Service NHS Ayrshire and Arran work with partners to support the National Mission on Drugs to reduce drug related deaths and improve lives. Priority areas include the implementation of Medication Assisted Treatment (MAT) Standards, delivery of the treatment target and increasing access to residential rehabilitation. Services will prioritise the delivery of the MAT standards by implementing their local improvement plans with the support of the national MAT support team (MIST). Whilst reviewing and improving MAT access through established community alcohol and drug services, the additional focus over the next 3 years will be on implementing actions to support MAT access through wider settings e.g. primary care, prison and police custody. A specific challenge in implementing and embedding MAT within primary care is the absence of recurring funding. Discussions continue with colleagues across primary care, finance, the Health Board, Health and Social Care Partnerships (HSCP’s) and Alcohol and Drug Partnerships (ADP’s) to highlight the funding challenges and explore ways to continue to resource this work. Services will continue to offer an ‘open’ referral process and be flexible in their approach to meet the ongoing national ‘Access to treatment’ waiting time’s standards. The promotion of Alcohol Brief Interventions will continue across core and wider settings. We will work with our partners to implement additional measures to reduce both drug and alcohol related deaths. Increased support will be available to individuals following a Non-Fatal Overdose, local ADP drug related death prevention strategies will be implemented, improved pathways 401
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of support will be available to better support individuals with co-occurring mental health and drug and/or alcohol use (with updated guidance being available for staff) and Naloxone related training and supply will be prioritised. In March 2022, the Minister for Drug Policy set a new ‘substance use’ treatment target to increase the numbers of individuals accessing treatment support by April 2024. Pathways and processes are in place to offer quick access to treatment including having an ‘open’ referral system and supporting more individuals into treatment via MAT interventions. In terms of a future target, post April 2024, services are awaiting new information whilst advice has been sought from the Minister. Individuals from across Ayrshire and Arran will continue to be supported, as required, to access local hospital based detoxification and rehabilitation support via Ward 5, Irvine. Families will be prioritised for support via access to the national family support facility (Harper House) based in North Ayrshire, who provide safe, structured support for the whole family to address their problematic drug and/or alcohol use, improve their mental health and quality of life. Individuals will also be supported to access external residential rehabilitation, however, due to current demand, the challenge will be securing sufficient funding from local ADP’s and/or the Scottish Government. Aims/Objectives 2025-2026 (Year 1) KPI Consistently deliver safe, accessible, high quality drug treatment across Ayrshire and Arran. Sustain delivery of MAT Standards Meet national 'access to treatment' Waiting Times Standards of 90% of individuals to commence treatment within 3 weeks of referral and 100% within 6 weeks. Treatment Waiting Times Standard 90% within 3 weeks North Ayrshire – 90% South Ayrshire – 90% East Ayrshire – 90% 100% within 6 weeks North Ayrshire – 100% South Ayrshire – 100% East Ayrshire – 100% Ensure naloxone remains a priority and is accessible for those who most need it. Minimum kits will be supplied by March 2026 North Ayrshire - 480 kits East Ayrshire - 330 kits South Ayrshire - 350 kits Build upon the residential rehabilitation pathways for individuals from pre rehabilitation, during and post rehabilitation. Review and improve on current Residential Rehabilitation Pathway and Integrate use of the Scotland Excel rehabilitation provider framework into the pathway. Actions 2025-2026 (Year 1) By When North Ayrshire Benchmark current provision to support individuals seeking help for stimulant and benzodiazepine use. Work with partners to identify gaps and improvements, implement agreed actions and evaluate. March 2026 North Ayrshire March 2026 402
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Implement local Naloxone action plan, offering Naloxone training, raising awareness and promoting use of Naloxone. Supply a minimum of 480 Naloxone kits (and emergency life-saving intervention). North Ayrshire Continue to implement pathways of support into, during and after residential rehabilitation through the co- ordination and support of a Single Point of Contact (SPoC) and Recovery Development Workers (RDW) - peer workers. March 2026 East Ayrshire An increase in ANP/ Clinical Nurse Specialist and Specialist GP in our rural cluster areas to improve access at a primary care level. March 2026 East Ayrshire Via the Multi agency Residential Rehabilitation Working Group, develop and implement the Residential Rehabilitation pathway which is clear, consistent and easy to navigate from pre rehabilitation to post rehabilitation stage. March 2026 East Ayrshire Rapid Access to Drug and Alcohol Recovery Service will work with HMP Kilmarnock Healthcare to implement a process to enable individuals who are East Ayrshire residents and are prescribed Opiate Replacement Therapy to be provided with a "Safe Talk" via Near Me. March 2026 East Ayrshire Implement the use of Near Me technology for planned liberations from HMP Kilmarnock for individuals who are prescribed Opiate Replacement Therapy. March 2026 East Ayrshire Deliver a Recovery Oriented System of Care for drugs and alcohol via the Alcohol and Drugs Partnership Strategic Plan. March 2026 South Ayrshire Test of change (TOC) in South Ayrshire to demonstrate proof of concept for a model to deliver on MAT 7. TOC will be evaluated in 2026, for any further developments or improvements. 10.7 Learning Disabilities Learning Disability Services are delivered within each of the Health and Social Care Partnerships, with North Ayrshire HSCP taking the lead in relation to some elements of shared delivery, specifically the Assessment and Treatment facility delivered in Ward 7A Woodland View. The model of delivery within Ward 7A has already undergone review in recent years, with the result that the number of beds available within the ward have been scaled back in order to create a better care environment. Despite these positive changes, issues within the ward, compounded by the ongoing problem of delayed discharge linked to limited availability of appropriate community supports, have created an urgent need to again look closely at its model. This is being done with a view to informing possible changes, and the work is being led by North Ayrshire HSCP. The need for this work is further highlighted by the publication of reports by the Scottish Human Rights Commission (2025), and by the Mental Welfare Commission (2025), regarding the situation regarding delayed discharges across Scotland, and the lack of progress nationally in relation to meaningful delivery of human rights informed in this regard. 403
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This national focus on hospital admissions is complemented by a national focus on more preventative activity, ideally delivered within Primary Care, namely Annual Health Checks. Implementation of the Scottish Government’s new specification regarding Annual Health Checks for people with learning disabilities has been progressing at pace within Ayrshire. This work has benefited to a large degree from the pre-existing work around the establishment of GP Registers of people with learning disabilities, linked to a previous Enhanced Service specification. While a great amount of positive work has been undertaken regarding delivery of the new Health Checks, there remains an awareness of the need to learn from their delivery, and that of the Learning Disability Health Checks which preceded them, with a view to informing future activity. To a large degree, this reflects findings of note identified in initial delivery of the new checks in North Ayrshire, including the large number of individuals for whom the check identified no required actions (over those already in place). In their ideal form, the Annual Health Checks represent an opportunity to support mainstream and other services in meeting their obligations regarding the care and inclusion of people with learning disabilities. While much evidence already exists regarding the needs of people with learning disabilities, and how services can best respond to these, understanding this from a local context remains a necessary activity. With this in mind, the North Ayrshire Learning Disability Service has commenced a collaboration with the Local Information Support Team from Public Health Scotland, with a view to understanding the service use and health needs of the local known learning disability population; how this might differ the general population; and what this suggests about relevant service responses. While this work has started with a focus on North Ayrshire, the hope is that LD Services in East and South Ayrshire will also become involved. Aims/Objectives 2025-2026 (Year 1) KPI Continue delivery of Annual Health Check under new specification, and identification of learning and innovation opportunities linked to this and pre-existing experience of delivery of enhanced primary care services to people with learning disabilities across Ayrshire. Delivery of report on 2025-26 activity and identification of development plans for coming years. Building on work to date, review provision of care and built environment within Ward 7A, with a view to identifying necessary development work for enhanced or alternative provision. Deliver relevant change in model of inpatient delivery. Further develop collaboration with Public Health Scotland (Local Information Support Team) as part of a broader programme of learning and co-design within the service, with a view to annual delivery of reporting. Annual delivery of reporting. Actions 2025-2026 (Year 1) By When Develop an overarching understanding of activity and associated outcomes linked to delivery of the new Health Checks in each Ayrshire authority. April 2026 Benchmark against provision elsewhere in Scotland; review admissions to date and associated learning e.g. around admission avoidance; explore workforce requirements, informed by recruitment to date and use of Bank Staff; review delayed discharges to date and implications. July 2025 404
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Continue to link regularly with PHS colleagues and ensure appropriate use of learning data, as well as ensuring that the LIST team stay informed about and involved in the ongoing learning and improvement work. Ongoing 11. Healthcare in Custody In 2023 the Scottish Government established a Short Life Strategic Leadership group to drive meaningful improvement to prison health care. This identified three priority areas with one of these being to develop a Target Operating Model (TOM) for healthcare service delivery. The National Prison Care Network has been asked to lead on the development of a TOM. The aim of this work is to provide a framework for nationally consistent model for healthcare delivery in prisons alongside tangible change ideas to deliver this. A TOM has been developed with 9 domains identified. Baseline information has been recorded with a plan for 6 monthly updates of progress made that is shared in a data dashboard. Areas of work have been identified with the HMP Kilmarnock healthcare leading on national work in relation to the prison admissions process. Drug misuse treatment and reducing drugs deaths continue to be a priority for service improvement. Nationally the MIST team are co-ordinating work on the delivery of MAT standards in custodial settings with a prison toolkit being finalised. Reporting on progress of MAT standards in custodial settings will commence in 2025. Improvement work for prison healthcare is in the context of some particular service pressures following HMP Kilmarnock moving from SERCO the private provider to the Scottish Prison Service in March 2024. Principally these are in relation to an 18% increase in the prison population and changes to the prison regime which have an impact on clinical service delivery. Aims/Objectives 2025-2026 (Year 1) KPI Further progress implementation of Medication Assisted Treatment (MAT) standards working with the national MIST (MAT implementation Support Team) to embed practice improvement in prison setting and develop improvement areas in Police Custody. Implementation of Medication Assisted Treatment (MAT) standards in Prison and Police Custody. Progress service improvement in priority areas identified by the Target Operating Model under the oversight of the National Prison Care Network (NPrCN). Particular focus on prison admission process where development is being led by HMP Kilmarnock healthcare. Implementation of service improvement in priority areas identified by the Target Operating Model. Actions 2025-2026 (Year 1) By When MAT Implementation • Benchmark HMP Kilmarnock practice against Prison Toolkit which is anticipated to be finalised in March 2025; • Develop recommendations from review of staff training and support needs in relation to MAT 6 & 10; • Recruitment of Psychology post; March 2026 405
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• Complete framework for range of evidenced interventions to be delivered by mental health MDT and addiction team; and • Explore improvement areas that be delivered by existing on-call FME healthcare model. Target Operating Model • Six monthly (April / October) reporting into National Prison Care Network (NPrCN) on progress of improvement areas; • Agree revised model focussing on immediate risk and need on day of admission and follow up appointments for holistic assessment of healthcare need; • Build new admission process on Vision; • Test revised model; and • Undertake evaluation of revised model with focus on evidence of improved outcomes and areas of model that may require adaptation. March 2026 12. Pharmacy The priorities for the pharmacy directorate in 2025/26 are to support our key areas of risk, cancer services including aseptic dispensing; to deliver the objectives of the Primary Care Phased Investment Programme (PCPIP); to support acute services to optimise patient flow and minimise delays to discharge; and to work collaboratively with regional colleagues on developing and implementing a Regional Medicines Formulary and joint priorities to support clinical pharmacy services using Hospital Electronic Prescribing and Medicines Administration system (HEPMA). Focussing on digital solutions to support clinical pharmacy service delivery will lead to movement of the workforce away from tasks that can be automated to more complex roles such as polypharmacy reviews and long term condition management. Where additional workforce is required this is dependent on available funding and available workforce. Limited pipeline of pharmacists via the Foundation Training Year Trainee Pharmacist programme and lack of pipeline of Pre-registration Pharmacy Technician Trainees are key risks to recruitment to support the additional workforce required to deliver safe care to patients in high care areas, cancer services and to deliver pharmacy services across 7 days. Uncertainty regarding ongoing funding of workforce recruited to the PCPIP is also a risk to delivery of the programme and, subsequently, fuller implementation of pharmacotherapy. Aims/Objectives 2025-2026 (Year 1) KPI Work with colleagues in the West of Scotland to develop a Regional Formulary process and implement a Regional Formulary. The development of a Regional Formulary process and implementation of a Regional Formulary. Deliver the pharmacotherapy elements of the PCPIP demonstrator site programme. PCPIP demonstrator site programme pharmacotherapy elements delivered. Scope the redesign and delivery of 7 day clinical pharmacy services to critical & high care areas to improve compliance with national standards for clinical pharmacy services and contribute to reducing length of stay. Deliver a 7 day clinical pharmacy services to critical & high care areas. 406
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Scope the expansion and delivery of the current 7 day operational pharmacy service to provide an equitable service across the full week. Equitable pharmacy service across the full week. Work with colleagues across NHS Scotland THBs to implement, maintain and develop the Pharmacy Early Warning (PhEW) score to ensure patients are prioritised appropriately for clinical pharmacy review. Implement, maintain and develop the Pharmacy Early Warning (PhEW) score. In line with Scottish Cancer Action Plan 2023-26, ensure available pharmacy infrastructure, capacity and workforce to ensure that SACT medicines are available to people with cancer. SACT medicines are available to people with cancer. Actions 2025-2026 (Year 1) By When Regional Formulary process - Project working group to be convened; - Key project personnel to be recruited; - Governance processes to be developed, agreed by ADTCs and implemented; - Board Formulary processes to be stood down; and - Regional Formulary Governance structure to be implemented following approval by Board ADTCs. March 2026 PCPIP demonstrator site programme - Expand pharmacy support worker role in delivery of service; - Clearly define roles of each member of the team- right person, right task; - Expand pharmacy hubs - skill mix and resilience; - Develop a supervision/ preceptorship programme to improve pharmacists confidence in clinical decision making and risk management; and - Test and evaluate Advanced Pharmacist Practitioner role. March 2026 7 day clinical pharmacy services critical and high care areas - Identify clinical areas where 7 day clinical pharmacy service is required; - Design service specification, define roles and scope workforce required to deliver ensuring right person right task; - Secure funding to recruit workforce; - Address any contractual changes required; and - Implement training programme to ensure appropriate skillmix and resilience for service delivery over 7 days. March 2026 7 day operational pharmacy service - Agree the operational areas that require to be covered at weekends; - Scope the workforce required to deliver the service robustly; and - Ensure appropriate skills mix and secure funding to recruit additional workforce to deliver this service. March 2026 Pharmacy Early Warning (PhEW) score - Implement PhEW tool to all WoS boards; - Identify boards out with WoS wishing to adopt PhEW; - Provide clinical and digital pharmacy support to adopting boards to ensure successful implementation; - Establish SLA with participating boards; - Embed governance process for maintenance and validation of PhEW score; and March 2026 407
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- Scope clinical specialties that would benefit from bespoke PhEW score, develop modified PhEW score for identified clinical specialties. Scottish Cancer Action Plan 2023-26 - Review Cancer Forward-Look reports to anticipate growth in SACT provision; - Complete capacity planning exercises for aseptic and dispensary areas to ensure appropriate capacity for growth; - Implement SACT Dispensing Hub to ensure capacity, dedicated workforce and appropriate procedures for safe dispensing of SACT; - Complete workforce review to inform recruitment, training and allocation; - Regularly evaluate provision of SACT services, workforce and capacity; and - Implement training programme to ensure appropriate skill mix and resilience for service delivery. March 2026 13. Infrastructure Scottish Government issued a Director’s Letter (DL) to all NHS Boards outlining the requirements for all NHS Boards to prepare a whole-system infrastructure plan. Since receiving this, efforts were renewed on the whole-system Programme Initial Agreement (PIA) document. Work was restarted and has been repositioned to reflect the impact of the pandemic and the reform narrative will form the whole-system PIA, our plan is to become operationally and financially sustainable through significant reform. This version builds upon the original PIA while incorporating the specific details requested in the DL letter. Scottish Government indicated in the DL that the PIA should be submitted by NHS Boards in January 2026 however, given the substantial progress made, NHS Ayrshire and Arran intends to submit this PIA document in draft in January 2025, aligning with the submission of the Business Continuity Plan. At this stage, we do not anticipate formal feedback on the PIA but rather seek a discussion with Scottish Government on its content and the proposed direction of travel. The whole-system PIA narrative will empower us to focus on engaging our stakeholders, communities, staff and services in the essential work now needed to take service reform and redesign to the next level. To deliver on our Caring for Ayrshire ambition, it is crucial that we elevate our engagement with stakeholders, to actively listen and learn from their experiences and perspectives. Our commitment to effectively engage with citizens, communities, and staff is paramount. We therefore propose a comprehensive approach, involving widespread stakeholder engagement using co-production methodologies to redesign care models with a ‘whole system’ perspective. We will maintain open and transparent communication and engagement with both internal and external stakeholders, as well as our citizens, to inform and shape the programme. A dedicated engagement and communications group will provide advice, support and guidance on all associated stakeholder engagement activity aligned to the Caring for Ayrshire ambition. Engagement and communication will be embedded throughout work 408
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streams and plans, to provide clarity, guidance and consistency for those leading on the high impact changes. The Board’s Business Continuity Plan (BCP) was submitted to Scottish Government in January 2025 and confirmation of what funding will be provided is expected by end of March 2025. The Board’s submission plans for an additional £12.2m of funding for FY25-26 with main areas of expenditure targeting: • Improved accommodation for Critical Care and Oncology at UHC; • Purchase of and improvement works to several GP Premises; • Backlog Maintenance Work; and • Investment in digital and medical equipment. What will be able to be delivered will be dependent upon the final funding allocation provided by Scottish Government. Sustainability and Net Zero investment will be reflected through investment in building infrastructure. Aims/Objectives 2025-2026 (Year 1) KPI Ensure that sustainability and net zero aspirations are embedded within brief requirements for major developments and comprehensive refurbishments. March 2026 Improve utilisation of accommodation to support the reduction in energy use. March 2026 Actions 2025-2026 (Year 1) By When Distributed Working and Estates Rationalisation. TBC Completion of Lister Street Distributed working Hub. 31 March 2025 Consolidate non clinical offices within Ailsa Main Building facilitating exit from Eglinton, Greenan and Stair Buildings. TBC (Except Eglinton Meeting Room 1) TBC (Including Eglinton Meeting Room 1) Exit from Afton House. Demolition of Arrol Park Houses 4 to 9. 30 April 2025 Demolition of Lochranza ward, Ailsa. TBC Demolition of Eglinton Greenan and Stair Building. TBC Demolition of Afton House, Ailsa. TBC Commence design and procurement work for wind turbine UHA. 30 April 2025 (Subject to BCP funding) 14. Community Wealth Building / Anchor NHS Ayrshire and Arran has developed an Anchor/Community Wealth Building (CWB) Strategy to harness our power as an anchor institution and to positively impact health, social, economic and environmental outcomes in Ayrshire and Arran. NHS Ayrshire and Arran’s Anchor / Community Wealth Building (CWB) Strategy 2023-26 sets out the Board’s plans to deliver on the anchor organisation ambitions alongside our anchor partners in the Ayrshire 409
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Community Wealth Building Commission and in support of the Ayrshire Regional Economic Strategy and the Ayrshire Growth Deal. The strategy sets out the Board’s ambition to support creation of a fair local wellbeing economy which enhances local wealth, reduces poverty and inequality through investing and spending locally, creating fair and meaningful employment, designing and managing our buildings, land and assets to maximise local and community benefits and reduce our environmental impact. Tackling Ayrshire’s social and economic inequalities will not be easy. Poverty rates in Ayrshire and Arran are higher than the Scottish average, Ayrshire’s workforce has fewer qualifications, and it is forecast to experience less economic growth and greater reductions in workforce in the short and medium-term. Given these stark economic inequalities, if Ayrshire’s health inequalities are to be reduced, strategies must tackle the ‘fundamental causes’ driving inequality. This requires a joined-up approach, bringing together local partners to tackle inequality and to maintain a long-term vision of developing a local Ayrshire wellbeing economy. Our Anchor/CWB programme is governed by the Community Wealth Building Programme Board which meets quarterly. Our Anchor/CWB Programme focuses on the six pillars of Community Wealth Building (Fair Work/ Workforce; Procurement; Land and Assets; Financial Powers; Service/ Plural Diverse Ownership and Climate Change) with leads appointed for each pillar. The Anchor/CWB Year 2 Annual Report was presented to the NHS Board in October 2024. The report provided assurance that progress has been made to deliver on NHS Ayrshire and Arran Anchor/Community Wealth Building (CWB) Strategy in line with requirements of the NHSScotland Annual Delivery Plan 2024. The report shared progress to-date on building our Anchor/CWB programme demonstrating some of the work carried out during year 2 of the programme. A Year 3 plan has been drafted and will be presented through governance in Quarter 4 2024/25 for approval. The Community Wealth Building Programme Board will continue to progress workstreams set out in our Anchor/CWB Strategy 2023-2026 and to deliver the actions set out in the accompanying Year 3 plans. Aims/Objectives 2025-2026 (Year 1) KPI Continue to lead on capacity building, building the evidence base, supporting ongoing improvement, and awareness raising of Anchors workstream and align work with wider Community Wealth Building agenda, and as a Board, support the redirection of wealth back into local communities to help address the wider determinants of health inequalities, by progressing specific, measurable objectives that align with their Anchor Strategic Plan. Delivery of the Anchor Strategic Plan 2023- 26 Actions 2025-2026 (Year 1) By When Complete refresh of Community Wealth Building Strategy. June 2025 410
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Meet with pillar leads to develop in year actions (2025- 2026). June 2025 Agree sign off at CWB Programme Board of in year actions. June 2025 Complete SG Anchor Metrics Return for FY 23/24. June 2025 Pillar leads to progress in year actions and report implementation to CWB Programme Board. September 2025 Pillar leads to continue to implement in year actions and report progress to CWB Programme Board. September 2025 Prepare yearly report to reflect progress on in year actions. March 2026 15. Workforce Further detail on our workforce positon will be submitted in accordance with the requirements of Directors Letter on workforce planning and in addition, some detail is and will continue to be provided via the NHS Scotland Financial Delivery Unit 15 box grid quarterly self-assessment returns. Strategically the Board continues to have strategic workforce risks in relation to clinical registrant supply and capacity, with a distinct medical staffing supply and capacity risk being established this year, both being very high risk and ongoing work to treat. These risks materially require national intervention as they are not unique to our Board and supply chains for controlled staff groups are determined by government and as such constrains our ability to make significant traction on some of the prescribed planning priorities for the Delivery Plan. We anticipate that a consequence of the Agenda for Change Pay reform reduced working week, and to a lesser extent protected learning time, will materially impact on our clinical registrant risk stimulating further challenges in relation to supply and capacity which again will not be unique to our Board. NHS Ayrshire and Arran is proactively taking steps to assess the risk and potential staffing resource required as mitigation in implementing the residual hour that remains of the reduced working week which will have a material impact across all organisational activity both clinical and non-clinical. An implementation plan for eRostering was in place during 2024/25 with the early adopter areas being Nursing, Midwifery and Allied Health Professions by November 2026, with a full rollout to the organisation by approximately November 2027. Following a review, the rollout was paused in October 2024, due to a number of issues and challenges that had been identified during the first phase of the roll out. A recovery plan is being drafted detailing the challenges and barriers identified and recommendations to progress with implementation. The University of the West of Scotland (UWS) work in partnership with NHS Ayrshire and Arran Nursing and Midwifery Teams to provide Practice Learning Experience for their students. The overall aim of the UWS pre-registration programmes are to prepare students for the academic awards and eligibility to apply for Professional Registration with the NMC. The Executive Nurse Director along with Chief Nurse for Professional Development meet with Strategic UWS Partners to ensure robust planning is in place. 411
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Post registration education is supported through an education fund (previously known as SLA). This supports Nursing, Midwifery and Allied Health Professionals (NMAHP) Registrants with continual professional development. NMAHP clinical teams from NHS Ayrshire and Arran, led by the Chief Nurse for Professional Development, work with UWS lecturers to ensure appropriate transition from 3rd year undergraduate student to Newly Graduated Practitioners. This ensures clear communications on recruitment processes, support in terms of the National Flying Start Programme. The Practice education facilitators (PEFs) team support clear collaborative between service and Higher Education Institutions (HEIs). PEFs are a national network of nursing and midwifery registrants that support learning in practice by working with staff within the practice learning environments. They work alongside other partners in practice education such as Care Home Education Facilitators (CHEFS) and Practice Education Leads. Practice education involves teaching and learning that happens in practice or work based settings. PEF’s work in partnership involving NHS Education Scotland (NES), National Health Service Boards (NHS) and HEIs. Close partnership working with Ayrshire College and NMAHP Professional Development Teams, has led to the development and graduation of 19 band 4 Assistant Practitioners within Acute Services with a further Mental Health Cohort of 11 trainees this academic year. A Practice Development Unit has been opened over the last 12 months by the Lead for Practice Development. This allows an education space that can be utilised for education of both registrants and Healthcare Support Workers. This unit supported the education of 30 Internationally Educated nurses to achieve NMC registration. AHP Workforce transformation has continued through four distinct work streams: • Digital and business support; • AHP Healthcare support workers; • Recruitment and retention; and • Advancing practice. A block recruitment approach for newly qualified AHPs was tested in 2024/25 with successful outcome in terms of appointment to Band 5 posts across professions. International recruitment has also been utilised with success, in particular in filling previously hard to fill posts in radiography. The AHP Leadership team continue to work in partnership with Ayrshire College in delivering the ‘Access to AHP’ programme and are building strategic links with the Scottish HEIs who deliver pre-registration AHP programmes. Aims/Objectives 2025-2026 (Year 1) KPI Achieve further reductions in nursing agency staffing use and continue to optimise bank arrangements. • Zero off framework usage • HCA usage via bank only • £1.2 m reduction in nurse agency expenditure related to reduced agency rate cards 412
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• £2.1 m reduction in nurse agency 2025/2026 Achieve reductions in medical locum spend. Lower level of agency spend via substantive appointments to vacant medical posts (reduction in consultant vacancies) and where locum spend is necessary appointment as NHS locum or adherence of Direct Engagement compliance. Encourage attendance - continued focus on our sickness absence position with aspiration to narrow the gap between current versus 2019/20 performance. Cumulatively will contribute to our overall ambition of a **% reduction for FY 2025/26 i.e. a rate of **%. Please note this trajectory will be set once we have the final outturn for FY 2024/25, which has been an atypical performance year with significantly elevated levels of absence, and can assess the position and determine a realistic trajectory of improvement for 2025/26 Actions 2025-2026 (Year 1) By When Within our Acute Services sector work is ongoing in collaboration with external contractors to review establishment by all ward areas so as there is clarity as to vacancy pressures and spend is more appropriately directed towards substantive staffing solutions. Work is underway in tandem regarding rostering practice to ensure that headroom / unavailability criteria and parameters are robustly followed and we have ongoing open adverts for staff joining our bank. March 2026 Continue to engage locums directly with the Board Medical supplemental staffing group in place and grip and control measures have been introduced. Work remains ongoing in looking at workforce planning across our medical specialties, and implementing our vision of Best Medical Workforce Strategy March 2026 Make best use of our technology to increase efficiencies in administrative and support services. March 2026 Undertake deep dive to look at how we may better address the largest reason for absence (approximately 30% of all sickness absence relates to anxiety, stress, depression and other mental illness). March 2026 Consistent and ongoing organisational messaging to employees advising of support and wellbeing as well as encouraging all staff to use their annual leave entitlements fully, and throughout the year, to ensure they have rest and recuperation. March 2026 Develop and launch a programme for undergraduate nursing students to increase their knowledge of NHS Ayrshire and Arran to further support their transition into a Newly Graduated Nurses. April 2025 Introduce a leadership programme for Band 6 and 7 within NMAHP in line with the NMAHP Strategy to ensure a prepared workforce. May 2025 To educate the current Practice Assessors and Supervisors on the new C25 programmes for undergraduate BSc Adult and Mental Health Programmes. August 2025 413
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Increased communication and processes of the 2025 yearly recruitment for Newly Graduated Nurses and Midwives to both students, HEIs and clinical teams. September 2025 16. Digital The NHS Ayrshire and Arran Digital and Data Strategy 2023–2026, titled "Digital Excellence in Healthcare: A Platform for Change," outlines our vision for creating a unified digital infrastructure. This will ensure our organisation is equipped to seamlessly connect with health and social care partners and national networks. The strategy establishes a technical foundation for integration, enabling the delivery of efficient, patient-centred care when and where it is needed. Our digital strategy takes a system-wide approach and embodies a commitment across Ayrshire and Arran to deliver an integrated care record. Capital investment has been prioritised to advance this strategy, as it is seen as a cornerstone of reforming how the Health Board delivers care closer to the patient. By embracing digital transformation, we aim to introduce new ways of working across clinical and non-clinical settings, reducing duplication, mitigating clinical risks, and supporting our workforce to deliver health and care services effectively. The optimisation of digital and data technologies is central to improving health and care services. Enhanced patient access, improved safety, and continuity of care are achieved through integrated single patient records that track the patient journey. This transformation enables real-time care delivery supported by accurate and insightful data, live bed management tools, and improved collaboration across the health system. These initiatives prepare the Board for the future demands of the National Care Service and support reform programmes, such as the integrated care record and distributed working. Ongoing investment in TrakCare, our Patient Management System, is pivotal to developing a fully integrated care record. The first milestone in this journey was migrating to a Software as a Service (SaaS) solution, which ensures system stability and availability while reducing hardware costs and aligning with national cloud-first objectives. TrakCare as a Service supports innovation by enhancing clinical decision-making through real-time data integration. The system’s scalability accommodates growth without significant investment in physical infrastructure, underscoring its long-term value. Maximising M365 capabilities remains a priority. Ayrshire and Arran participate in the federation project, enabling seamless collaboration with two local authorities via Teams. Work is underway to bring the third local authority onto the M365 platform. Developers are also exploring the Power Platform to reduce reliance on third-party digital solutions. One early success is the creation of a Desk Booking app to support the Distributed Working Programme. Applications nearing the end of their lifecycle are being evaluated for replacement with M365-based solutions to ensure cost-effectiveness and return on investment. Additionally, dedicated resources are developing multidisciplinary teams (MDTs) within the Teams environment for cancer care, fostering efficiency and cross- specialty collaboration. 414
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Cyber resilience is an ongoing focus. Over the past 12 months, compliance with the Refreshed Public Sector Cyber Resilience Framework (NIS audited areas) has increased by 19%, compared to a 2% rise the previous year. Improvements in supplier and risk management, alongside initiatives such as the Digital Champions Network and digital training for non-executive directors, have been highlighted as examples of good practice. Continued engagement with the Cyber Centre of Excellence ensures proactive monitoring, reporting, and incident response. Developing digital skills is integral to our strategy. A Digital Skills Champion role has been established to lead this work, complemented by a growing Digital Champions Network. A recent digital skills survey is informing resource planning to ensure staff are equipped to navigate the digital world as both employees and citizens. A governance framework for Accelerated National Innovation Adoption (ANIA) projects is in place to ensure alignment with local and national priorities. This process includes pre- scoping checklists, business case development, and approval workflows to coordinate resources, avoid duplication, and support evidence-based decision-making. A Strategic Digital Delivery Group (SDDG), chaired by the Chief Executive, oversees the implementation of the digital strategy. This group ensures strategic alignment across NHS Ayrshire and Arran, including close collaboration with the three Health and Social Care Partnerships. By adhering to this structured approach, the following benefits are realised: • Efficient resource utilisation to deliver best value; • Improved coordination to identify synergies and minimise overlap; • Informed, strategic decision-making; and • Elimination of siloed working practices. The SDDG ensures that NHS Ayrshire and Arran remain at the forefront of digital transformation, driving innovation and delivering sustainable improvements in healthcare delivery. Aims/Objectives 2025-2026 (Year 1) KPI Adoption and implementation of the national digital programmes. - Open Eyes Optometry project initial implementation complete in first services. - National Child Health system to go live within Ayrshire and Arran. - M365 launch of One Drive and Sharepoint pilot to expand to other areas following completion of work in Digital Services. - eRostering - completion of Nursing Directorate rotas. Improving cyber resilience and compliance. Cyber resilience and compliance Provide Executive support and commitment to optimising use of digital and data technologies. Optimisation of use of digital and data technologies. Work collaboratively with other organisations to scale and adopt innovation. - Options appraisal for Digital Dermatology project approved - Scan for Safety project implemented within Ayrshire and Arran Set priorities and report progress in line with Board's Digital Strategy. New Digital Strategy for the Board. 415
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Actions 2025-2026 (Year 1) By When Continue to work with Digital Health and Care and NSS on a number of national projects. March 2026 Improve on the overall compliance score for NHS Ayrshire and Arran in the 2024/25 Network and Information Systems (NIS) Audit. February 2026 Continue with quarterly meetings of the Strategic Digital Delivery Group chaired by the Chief Executive. June 2026 Continue working with regional and national groups including the Accelerated National Innovation Adoption group. March 2026 Align with the national cloud first strategies to provide resilient access to systems, flexible approaches to our data and storage requirements and increased security of systems. March 2026 Review and update the Board's Digital Strategy during 2025/26. December 2025 17. Climate To establish a greener, board-wide estate, continuous engagement with stakeholders, including building occupiers, is essential. These teams play a crucial role in promoting efficient energy use. Despite the current system pressures, sustainability must remain a priority alongside patient care. Emphasising the benefits and importance of sustainability is critical, as it contributes to creating a safe, energy-efficient, and environmentally friendly estate, which ultimately enhances patient care. Energy consumption is a key factor in decarbonising the NHS Ayrshire and Arran estate and requires a flexible approach to reduction. A significant challenge lies in transitioning the retained estate’s heat sources to low-carbon alternatives. Implementing innovative technologies such as solar power and heat pumps is particularly challenging in ageing buildings, where structural limitations can restrict feasibility. Additionally, hospitals operating around the clock require a dependable, uninterrupted energy supply. There is strong interest in exploring new renewable and green energy sources. The Board will collaborate with NHSScotland colleagues, other health boards, and external partners to better understand the processes required to procure such energy solutions. It is recognised that achieving this will require robust infrastructure planning, sufficient time, and coordination, particularly for transitioning high-emission sites within the ageing estate. The transport fleet transition to fully electric vehicles is progressing, with the pool car fleet procurement complete and efforts underway to convert the commercial fleet. Over the next 12 months, charging infrastructure will be expanded to ensure all EV pool and commercial users can charge their vehicles at work. Additionally, the NHS Ayrshire and Arran Sustainable Travel Action Plan (2024–2027) will be implemented through the Active Travel and Transport subgroup of the Climate Emergency and Sustainability Officers Group (CESOG). 416
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We will continue to optimise greenspace to enhance biodiversity for the benefit of patients, visitors, and staff. This includes advancing the Kyle Chemotherapy Garden project in 2025/26 and exploring creative uses of greenspace for therapeutic purposes, such as green gyms, mindfulness activities, walking groups, and other outdoor initiatives known to support physical and mental health. Active travel to our sites will also be encouraged, and we will collaborate with local authority partners to develop active travel routes. Our pharmacy sustainability program will continue efforts to reduce the use of harmful substances and adopt more sustainable delivery methods, including reducing the prescription of antimicrobials. Progress on these initiatives will be monitored and reviewed by our Climate Emergency Sustainability Operational Group (CESOG). Aims/Objectives 2025-2026 (Year 1) KPI Greenhouse Gas Emission reduction (Energy) Improve the overall Building Energy Emissions in line with national targets and from the previous year generated from the Boards estate assets. Complete the delivery of agreed list of in year energy efficient projects and agreed programme of works for the next 12 months. Report on savings to be achieved based upon actual datasets. Sustainable Travel - Improve the overall Transport Emissions in line with national targets and from the previous year generated from the Boards estate owned transport and infrastructure. Completion of the fleet hand over to the various services across the organisation. Report on progress. National Waste Targets - Reduce domestic waste by a minimum of 15%, and greater where possible, compared to 2012/13. Reduce domestic waste by a minimum of 15%, and greater where possible, compared to 2012/13. National Waste Targets - Reduce food waste by 33% against 2015-16 baseline. Reduce food waste by 33% against 2015-16 baseline. National Waste Targets - Ensure 70% of domestic waste is recycled or composted. Ensure 70% of domestic waste is recycled or composted. National Green Theatre Actions - Improve on the reduction in medical gas related emissions across the board wide estate. Implementation of changes to current processes and procedures. Greenspace and Biodiversity Kyle Chemotherapy Garden will be producing year 1 spring bulbs and patients, visitors and staff making use of the area. Green gym and walking programmes fully embedded at UHA/ Ailsa and woodland view and walking programme in place for UHC and other sites Actions 2025-2026 (Year 1) By When Reduction of Boards carbon and greenhouse gasses through estates rationalisation and demolition programme – risk that distributed working is resisted and unable to vacate buildings earmarked for demolition. March 2026 Continue to reduce emissions from travel and transport activities through: - Electrifying fleet – risk that suitable commercial vehicles are not available at this time to replace current fleet vehicles; and - Continue to work with public health on the development and delivery of the sustainable travel Action plan-24-27 Ongoing until 2035 Ongoing until 2027 417
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and installing infrastructure with funding available in 25/26. Waste - Reducing domestic waste by 15% compared to 2012/13; - Reduce food waste by 33% against 2015-16 baseline; and - Ensure 70% of domestic waste is recycled or composted. All ongoing throughout year and will all be tied into the new waste contract commencing 1/4/25 Work in conjunction with Local Authorities and other partner organisation to adopt more environmentally friendly processes for grassland management on grassland management. All Ongoing throughout year, with different phases being implemented in different seasons. Continue to progress the development of Kyle chemotherapy garden and green gym initiatives with partner organisations and community wealth building initiatives. Opportunity to support community justice teams in the Kyle garden project. All Ongoing throughout year, with different phases being implemented in different seasons. 18. Finance Situation The health board set a deficit budget of £56.4 million for 2023/2024 financial year and £53.5 million for 2024/2025. For 2025/26, the scale of cost pressures requires the Board to achieve 3% CRES to stand still. The funding for New Medicines is less than the cost pressure. In 2024/25 the NHS Ayrshire and Arran deficit is about £8.8 million expected gap between funding (£16.7 million) and expected spend (£25.5 million). A 10% increase in 25/26 would increase cost to £28 million. The Board is striving to achieve 3% (£30 million) cash releasing efficiency savings in 2025/2026, however currently not all of these have firm plans. We expect CRES to rise to £30 million recurring savings in the next plan due in mid-March 2025. A significant risk for 2025/2026 will be the pay settlement which is not within the Board’s control. Background Throughout 2022/2023 our acute hospitals had 180 unfunded beds open at a cost of £12.5 million. Many of these were occupied by Delayed Transfer of Care (DToC) patients. Our objective in 2023/2024 was to close all of these unfunded beds and achieve cost avoidance. We only partially achieved this in 2023/2024 and still had 150 unfunded beds open with a cost of around £12.5 million. During 2024/2025 further progress has been made, however we still have 90 unfunded acute beds which could all be closed if we achieved the Scottish average length of stay through the SAFER programme. NHS Ayrshire and Arran is unusual in that our integration scheme leaves the risk for primary care prescribing overspends and the associate cost pressure with the Health Board rather than Integration Joint Boards. In 2022/2023 the primary care prescribing volumes increased by 2% which was budgeted for, however the price per item increased by over 10% which was not budgeted for and resulted in a 2023/2024 cost pressure of about £12.5 million. This contributed to the underlying deficit position. As part of the updating of the Integration 418
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Scheme finance leads requested for Integration Joint Boards to take full financial responsibility from 2024/2025 for primary care prescribing and in 2024/25 finance leads agreed to a shadow year. However, as the year has progressed there is no consensus nor partnership agreement that enables that transfer of this cost pressure and it remains an area of discussion as part of the partnership agreement review. £11.3 million of the underlying recurring financial deficit has been in place since 2017/2018 and relates to a number of cost pressures in that year where the general allocation funding uplift was 0.4% and the balance could not be met from efficiency savings. In 2022/2023 this deficit increased to £26.4 million as a result of unfunded Covid related costs and inflationary and demand pressures. The core e-health infrastructure for NHS Ayrshire and Arran was very poor and therefore there is a requirement to upgrade systems, make networks more secure and increase band width to improve speed of connection. A strategy of moving toward cloud based hosting (in line with Scottish Government policy) comes with significant costs and is a revenue cost pressure as opposed to capital cost for replacing servers etc. The additional costs of Microsoft Office 365 were only partially funded in previous years and therefore in 2023/2024 there was a cost pressure of £1.4 million for Microsoft Office 365 and in 2024/2025 a further £0.5 million. In addition there was a £3.15 million cost pressure for other system infrastructure upgrades, additional digital staff and some cloud hosting of key systems in 2023/2024 with a further £0.5 million investment in digital in 2024/2025. Historical Deficit Contribution £million New medicines 8.8 Unfunded acute beds 12.5 Primary care prescribing 12.5 Pre pandemic deficit 11.3 Covid and inflationary pressures 15.1 Teams and digital investment 5.6 Total 65.8 In the 2024/2025 revenue plan, planned CRES of £24.1 million (plus sustainability funding of £5.6 million) exceeded the cost pressures of £18.5 million by £11.2 million which reduced the underlying deficit of around £54 million, however inflationary pressures on supplies budgets and delays in CRES delivery have required non-recurring measures to live within the £53.5 million deficit for 2024/25. The underlying recurring deficit remains similar to the table above as some of the 24/25 CRES was not achieved recurringly and backfilling measures are non-recurring. Assessment The energy cost increase over 2022/2023 and 2023/2024 amounted to over £5 million which required a doubling of the recurring budget. The £1.6 million further cost pressure in 2024/2025 was treated as non-recurring (in the expectation of a price fall) as was the clinical negligence or risk indemnity scheme (CNORIS) contribution temporary increase of £1.1 million. Demand increased for pathology reporting which required extra reporting capacity to be purchased from the private sector in 2023/2024 and 204/2025 at a cost of £0.5 million. Biochemistry test volumes from GPs have increased the cost of the managed service 419
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contract. The integration scheme sets out the position in relation to the set aside budget that the Integration Joint Boards should contribute financially if they are responsible for increased use of acute services and an analysis of occupied bed days used by them on relevant specialties show an increase by 22,000 compared to pre-pandemic. Risk sharing in these areas is an area of discussion between NHS Ayrshire and Arran and the Integration Joint Boards as the Integration Schemes are being reviewed however the financial aspect of commissioning will not be implemented in 2025/2026. Actions Being Implemented Governance The Board has re-set and strengthened the governance supporting and enabling CRES creation and delivery, during 2024-25 with additional Programme Management support provided by external contractors. Best practice documentation and the introduction of an Improvement Programme Steering Group, which is the improvement delivery group reporting through to an Executive assurance and delivery group (Financial Improvement Scrutiny Group). Quality / Patient Care The Corporate Management Team have approved a CRES approach based on the national strategy ‘Delivering Value Based Health & Care; A Vision for Scotland’. The Medical Director is the Executive lead supported by the Recovery Director. This will ensure clinical buy-in for fundamental service change. The aim is to build out from the Realistic Medicine approach and implement a three year programme that is a clinically led value-based efficiency approach to support delivery of the medium-term efficiency programme. The efficiency programme will run alongside the cost reduction approach to reduce costs further. Enhanced performance management arrangements and reporting will provide additional scrutiny and assurance. To achieve the latter an extension of the support from external contractors has been sought. The average length of stay within the Ayrshire acute hospitals post pandemic has been around 10 days which is significantly higher than the Scottish average and much higher than that achieved in England. Actions being taken to reduce the length of stay include pathway reviews, training of clinical staff on SAFER methodology and cohorting of patients clinically fit for discharge with more AHP and less medical input. The wards where SAFER has been introduced have seen a reduction in length of stay therefore it is being rolled out more widely. Workforce The use of agency staff is largely driven by the acute unfunded beds. Agency nurse spend for 2022/2023 was £10.6 million and reduced to £9.7 million in 2023/2024 with further reduction projected in 2024/2025. Medical agency has been around £6 million per annum due to consultant vacancies, however has a target to reduce this by £1 million in 2025/2026. Both reducing agency and the closure of the unfunded beds are cost reduction rather than cash releasing efficiency savings as there is no recurring budget for these. A reduction in sickness absence would reduce the need for agency staff. 420
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To support the CRES programme, there is a need to continue the Recovery Director in 2025/2026, supported by Programme Management and a Finance Business Partner. We are structuring the 2025/2026 plan around Realistic Medicine (Better Value Better Health) to get strong clinical support and leadership of change. Individual schemes will be approved through an Improvement Programme Steering Group which has strong operational membership and each scheme will have a workbook and Quality Impact Assessment. An operation Programme Management Office within our Acute Directorate will comprise Improvement Leads, Project Managers and will be supported by finance, HR, digital etc. Operational Grip and Control Additional grip and control measures have been introduced during 2024-25 across core pay and non-pay areas. Each area being Director led. The Board is currently refreshing the bed demand model which will be used to inform the relevant establishment (demand and supply) requirements from 2025-26. Through this work the whole system bed requirements will be better understood. Integration and whole system working will improve from 2025-26 with a focus on population health, public health and prevention with the aim of adopting an open book policy, optimisation of the Ayrshire resource budget, development of integrated pathways, to support workforce transformation, clear Partnership Agreement underpinned by a clear risk share and reward framework. Financial The financial plan details the CRES plan for 2025/26 which includes IJB CRES as these count towards the 3% CRES target (although these do not offset any of the Health Board cost pressures and a net 3% increase in funding for IJBs has been ‘passed through’). Tighter grip and control on non-pay spend through procurement controls, reducing waste in theatre consumables, managing demand for laboratory tests, replacing taxis with community transport provider for renal patients and reducing energy expenditure will reduce overspending areas through cost reduction schemes. To minimise the deficit, three parallel streams of work are needed:- • Reform of acute services to reduce length of stay, close speedily all unfunded beds (cost avoidance) and thereafter close funded acute beds to release cash releasing efficiency savings. • Achievable cash releasing efficiency savings targets set for most Directorates (3%) except Integration Joint Boards. The savings template does not yet reflect all of these as firm plans for savings and the pipeline is being validated to get a realistic target. • Rebalance the financial risk between the Health Board and Integration Joint Boards in relation to:- - primary care prescribing and overspends; and - payments through set aside for acute beds occupied by delayed discharge patients. Risk Assessment / Management Added unfunded beds have been a constant cost pressure for the Board and securing the right sized bed-based for care in all care settings, remains a priority for the system. This work is being supported with the additional and experienced resources provided by external contractors and remains an important part of the Boards sustainable recovery plan. 421
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For the first time our IJBs, North, South and East Ayrshire have raised concerns for the sustainability of the services devolved to them. Our IJBs no longer have financial reserves, and North Ayrshire has required a year end settlement to break even. The 3% uplift does not cover the cost pressures for our IJBs and service reductions will need to be made which will put further pressures throughout all parts of our system. We will continue to work in partnership, revised the partnership commission and secure an Urgent and Unscheduled Care commission in order that system pressures are as transparent as they need to be. It is acknowledged that any significant redesigns of service provision would require public and clinical consultation, and Scottish Government support therefore cannot be implemented speedily however a major driver for change is delivering a sustainable health service within the envelope of funding available. It is difficult to quantify the savings from the above as the main driver is reduction in the acute bed base. Policy Drivers A significant cost pressure for 2024/2025 is the New Medicines Fund where the cost of medicines approved by the Scottish Medicines Consortium continually increases in line with the Government policy to increase access to medicines. This includes cystic fibrosis medicines, end of life cancer drugs, orphan drugs and ultra-orphan drugs which have a very high cost per quality adjusted life year. A potential new cost pressure of £11 million for injectable drugs for weight loss has not been included in the financial plan. Limited investment for social care through our Local Councils. Finance Projections A three year financial plan has been developed showing detailed cost pressures for 2025/26 and estimates for future years. Funding settlements for 2026/27 and 2027/28 are currently unknown, however the assumption is that cash releasing efficiency savings of at least 3% will be required each year. The financial plan is to reduce the deficit to move towards financial sustainability over a number of years, as major service change requires public consultation and Scottish Government approval. 422
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