Agenda Document Pack - Integration Joint Board - 25/09/2025
North Ayrshire Council · 25 September 2025
Back to Integration Joint Board — 25 September 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, 25 September 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 21 August 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 Primary Care Update Submit report by Debbie McGill, Head of Primary and Urgent Care Services, on the provision of Primary Care Services across Ayrshire and Arran (copy enclosed). 6 Primary Urgent Care Update Submit report by Debbie McGill, Head of Primary and Urgent Care Services, provision of primary urgent care services delivered through the Ayrshire Urgent Care Service (AUCS) (copy enclosed). 1
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7 North Ayrshire HSCP & ADP Annual Performance Management Report – 2024/25 Alcohol and Drugs Submit report by Peter McArthur, Alcohol and Drug Services on the annual performance information in relation to the partnership’s Alcohol and Drug services (copy enclosed). 8 North Ayrshire HSCP & ADP Medication Assisted Treatment - Annual Report Submit report by Peter McArthur, Alcohol and Drug Services on the North Ayrshire HSCP & ADP Medication Assisted Treatment - Annual Report (copy enclosed). 9 2024/25 Audited Annual Accounts Submit report by Eleanor Currie, Chief Finance Officer, on the audited annual accounts for 2024-25 and the report from External Audit (copy enclosed). 10 External Audit Report 2024/2025 Submit report by Audit Scotland on the External Audit Report 2024/2025 (copy enclosed). 11 2025-26 – Month 4 Financial Performance Submit report by Eleanor Currie, Chief Finance Officer, providing an overview of the Integration Joint Board’s financial performance as at month 4 (July) (copy enclosed). 12 IJB - Reserves Policy Submit report by Eleanor Currie, Chief Finance Officer, on the IJB Reserves Policy following review (copy enclosed). 13 Financial Inclusion Strategy 2025-30 Submit report by Annie Johnson, Principal Manager, on the Financial Inclusion Strategy 2023-28 (copy enclosed). 14 Chief Social Work Officer Annual Report 24/25 Submit report by Scott Hunter, Chief Social Work Officer (NAHSCP) on the annual Chief Social Work Officer (copy enclosed). 15 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. 2
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You should be aware that the Council is a Data Controller under the Data Protection Act 2018. Data collected during the webcast will be retained in accordance with the Council’s published policy, including, but not limited to, for the purpose of keeping historical records and making those records available via the Council’s internet site. Generally, the press and public will not be filmed. However, by entering the Council Chambers and using the press or public seating area, you acknowledge that you may be filmed and that any information pertaining to you contained in the video and oral recording of the meeting will be used for webcasting or training purposes and for the purpose of keeping historical records and making those records available to the public. In making this use of your information the Council is processing data which is necessary for the performance of a task carried out in the public interest. If you have any queries regarding this and, in particular, if you believe that use and/or storage of any particular information would cause, or be likely to cause, substantial damage or distress to any individual, please contact dataprotectionofficer@north-ayrshire.gov.uk 3
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IJB Sederunt Voting Members Joyce White (Chair) NHS Ayrshire & Arran Cllr Chloe Robertson (Vice- Chair) North Ayrshire Council Cllr Tom Marshall North Ayrshire Council Cllr Anthea Dickson North Ayrshire Council Cllr Nairn Angus-McDonald North Ayrshire Council Linda Semple NHS Ayrshire & Arran Tom Hopkins NHS Ayrshire & Arran Marc Mazzucco NHS Ayrshire & Arran Professional Advisors Caroline Cameron Director Eleanor Currie Interim Chief Finance Officer Aileen Craig IJB Monitoring Officer Iain Jamieson Clinical Director Scott Hunter Chief Social Work Officer – North Ayrshire Thelma Bowers Mental Health Adviser Darren Fullarton Associate Nurse Director/ Lead Nurse Vacany Acute Services Representative Dr Louise Wilson GP Representative Sharon Hackney Lead Allied Health Professional Lisa Davidson Public Health Representative Wendy Van Riet Director of Psychological Services Stakeholder Representatives Lorna Sim Staff Rep - NHS Ayrshire and Arran Lynda MacFarlane Staff Rep 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 21 August 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 Chloe Robertson, North Ayrshire Council (Vice-Chair) (Chair) Councillor Nairn Angus- McDonald, North Ayrshire Council Councillor Anthea Dickson, North Ayrshire Council Councillor Tom Marshall, 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 Darren Fullarton, Associate Nurse Director/ Lead Nurse Present (Remote Participation) Voting Members Marc Mazzucco, NHS Ayrshire and Arran Professional Advisers Sharon Hackney, Lead Allied Health Professional Iain Jamieson, Clinical Director Stakeholder Representative Paul Smith, Carer Representative Vicky Yuill, Third Sector Representative In Attendance (Physical Participation) Elizabeth Stewart, Head of Service (Children, Families & Criminal Justice) Kerry Logan, Head of Service (Health and Community Care) Loretta Galloway, Unity Enterprise Alisa Weir, Senior Manager (Montrose House) Karen Andrews, Team Manager (Governance) Annie Johnston, Principal Manager (Business Support) Raymond Lynch, Senior Manager (Legal Services) Ruth Wilson, Team Leader (Litigation) Hayley Young, Senior Committee Services Officer Claudia Cheung, Digital, Media and Marketing Analyst Agenda Item 3 5
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Apologies Linda Semple, NHS Ayrshire and Arran Lynne McNiven, Public Health Representative Lorna Sim, Staff Representative NHS Ayrshire and Arran Tom Hopkins, NHS Ayrshire and Arran Scott Hunter, Chief Social Work Officer Aileen Craig, IJB Monitoring Officer 1. Apologies for Absence and Chair Remarks Apologies for Absence were noted. The Chair welcomed Councillor Chloe Robertson as the new Vice-Chair of the Integration Joint Board and thanked Councillor Margaret Johnson for her valuable contributions to the work of the IJB. 2. Declarations of Interest There were no declarations of interest in terms of Standing Order 7.2 and Section 5.14 of the Code of Conduct for Members of Devolved Public Bodies. 3. Minutes The accuracy of the Minutes of the meeting held on 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. Officers responded to members’ questions on various aspects of the report. Noted. 5. 2025-26 – Month 3 Financial Performance Submitted report by Eleanor Currie, Interim Chief Financial Officer (HSCP) on the Integration Joint Board’s financial performance as at Month 3 (June). Appendix A to the report detailed the financial overview of the Partnership position, while Appendix B provided an overview of those service changed which did not have financial savings attached and the BRAG status around the deliverability of each saving. Appendix C highlighted the movement in the budget position following the initial approved budget, with further detail on the reserves set out at Appendix D. The proposed recovery action was outlined in Appendix E, while Appendix F highlighted information on the costs of bank and agency staff. Officers responded to members’ questions on various aspects of the report. The Board agreed to (a) note the overall integrated financial performance report for the financial year 2025-26 and the current overall projected yearend overspend of £5.187m reducing to £1.175m after planned recovery actions; (b) note the progress with delivery of agreed savings; (c) approve the actions which are being taken to 6
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progress financial recovery and that an updated recovery plan will be presented to the next IJB; and (d) note the remaining financial risks for 2025-26; 6. 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, as a follow up to the report presented to the IJB in June 2025. The report details the outcome of the recent options appraisal for Montrose House, engagement feedback from over the summer period and 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. The report asked support of the IJB to adopt and implement a revised service delivery model, with the full Options Appraisal set out at Appendix 1 to the report. This would see permanent bed numbers in Montrose House reduce from 15 to 10, while protecting existing respite provision and re-introducing flexible day care opportunities. 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. And to support the implementation of an admissions policy to prioritise access for Arran residents with close familial and community ties on the isle of Arran, that would be developed taking cognisance of legal advice from North Ayrshire Council. Officers responded to members’ questions on various aspects of the report. Members also queried the comparator costs of a care home bed in Montrose House of £107,982 vs average cost other care home placements of £30,579. Clarification was provided that the values reflect the net cost to the HSCP of each type of placement: • £107,982 Montrose House – cost in 24/25 for 15 beds per bed based on actual costs net of resident charges • £30,579 other care homes - all other care home placements are through independent or third sector care home providers - for local authority placements in older peoples care homes we pay a set national care home contract rate It was highlighted that every resident a local authority places into a residential or nursing care home contributes towards the financial cost of their placement, this was means tested and follows national guidance. For individuals with higher levels of income and savings the HSCP only fund the free personal care element of care. The costs above for both placements are an average of the net for all placements, ie. for Montrose House an average based on 15 residents and for mainland placements the average of over 700 individual placements. The comparator was included as the average cost of an alternative mainland placement as an alternative to Montrose House is currently £30,579. Joyce White, seconded by Councillor Robertson, moved the approval of the recommendations set out in the officer’s report. As an amendment Councillor Angus-McDonald, seconded by Vicki Yuill, proposed the following: The IJB notes: 7
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• The overwhelming rejection of the Montrose House proposals by the people most affected: 97% of Arran residents and 61% of staff opposed the plans in consultation. Our statutory duties under: • The Islands (Scotland) Act 2018, including the requirement to conduct an Island Communities Impact Assessment (ICIA) before decisions that may significantly affect an island community. It is clear that this proposal, if implemented, would negatively impact island residents by reducing local access to care, increasing travel and time to care, and undermining resilience during winter disruption. • The European Convention on Human Rights (particularly Article 8, right to respect for private and family life, and Article 14, non-discrimination). • The Equality Act 2010 (Public Sector Equality Duty) and the Fairer Scotland Duty, which require us to consider impacts on protected groups and those experiencing socio-economic disadvantage. Early analysis indicates that older people, disabled residents, and lower-income families would be disproportionately and negatively affected by the proposal. • The Public Bodies (Joint Working) (Scotland) Act 2014, which requires the IJB to plan services in partnership with communities and deliver services in a way that improves outcomes. The IJB therefore resolves: That no implementation of the Montrose House proposals will proceed until: • A full paper is brought to North Ayrshire Council, requesting that they fund the identified shortfall in recognition of the unique statutory duties and additional costs arising from Arran’s Island status; and • A focus group of Arran residents and stakeholders is formally established, as previously promised, to examine and co-design alternative models of care provision that meet the island’s specific needs. On a point of order, Councillor Dickson asked and received clarification on whether the Partnership could request that Council fund the identified shortfall, when not at the end of the financial year. The Chair agreed that the meeting be adjourned at 11.45 a.m. for a short comfort break to consider the amendment, reconvening at 11.55 a.m. with the same Members and officers present and in attendance with the exception of Sharon Hackney. There followed debate and summing up. On a division and roll call vote, there voted for the amendment, Councillors Angus- McDonald and Marshall (2) and for the motion, Councillors Robertson, Dickson, Joyce White and Marc Mazzucco (4) and the motion was declared carried. Accordingly, the Board agreed as follows: To (a) approve the outcome of the Montrose House options appraisal and the recommended option for future delivery in Montrose House of 10 permanent beds and 8
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1 respite bed; (b) approve the recommended model of day care delivery for older people on the island of Arran; (c) 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; (d) 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; and (e) 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. Councillor Marshall and Marc Mazzucco left the meeting at this point. 7. Transformation Plan – Progress Update Submitted report by Caroline Cameron, Director (NAHSCP) on the progress of the HSCP transformation plan. 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, with updated now every six months. Officers responded to members’ questions on various aspects of the report. Noted. 8. North Ayrshire HSCP Clinical and Care Governance Report 2024-25 Submitted report by Darren Fullarton, Associate Nurse Director/ Lead Nurse, NHS Ayrshire and Arran on the HSCP Clinical and Care Governance Report 2024-25. The report provided an update and overview of governance activity for the period August 2024 – July 2025 and was set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. Noted. 9. Annual Performance Report 2024-25 Submitted report by Caroline Cameron, Director (NAHSCP) on the key achievements during 2024-25 and the publication of the Partnership’s Annual Performance Report, set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. Noted. 10. NHS Ayrshire and Arran Delivery Plan 2025-2026 Submitted, for information NHS Ayrshire and Arran Delivery Plan 2025-2026. Noted. 11. Strategic Planning Group Meeting Minutes Submitted, for information the minutes in relation to the Strategic Planning Group Meeting on 12 March 2025. 9
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Noted. The meeting ended at 12.40 pm. The full meeting proceedings can be viewed at https://north-ayrshire.public-i.tv/core/portal/home 10
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Integration Joint Board 25th September 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 LS/CMI Comprehensive general offending assessment and case management planning method. CMI HMIPS HM Inspectorate of Prisons for Scotland 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 11
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3. CURRENT POSITION National Developments 3.1 Palliative Care Matters for All : Palliative Care Strategy (2025-30) Scottish Government’s palliative care strategy has been recently published, this highlights the changes needed to improve experiences of people of all ages with life shortening conditions and their families and carers. Palliative Care Strategy 2025 – 2030 Palliative Care Delivery Plan 2025 – 2028 - Scottish Government The delivery plan includes 23 actions grouped into six action groups: 1: Enabling Communities 2: Delivering Palliative Care 3: Future Care Planning in Palliative Care 4. Education and Learning in Palliative Care 5. Palliative Care Data and Experiences 6: Governance and Reporting for Palliative Care Integration Authorities and Health Boards are noted as delivery partners under all actions. A more detailed breakdown of action points relevant to IJBs is also included. The HSCP will undertake a self-assessment against the actions to ensure our services are aligned with the priorities in the strategy and delivery plan. 3.2 Prison Based Social Work Review : Phase 2 Care Inspectorate and HMCIP have notified of their intention to undertake Phase 2 of the review of prison-based social work services in Scotland. This review is being carried out under Sections 53 and 115 of the Public Service Reform (Scotland) Act 2010. The work will commence in August 2025 and concludes in April 2026. A Thematic Review of Prison-Based Social Work (2024) was undertaken in partnership by the Care Inspectorate and HM Inspectorate of Prisons for Scotland (HMIPS). Phase 2 will therefore also be undertaken in collaboration with HMIPS. Within the Thematic Review of Prison-Based Social Work a further phase of work with a specific focus on the efficiency and effectiveness of prison-based social work practice was agreed. The focus of Phase 2 will therefore be on the execution and results of prison-based social work practice and linked SPS processes in relation to the use of LS/CMI. The LS/CMI is a comprehensive general offending assessment and case management planning method. It is used by all community and prison-based justice social work services in Scotland to aid decisions on the level and focus of intervention with people (aged 16+) who have been involved in offending. 12
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3.3 Online Tool to Support Young People with Additional Support Needs through Transitions Compass is free online tool offering support to young people with additional support needs – and the adults in their lives – throughout the transition to adulthood. With separate versions for young people, parents/carers and professionals, this interactive digital platform contains up-to-date information and advice, all in one place, and is accessible at any time. Compass is tailored to the individual, so it’s always relevant and specific, saving time and reducing stress. It helps young people explore what matters to them and allows them to share their thoughts, as well as giving parents and carers an individual transitions timeline and highlighting key actions at each stage. Additionally, it can guide professionals through the statutory duties that apply to transitions and supports a joined-up approach. Compass was developed by ARC Scotland, working with young people and their families. To find out more, or to sign up, visit the Compass website. If you require any additional information, please contact Dominic.Jarrett@aapct.scot.nhs.uk or fionadalziel@north-ayrshire.gov.uk. Ayrshire Wide Developments 3.4 Innovation in Health and Social Care Eent The next Ayrshire Innovation in Health and Social Care event, sharing support and experiences of innovation from health and social care across Ayrshire and nationally is taking place on 30th September 2025. Registrations for the next event on Tuesday 30 September are now open and based on previous feedback, will be a slightly smaller agenda to allow more time for questions. Speakers include : • David McColl, Deputy Director of Technology Services, NHS Education for Scotland, giving an update on the National Digital Front Door Project. • Julia McMurdie and Muhammad Shakir from the Ayrshire 5G Innovation Region, speaking about exciting plans for the health and social care sector. • Paula Baird from NHS Education for Scotland, speaking about their Digital and Data Capability Framework and self-assessment tool. • Thomas Griffin from South Ayrshire HSCP, who will present on their Technology Enabled Care Plan. • Kristin Carpenter from North Ayrshire HSCP, who will speak about the results of the network survey and plans for the future. 13
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3.5 NHS Ayrshire & Arran Quality Strategy On Tuesday 7 October, NHS Ayrshire & Arran is hosting a collaborative event at CentreStage, Kilmarnock, bringing together staff, students, volunteers and people with lived experience to help shape the next NHS Ayrshire & Arran Quality Strategy. It’s a chance to contribute, listen and collaborate in a meaningful way, to ensure that the next NHS Ayrshire & Arran Quality Strategy reflects the experiences, values and priorities of our patients and communities. • Get involved in the discussion • Share your ideas • Identify opportunities for change • Tell us what matters to you For more information on the event, or to register online, visit the NHS A&A website. North Ayrshire Developments 3.6 Shout for Support with Mental Health & Wellbeing North Ayrshire Council and NAHSCP have launched free, in the moment mental health support via text message thanks to a new partnership with Shout. This text- based service offers tailored support to people of all ages in North Ayrshire whenever they need it. To access the service, residents can text SUPPORTNA to 85258 to be connected there and then to a trained Shout volunteer. The service can provide confidential support with: • Anxiety and stress • Depression and sadness • Suicidal thoughts and self-harm • Panic attacks • Loneliness and isolation • Bullying and abuse Shout volunteers are on hand to help 24 hours a day, seven days a week, when things get tough or if you are feeling overwhelmed or need support. 14
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3.7 Learning Disability Awareness Week / Launch of LD Service Learning Plan The Learning Disability Awareness Week in September saw a host of events taking place nationally to celebrate this annual awareness raising campaign. Trindlemoss Day Opportunities in Irvine joined in the celebrations, with activities which include the popular TM Fest, as well as drop-in sessions with local visual artist Lynn McNally and Poet Simon Lamb. The theme for Learning Disability Week this year was ‘I Am Here’ - a theme chosen by people with learning disabilities themselves, demonstrating their continuing experience of often feeling excluded from jobs, healthcare, social events and culture. Much of the work undertaken by our North Ayrshire Learning Disability Service reflects this continuing experience of exclusion within communities, but it is evident that progress remains to be made. With this in mind, the LD Service has launched its new learning plan, which sets out the need for new thinking and practice to address long standing issues of exclusion, and the need for service users, carers, and other stakeholders to be meaningfully and consistently involved in generating those new ideas. The plan is made up of two documents – What Makes a Good Life and Living and Learning Together – which you can find on the NAHSCP website. A range of activities will take place in the months ahead as part of this ambition. If you would like to be involved in this, or would like to learn more about the LD Service's hopes for this process, please contact Dominic Jarrett (Learning Disabilities Development Manager) by emailing dominic.jarrett@aapct.scot.nhs.uk 3.8 Moving and Handling Information Sessions for Carers and Families Safety is paramount when caring for someone who requires the use of moving and handling equipment, so we’re offering families and carers the opportunity to attend a free Moving and Handling information session at Castleview Hub in Ardrossan on one of the following dates, with separate sessions running in the morning (9.30am to 12.30pm) and afternoon (1.30pm to 4.30pm). • Monday 29 September • Wednesday 22 October • Monday 17 November • Tuesday 9 December 15
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These sessions will cover the use of profiling beds, hoists and slings, slide sheets, commode chairs and more. Staff within the facility are trained in line with the Scottish Manual Handling Passport. Carers can book a place on one of these sessions by calling 07385 399 746 and leaving a message with their name, preferred date, and whether they want to attend the morning or afternoon session. Please note that there are 10 places available for each session, which will be allocated on a first come, first served basis. 3.9 Care at Home – Inspection Our Three Towns, North Coast and Arran Care at Home Service has received a very positive report from the Care Inspectorate after an unannounced inspection in August. The service, which supports almost 800 residents to live independently in their own homes, was rated ‘very good’ in terms of how well it supports people’s wellbeing, its leadership and staff team, with a number of significant strengths identified. It also received a rating of ‘good’ for its care and support planning. Inspectors spoke to 39 service users and 129 staff members, observed practice, and reviewed documents including care plans as part of the evaluation. The very positive inspection outcome reflects the continued high quality of care delivered by our skilled care at home staff and managers, congratulations to the whole team. If you’d like to read more, the inspection report can be downloaded from the Care Inspectorate website. 3.1- Overdose Awareness Day MINDS of Recovery and Cafe Solace hosted a deeply moving event to mark International Overdose Awareness Day on 29th August 2025. Recovery organisations, community members, and those affected by substance use came together to reflect, remember, and honour the lives lost. The day was filled with compassion and connection, with support from organisations including Children 1st, KA Leisure, Turning Point Scotland PEAR service, Police Scotland, Broken Chains, Cocaine Anonymous and Harbour Ayrshire. Guests were warmly welcomed with catering and refreshments provided by Cafe Solace in Irvine. 16
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The event also included a flower float ceremony at the Low Green in Irvine, offering a peaceful and symbolic moment of remembrance for those no longer with us. 3.11 First Digital Community Alarm Connection The Community Alarm team has completed its very first digital connection. Mrs Wilson from Irvine was delighted to be the first in North Ayrshire to have her alarm successfully upgraded to use digital communication, which connects directly to our monitoring centre. Moving to digital connectivity means even greater reliability and reassurance, helping us keep our service users safe at all times. Our community alarm team is already well under way with the reprogramming of alarms across our localities ahead of the switching off of analogue telephone lines in the UK in early 2027. 3.12 North Ayrshire Premiere of The Low Road Staff and partners attended t the North Ayrshire premiere screening of The Low Road on 9th September 2025 in the Harbour Arts Centre, Irvine. This film was developed by authentic voices of lived experience and is filled with hope and inspiration. As well as challenging stigma and raising awareness, the film can also be used as a tool in suicide prevention activities across communities. The screening event was followed with a Q & A with the film makers and coordinating staff within mental health services to explore how we might utilise this resource in our suicide prevention work across North Ayrshire services in the future. 3.13 Gambling Awareness / Gambling Harms in Children and Young People Workshop Arran Community and Voluntary Service, working in partnership with Ygam hosted a ‘gambling awareness and gambling harms in children and young people’ workshop on Tuesday 2nd September in Saltcoats Town Hall. This was attended by third sector and statutory services working with people under 25 and families in North Ayrshire. Participants will receive a City & Guilds Certificate and digital accreditation, and will also gain access to digital resources to support them within their role. 17
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Topics covered on the day included : • Why children and young people may game and/or gamble • Risk and associated harms • The influence of advertising, products, social media, in game purchases and digital convergence • The young brain: decision making, addiction and motivation • Barriers to seeking support • How to spot the signs of harm • How you can support the children and families you work with • Conversations, screening, planning, follow-ups and signposting 3.14 Call for Evidence – Health, Social Care & Sport Committee The HSCP have been invited to give evidence to the Health, Social Care and Sport Committee’s Attention Deficit and Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) Pathways and Support Inquiry. 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 inquiry will consider the following in relation to neurodevelopmental pathways for ADHD and ASD: • referral pathways • assessment, criteria and treatment thresholds • waiting times • "waiting well" and support pre-diagnosis • transitions between services • funding • workforce • the impact on individuals of receiving a diagnosis or waiting for a diagnosis Thelma Bowers, Head of Mental Health & Learning Disability will attend to provide evidence to the Committee on 7th October 2025. 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 25 September 2025 Subject : Primary Care Update Purpose : This report is presented as the annual update to the Integration Joint Board (IJB) on the provision of Primary Care Services across Ayrshire and Arran. Recommendation : IJB members are asked to: a) Note the current position of Primary Care Services including within General Practice through the General Medical Services (GMS), Community Optometry, Community Pharmacy, General Dental Services and Public Dental Services. b) Note the areas of development work being undertaken across all Independent Contractor groups and progress of implementation of the Primary Care Phased Investment Programme Demonstrator Site in line with the 2018 GMS contract 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 AUCS Ayrshire Urgent Care Service BMA British Medical Association CPAA Community Pharmacy Ayrshire and Arran CTAC Community Treatment and Care EDS Emergency Dental Service EMG Expert Medical Generalist GDS General Dental Service GMS General Medical Services GOS General Ophthalmic Services GP General Practice / Practitioner HCSW Healthcare Support Worker HIS Healthcare Improvement Scotland HSCP Health and Social Care Partnership IJB Integration Joint Board MDT Multi-disciplinary team MHP Mental Health Practitioner MoU Memorandum of Understanding Agenda Item 5 21
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MSK Musculoskeletal OOH Out of Hours PDS Public Dental Service PLT Protected Learning Time PCIF Primary Care Improvement Fund PCIP Primary Care Improvement Plan PCPIP Primary Care Phased Investment Programme TOC Test of Change WTE Whole Time Equivalent 1. EXECUTIVE SUMMARY 1.1 General Practices continue to face challenges with increased patient demand and financial pressures. Previous analysis indicates that patients are continuing to present to General Practice with more advanced health concerns than they would have pre- pandemic. This in part can be attributed to this cohort of patients having more complex conditions and being managed longer by their GP whilst awaiting appointments in other parts of the system. Many of these patients require an extended (sometimes double) appointment time and clinicians may need to do a greater degree of follow up with the patient which again increases workload and reduces appointment capacity. 1.2 Many GP Practices are facing increasing challenges to accommodate the additional staff aligned to them through the Primary Care Improvement Plan (PCIP). Many buildings across the GP Practice estate are also needing significant investment or alternative accommodation identified for longer term viability. 1.3 Progress continues to be made implementing the 2018 GMS contract which provides the basis for an integrated health and care model with a number of additional services and multi-disciplinary teams (MDTs) including nurses, pharmacists, mental health practitioners, Musculoskeletal (MSK) physiotherapists, and community link workers. This includes signposting, where appropriate, to other primary professionals within the community. 1.4 Community Pharmacies continue to provide a fully comprehensive service as a first point of contact for the public, as an alternative to attending a GP, through the NHS Pharmacy First Scotland scheme which has been enhanced locally in some areas to deliver the Pharmacy First Plus Scheme due to an increase in the number of Pharmacies having Independent Prescribing Pharmacists. 1.5 Various areas of development work has been undertaken within Community Optometry to increase access to specialist care and treatment in the community, reducing the need for patients to attend secondary care services for some conditions. 22
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1.6 A programme of work to reset the vision for dental services across Ayrshire continues. Work is being undertaken to understand the population need, current status of all services within dental and determine what a future delivery model for dental services, could look like. 1.7 This report has been presented to: i. East Ayrshire IJB – 27 August 2025 ii. South Ayrshire IJB – 8 October 2025 This report will also be presented to: iii. NHS Ayrshire & Arran Board – 8 December 2025 2. BACKGROUND 2.1 The Public Bodies (Joint Working) Scotland Act 2014 provides a legislative framework for the delivery of Primary Care Services in Scotland. East Ayrshire HSCP, through Lead HSCP arrangements, are responsible for the delivery of Primary Care Services across Ayrshire and Arran. In addition NHS Ayrshire & Arran directly commission East Ayrshire HSCP to conduct Primary Care Contracting on behalf of the Board, this being a function that cannot be delegated to IJBs at this time. 2.2 The 2018 GMS contract was introduced to facilitate a refocusing of the GP role as Expert Medical Generalist (EMG). The contract is a joint agreement between the Scottish Government and the British Medical Association (BMA) which sets out to: • Provide a new direction for general practice in Scotland which aims to improve access for patients, address health inequalities and improve population health including mental health • Provide financial stability for GPs, and reduce GP workload through the expansion of the primary care multidisciplinary team • Redefine the role of the GP as an expert medical generalist focusing on complex care, reduce the risks associated with becoming a GP partner and encourage new entrants to the profession as well as help retain existing GPs • Provide new arrangements for GP premises, GP information technology and information sharing. The effect of these arrangements will be a substantial reduction in risk for GP partners in Scotland, and a substantial increase in practice sustainability. Which is critical to ensure service delivery. 2.3 The first Primary Care Improvement Plan (PCIP) (2018-2021) set out to implement the new contract across NHS Ayrshire & Arran by 2021. The PCIP 2 (2020-22) was approved at each of the IJBs, NHS Board and Local Medical Committee in December 2019. In 2022 Scottish Government advised that there would be greater focus on the delivery of Pharmacotherapy, CTAC and Vaccinations following agreement with the BMA that these would be the contractual elements of the 2018 contract. This then became the priority across Ayrshire and Arran. 23
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2.4 Since April 2024, the Ayrshire and Arran Primary Care Team, on behalf of the three Health and Social Care Partnerships (HSCPs) have been leading on the Phased Investment Programme Demonstrator site work with NHS Health Improvement Scotland (HIS). This is to demonstrate what fuller implementation of the 2018 GMS Contract would look like in General Practice, focussing on the contractual elements of Community Treatment and Care (CTAC) and Pharmacotherapy. This is a nationally funded 18 month programme delivered by the Primary Care Transformation team and service leads with local governance arrangements in place. Throughout the programme, qualitative and quantitative data is being collected to evaluate whether fuller implementation is achievable. 2.5 NHS General Dental Services (GDS) is typically the first point of contact for NHS dental treatment for patients within the community. People register with a dentist in order to receive the full range of NHS treatment available under GDS. 2.6 The Public Dental Service (PDS) acts as both a specialised and safety-net service providing care for individuals who are unable to obtain care through the GDS such as those with special care needs or patients living in areas where there were few NHS dentists providing GDS. 2.7 Secondary care is a referral based service which supports referrals from medical and dental practitioners. For example, maxillofacial surgery which specialises in the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck. Those patients who are unable or not suited to be treated locally are referred to the General Dental Hospital who not only specialise on oral health care but deliver education and research in West and Central Scotland. 3. OVERVIEW 3.1 General Practice (GMS) Primary Care Services are more often than not a patient’s first point of contact with NHS Ayrshire & Arran and it is estimated that around 90% of NHS contacts take place within general practice. There are 53 GP practices across Ayrshire and Arran who all operate as separate independent businesses in their own right, and are not directly employed by NHS Ayrshire & Arran. Within Ayrshire and Arran there are currently no Health Board managed practices (which would operate under a 2C contract). The core elements of a general medical services contract includes: • An agreed geographical or population area the practice will cover • A requirement that the practice maintain a list of patients for the area and sets out who this list covers and under what circumstances a patient might be removed from the list and the process to follow in the event. 24
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• The establishment of essential medical services a general practice must provide to its patients • Key policies including indemnity, complaints, liability, insurance, clinical governance and termination of the contract. Whilst every GP Practice delivers general medical services through their contract with NHS Ayrshire & Arran, they have flexibility to deliver that in a manner that best suits their patient population as well as business model. One size does not fit all and all practices operate very differently in terms of clinics that operate on a daily basis, their clinical workforce model, and also how appointments are triaged and allocated. All GP Practices have to complete an annual contract review survey which is followed up with visits to all by the NHS A&A Primary Care team to discuss the feedback around contractual matters and improvement work. Review of Enhanced Services – Additional services for specific health care needs beyond core GMS The programme of review for enhanced services (to determine whether they remain fit for purpose) recommenced in May 2025, with cognisance that some are being considered within the wider Caring for Ayrshire work. All enhanced services appropriate for review have now been categorised as High / Medium / Low priority level. The Local Medical Committee is supporting this work by commencing a group to review the pathways and funding attributed to each enhanced service and will feed their findings / recommendations into the Enhanced Services Review Programme Board for consideration. The review will be completed by March 2026. Any amendments to the enhanced services pathway will be ratified by GP sub and approved at Primary and Urgent Care Clinical Governance Group. GP Sustainability Payments NHS Ayrshire & Arran currently supports 11 GP Practices operating under 17C (GP- run / locally negotiated contracted) arrangements. These practices receive sustainability payments, low payment agreement contributions and specific and standard enhanced services. The nature and purpose of each type of payment is dependent on the specific arrangement with the GP Practice but typically, relate to delivery of services in remote locations or areas with specific demographic needs meaning that GP practices require financial assistance to operate. Following an external audit in late 2024 of 17C Contractual arrangements and subsequent recommendations, a review is being undertaken for all GP Practices with a 17C Contract. This will include reviewing the governance, the amount of sustainability payments these practices receive and also the practice specific enhanced services provision which is provided over and above the levels provided under GMS. 25
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There is the potential for additional funding support being required if it is determined, following review that the current level of payments does not meet the financial sustainability of the practice and therefore puts the practice at risk of resigning from their GMS Contract as the practice no longer becomes financially sustainable to continue in its current form. GP Sustainability Loans (GPSL) Scottish Government confirmed that the process to complete Band 1 & 2 GPSL transactions by end of financial year 2024/25 was successful and that all available funds were disbursed before the deadline. Scottish Government have confirmed that funds are available for each of financial years 2025/26 and 2026/27, in both instances the available funds are capped. Scottish Government have asked that Boards proceed with the negotiation of existing applications falling within all bands but must obtain funding confirmation for each transaction before signing the relevant documentation. This is necessary to allow Scottish Government to manage the cash flow within the project each year. NHSAA have six GP Practices to be concluded within Tranche 1 at a total value of £925,400 which are now guaranteed to be funded. Scottish Government is not able to authorise any further tranche 1 applications at this stage. Tranche 2 of the GP sustainability loans currently remains frozen. NHS Board Hosted Digital Telephony Platform Progress with this project had been slow due to delays from IT Security in approving the cloud-based system, Fuse 2, to have access to Health Board telephony systems. Due to this, there has only been three GP practices who have transferred over onto the Board current telephony platform to date. The Fuse2 3CX Cloud hosted solution was recently signed off by Cyber Security and Information Governance which will now allow the digital telephony team to progress at pace with implementing the roll out to the 15 practices who have agreed to transfer over onto the health board telephony platform. Two of these Practices to be made a priority for ordering and installation due to sustainability issues and concerns. The timeframe from order to installation is approximately two to four weeks which will allow the programme to build momentum and the work to be completed for the remaining practices during September 2025 to March 2026. Some of the remaining 38/53 Practices already use digital platforms and /or are tied into lengthy contracts with their current telephony provider. Further engagement will be undertaken with these 38 practices, to establish those on an analogue system for prioritisation and explore all options which would allow transfer to the Board platform for those wishing to do so. Due to the significant delays with this project, some practices may opt out of the Board telephony platform and make their own arrangements with an alternative supplier. 26
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This would have financial implications for the current model and potentially unmet costs not being covered through the proposed income from practices. GP IT Re-provisioning Following the collapse of the parent company, In Practice Systems Limited (InPS), involved in the IT Reprovisioning, a preferred new supplier has been identified and work is progressing at a national level. The hosted platform will remain as Vision and the only change is to the supplier. Locally, GP practices have been asked to submit details about the quality and safety searches and templates that they use. The information provided will then be used to create a suite of searches and templates that can be used in Vision and are available to all practices in Ayrshire and Arran. GP Recruitment and Retention There are issues being faced nationally around the retention and the declining availability of WTE GP workforce which is affecting all GP Practices across the country. These issues include workload pressures, recruitment and retention of practice teams and financial viability as many GPs are expressing burnout and uncertainty on whether to remain working in General Practice. GP vacancies within NHS A&A have reduced significantly than in previous years. In 2024/25 we had 22 vacancies, in comparison to 2025/26 there are currently only three vacancies. Many GP Practices will be considering or have put succession plans in place. It is therefore crucial that GP Practices are encouraged to become licenced sponsors and/or participate in the GPwER (GP with Extended Role) scheme and at the same time retain locally trained doctors, specifically the IMG (International Medical Graduate) cohort. Previous GPwER recruitment efforts have proven that offering something unique sets NHS Ayrshire & Arran apart from other Health Board areas and supports the future sustainability of General Practices. Urgent Care Home Visit Test of Change In December 2023 a Home Visit Test of Change (ToC) within Ayrshire Urgent Care Service (AUCS) was developed, in conjunction with the local GP Sub-Committee, to support local GP practices with unscheduled afternoon requests for home visits between the hours of 3pm and 6pm. This was in recognition of the increased demand in general practice (including increasing mental health presentations, increase in patients with core morbidities and managing more patients for longer with complex conditions whilst waiting on secondary care appointments). This also causes an impact on capacity and pressure on the workforce when faced with many conflicting priority patients including those presenting late in the afternoon with an urgent care need requiring a home visit. 27
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To ensure safe delivery and the ability to cope with demand, the ToC has been rolled out on a phased basis, through GP Clusters whilst closely monitoring and evaluating delivery. At the end of June 2025, 51 practices across all three Ayrshire Health and Social Care Partnerships were involved with the ToC with 43 of them using the service at least once. During 2024/25, 1020 patients have been seen by the GP to AUCS for Home Visit Service with just 17% (173) of patients requiring admission. This model aligns to the urgent care principles set out within the 2018 contract as well as the vision of creating a 24/7 seamless urgent care pathway with general practice and AUCS working together. 3.2 UPDATE ON 2018 GMS CONTRACT - PRIMARY CARE IMPROVEMENT PLAN Progress continues to be made implementing the 2018 GMS contract which provides the basis for an integrated health and care model with a number of additional professionals and services multi-disciplinary teams (MDTs) including nursing staff, pharmacists, mental health practitioners, MSK physiotherapists, and community link workers as well as signposting a number of patients, where appropriate, to other primary healthcare professionals within the community. This is aligned to the NHS Ayrshire & Arran Caring for Ayrshire vision to create a whole system health and care model focussing on individuals, families and communities with general practice and primary care providing accessible, continuing and co-ordinated care. NHS Ayrshire & Arran were one of four Scottish NHS Boards who were successful in a bid during 2023 to be a Primary Care Phased Investment Programme (PCPIP) demonstrator site to work with Scottish Government and NHS Healthcare Improvement Scotland (HIS). The aim is to demonstrate what a model of full implementation of the MDT (focussing on Community Treatment and Care (CTAC) and Pharmacotherapy teams) can look like in General Practice and to build evidence to understand the national context for full implementation and long-term Scottish Government investment. Demonstrator sites have been supported to work at pace using improvement methodologies to fully implement elements of the 2018 GMS Contract focussing on the contractual elements of Pharmacotherapy and CTAC locally. It seeks to understand the impact for people, the workforce and the healthcare system, with reduction in GP and practice workload with the key aim being to improve patient outcomes. The programme has been ongoing since April 2024 and is due to complete by the end of December 2025. NHS Ayrshire & Arran had a mature model of both the CTAC and Pharmacotherapy service implementation prior to the programme, and is undertaking the widest scope, scale and complexity of the four demonstrator sites. 28
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There has been strong collaborative working throughout the programme between Scottish Government, HIS and NHSAA, and internally within different services and teams. GP Practices have had multiple opportunities to be involved, for example, as standing members of governance groups, or to participate in evaluations; also, to have an understanding of the programme through regular PCPIP news bulletins. The Key elements of the programme for NHS Ayrshire & Arran Pharmacotherapy are to: • Expand the Pharmacy support worker role in delivery of the service • Clearly define role 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 • Test & evaluate Advanced Pharmacist Practitioner role The Key elements of the programme for NHS Ayrshire & Arran CTAC are to: • Expand and further development the CTAC resilience model ensuring sustainability of the CTAC service and ongoing support for General practice during times of long-term absence or maternity leave. • Test an adapted skill mix for resilience to inform future workforce planning and service delivery models • Continue and further develop the Primary Care Practice Educator role across the three HSCPs. • Work in partnership with General Practice colleagues to undertake a further audit of demand and activity • Develop systems to capture reliable, ongoing data around CTAC activity at both GP practice and HSCP level • Engage with key stakeholders including local population to evaluate current service and inform areas for improvement Pharmacotherapy and CTAC teams have been working hard over the past year to implement the key elements of the programme locally which is supported by a robust governance framework and programme management. Local Quality Improvement colleagues have been supporting Pharmacotherapy and CTAC teams in the collection of data for improvement for the key elements of the programme. Whilst the focus will be on these two services, all MoU Services will be considered in the monitoring and evaluation of the demonstrator sites as part of a whole systems approach to quality improvement. In 2024 NHSAA refreshed the detailed delivery framework to implement the 2018 GMS Contract. There has been significant progress across each of the contract areas with vaccinations already transferred and the majority of practices accessing the additional roles described within the contract. 29
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For each area of the programme there is delegated involvement, responsibility and accountability from representatives across the three HSCPs, NHS Board, and GP Sub Committee within Ayrshire and Arran. There are co-leadership arrangements with MoU workstream Leads and local GP Sub Executive Members to oversee decision making and progress through the current implementation structure. This is further strengthened with involvement from the Clinical Director and GP Stakeholder from each of the HSCP areas who are well engaged with practice teams and wider community teams on the ground. This group come together regularly as the GMS Contract Oversight Group with the additional responsibility to oversee the Demonstrator Site work. General practice and wider community teams have been fully engaged in developing service specifications aligned to the MoU. We are confident with additional support and focus we could demonstrate what full delivery could look like for a Board wide area. Pharmacotherapy The pharmacotherapy service is provided to all GP practices across Ayrshire and Arran and while full implementation of the Contract has not been achieved developments to improve efficiencies in systems and processes will be reviewed to ensure pharmacotherapy teams deliver the best possible service and add maximum benefit to patients. The delivery model has continuously been refined adjusting the ratio of pharmacists, pharmacy technicians, and the introduction of pharmacy support workers. The skill mix has developed over time as the service continues to promote advanced practice roles and ensuring that professionals are working to the top of their licence. New roles have recently been introduced to the team as part of the PCPIP programme including Pharmacy Support Worker team leaders and Advanced Pharmacist Practitioners. These new roles will be evaluated as part of the programme. Central hubs have expanded and are now covering all three Ayrshire HSCPs providing some (but not all) resilience cover for the pharmacy technician workload. Polypharmacy reviews are an area of national and local focus and this along with prescribing improvement activities are and will remain important aspects of service delivery by pharmacy colleagues working in our general practice network. Learnings from the current PCPIP programme will inform the development of the service. This as well as additional Quality Improvement support from HIS and local quality improvement teams will support closer review of processes at scale. Variation across the service both in terms of skills and confidence of pharmacy teams along with practice and processes in general practice continues to challenge. 30
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Standardisation of processes and development of staff will continue to be a priority for the leadership team within Pharmacotherapy. Community Treatment and Care (CTAC) Nursing In line with the 2018 GMS contract, a CTAC model was developed and implemented between 2020 and 2022. Following extensive consultation there was an agreement that the model would be practice based and seamless for patients accessing the service. The workforce consisted of 90 WTE staff; 58 WTE Nurses and 32 WTE HCSWs. In addition, there are 3 WTE CTAC Team Leaders; one per HSCP to manage the staff. A total of 52 GP Practices have full access to CTAC services. There is also a hub model tried and tested in South Ayrshire HSCP which has supported practices where accommodation within GP Practices has been challenging. In 2023, the model was further enhanced with the introduction of a staff resilience model to provide cover for maternity and long-term absence to prevent workload falling back to General Practice over a longer period of time. In addition, a Practice Educator role was tested to provide a robust education and supervision model whilst implementing the service specification. The CTAC element of the PCPIP bid focussed on the continuation and expansion of the resilience model with a focus on testing an adapted skill mix for resilience with a 2:1 ratio of HCSW to Nurses. It is anticipated that this will inform future skill mix requirements for the CTAC model which is based on a 2:1 ratio of Nurses to HCSW. The Practice Educators and resilience staff are currently in post until September 2025 in line with the PCPIP funding. In addition, a further 12 HCSWs were recruited to provide enhanced resilience cover. The additional posts were recruited in December and it is anticipated the full impact of the additional staff will be tested between April and September 2025. A further week of care audit was undertaken in September 2024 which demonstrated that CTAC staff were undertaking 85% of CTAC activities. National week of care audits were undertaken in each of the demonstrator sites in April and June 2025 with a further planned for September 2025 which will inform next steps. Feedback was captured from stakeholders including a patient and carer survey which was undertaken in six GP practices in April 2025. Feedback was very positive, and an infographic has been produced to share results with staff and stakeholders. Staff survey results have been collated, and an infographic has been produced. A ‘You Said, We Did’ session is being facilitated by Quality Improvement colleagues in August 2025 to note areas for celebration and for improvement. Information will be shared with staff at a future PLT session. A survey to capture feedback on the impact of the Practice Educator role was also sent to CTAC staff, Practice Managers and Practice Nurses. The results have been collated and a themed infographic is under development which will inform areas for improvement. A summary of the above feedback will be shared in the September 2025 PCPIP newsletter. 31
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Extended Multi-Disciplinary Team (MDT) Professional Roles Since its implementation, significant progress has been made to roll out the 2018 GMS Contract. • All Practices have access to Pharmacotherapy staff • All Practices have access to all immunisations through the Vaccine Transformation Programme (except pregnancy and non-routine adult vaccinations) • All Practices have access to a Community Link Worker • All Practices except one in South Ayrshire have access to a CTAC Nurse / HCSW. Due to the funding constraints there is a high risk of not being able to provide these services across all practices in Ayrshire and Arran creating an inequality of access. In addition it will widen the gap and increase health inequalities and access to services for patients resulting in a post code lottery. Unfortunately the financial envelope within the new GMS contract does not allow additional funding to be allocated to services at this stage. A breakdown of the MSK and MHP roles is noted in the table below. HSCP MSK MHP North 4.5WTE provide cover for 15 of 16 practices 10.2WTE provide cover for 16 of 16 practices South 4.85WTE provide cover for 15 of 19 practices 4.8WTE provide cover for 8 of 19 practices East 4.3WTE provide cover for 16 of 18 practices 8.1WTE provide cover for 18 of 18 practices The overall additional MDT resource in total is split as follows; 30% in the East, 35% in the North and 30% in the South. This was based on practice population at 2019-20 and was largely in keeping with the partnership patient list size. The figure below details practice population in 2025: • East Ayrshire – 136,663 patients (35%) across 16 Practices • North Ayrshire – 144,433 patients (37%) across 19 Practices • South Ayrshire – 108,890 patients (28%) across 18 Practices It should be noted that the analysis of the extended MDT workforce aligned to the new GP contract has been captured at a moment in time and can vary across the year. 3.3 PRIMARY CARE IMPROVEMENT FUND The implementation of the 2018 General Medical Services contract for Scotland intended to see an additional investment of £250m per annum in support of General Practice by 2021. 32
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This was part of an overall commitment of £500 million per annum investment in Primary and Community health services that was previously committed by Scottish Government. Since 2021/22 and 2022/23 Primary Care Improvement Fund (PCIF) was allocated as tranche 1 and tranche 2 based on projections and spend against each of the IJBs National Resource Allocation Committee (NRAC) share. Although the focus changed in 2022 to pharmacotherapy and CTAC, the HSCPs continued to invest in the additional wider roles set out as above. Each area has been at different stages throughout, and prioritised different services based on their population need. It should be noted that as the PCIF is ‘flat cash’ all pay awards/uplifts are consumed within the budget itself. This has impacted significantly on the funds available for additional investment. PCIF budget for 2025/26 has been confirmed as £13.4m plus £1m reserves carried forward from previous years. Discussions are still required to take place with all three HSCP’s in relation to a pan-Ayrshire approach to the Primary Care Improvement Plan budget for 2025/26. There are challenges with this budget not being managed pan- Ayrshire which has continued to delay recruitment in some areas. • East Ayrshire - £409,154.16 • North Ayrshire - £46,142.68 • South Ayrshire – £636,134.24 3.4 GP Practice Premises Many GP practices are facing increasing challenges to accommodate the number of additional staff aligned to them through the PCIP. The lack of availability of assessment rooms means some practices are unable to access their full allocation of MDT resource therefore capacity to appoint patients to these practitioners is reduced. Many of the buildings within the GP practice estate are also needing significant investment or alternative accommodation identified for longer term viability. Work has been undertaken throughout 2024 to examine patient populations and premises across each of the three HSCP areas and consider the best use of the estate, virtual appointment delivery and scoping potential for some MDT services to be provided from local community hubs and where these could be located. The Primary Care and Property Teams are taking forward a review of the Buchan Associates report, the work undertaken in 2024 regarding populations and premises with a view to developing a premises strategy with each HSCP. 33
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3.5 COMMUNITY OPTOMETRY Community Optometrists provide a first point of treatment for eye problems. If people require medicine for a basic eye problem this is provided free of charge from the community pharmacy through Pharmacy First Scotland. An increasing number of Optometrists are now Independent Prescribers. There are currently 50 Independent Prescribers based within 28 Community Optometry Practices who can now also manage complex eye issues by prescribing medicines such as topical steroids and oral antibiotics. This reduces the number of referrals to secondary care. Community Optometry provides a range of services in addition to routine eye examinations and dispensing glasses etc. Optometry practices can carry out post- operative cataract reviews, some are accredited to undertake Diabetic Eye Screening and some provide the Low Vision Aid service. Community Optometrists also have access to digital clinical systems such as Clinical Portal, which allows better patient management. Work is also underway to further develop new pathways and determine further areas of ophthalmic care which can transition into a community setting. The national General Ophthalmic Services (GOS) Specialist Supplementary Service will roll out from August 2025. This involves Independent Prescribing Optometrist treating 10 more challenging conditions, including Anterior Uveitis. This scheme enables the inter-referral from an Optometrist to an Independent Prescribing Optometrist. This allows more people to be treated closer to home, in the community. Clinical Portal Access This is now in place within a number of Optometry practices with Optometrists actively using the system when reviewing patients. Having access to the clinical portal has proved to be invaluable and provide a more informed consultation as it allows the clinician to access the patients clinical history and medications. Uveitis / Juvenile Idiopathic Arthritis Service (JIA) The local service for Anterior Uveitis and JIA screening are now in operation, with a total of 26 practices providing the Anterior Uveitis side of the service and three practices for the JIA service. A total of 46 patients were seen in Community Optometry for Anterior Uveitis in the first six months of the service being available and anticipated this will show a gradual increase. The local Anterior Uveitis service will soon end as Scottish Government plan to roll out a national service under GOS. This will allow Optometrists who are Independent Prescribers to claim a new fee (Specialist Supplementary fee) for managing complex acute anterior eye conditions. It is anticipated that this new GOS Specialist Supplementary service will be implemented around autumn time this year. 34
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Community Glaucoma Service (CGS) - The management of stable glaucoma patients in the community There are currently four accredited Optometrists qualified to provide the CGS within practices in Kilmarnock, Irvine, Largs and Prestwick. A new NESGAT candidate (based in Kilmarnock) commenced in January 2025, with an expected date for qualification around September 2025. Progress on the roll out of OpenEyes in secondary care to facilitate the implementation of the CGS has been slow due to delays from Digital Services in completing various actions including submitting the Data Protection Impact Assessment, (signed off now – June 2025) and progressing Trak integration. Timescales for the completion of these actions will have an impact on which version of Open Eyes will be used, as an updated version is due in the coming months. This may impact on the start date of the CGS to avoid a clash with the wider OpenEyes upgrade. Whilst there are concerns around the OpenEyes pathways for outpatients, the CGS pathway is a national pathway and Optometry colleagues are content with the structure of this, although it will require training across both primary and secondary care. Work continues to be underway for CGS in terms of identifying CGS candidates and establishing the capacity of qualified Optometrists for the next 12 months and identifying required user groups. We are committed to ensuring the local elements of the CGS roll-out are in place by March 2026, with appropriate risks identified and mitigated as necessary. Complex Contact Lens Fitting The review of the Complex Contact Lens Fitting service is underway and remains a priority. Capacity, financial and resilience implications continue to be highlighted as high risks and analysis has shown that only five local optometry practices are currently providing 98% of this service activity. Recent discussions with the Optical Contractors Committee have highlighted the need to encourage new optometrists to provide this service and to do so will require robust training and accreditation, although it is understood there is no recognised single training source available. Engagement will continue with the Contractors Committee and Ophthalmology colleagues to reduce and ultimately remove the risk around this service. A new claim form has been devised and information on claims for 2024/25 is awaited from Practitioner Services Division. The Primary Care Team have also been looking at various claim elements of the scheme and plan to revise these also. Provision of the service remains a risk due to the number of skilled providers in the community. There remains a concern around future provision of this service. This is on the Primary Care risk register and alternative models for complex contact lens provision across Ayrshire and Arran is currently being scoped out. 35
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3.6 COMMUNITY PHARMACY The number of community pharmacies reduced in 2024/5 from 99 to 97 however has now stabilised at 98, following the opening of a new pharmacy in Monkton in May 2025. Unplanned Pharmacy closures during the first quarter of 2025 were as follows: • April 2025 – 9 closures weekday and Saturdays across the month for a total of 21 hours which affected all three HSCP areas • May 2025 - 3 closures weekdays across the month for a total of 3 hrs 15 mins which affect only South and East HSCP area • June 2025 - 6 closures weekdays and Saturdays across the month for a total of 9 hrs 55 mins which affected all three HSCP areas These closures were mainly as a result of locums arriving late or cancelling plus power cuts and staffing issues and were predominantly closures for short periods, with no significant impact to patients. A review of Community Pharmacy opening arrangements is currently underway following a proposal from Community Pharmacy Ayrshire and Arran (CPAA) to close or reduce some pharmacy opening hours on a Saturday. Around a third (36) of Community Pharmacies have intimated their wish to close on a Saturday or vary their opening hours. The Board’s current hours of service scheme for community pharmacy allows pharmacies to close half day on a Saturday however some choose to open all day. Access to services is the priority concern therefore analysis is underway to determine the impact on patient access, increasing workload on neighbouring pharmacies and if a test of change could be undertaken to monitor and evaluate further. Pharmacy First Scotland The NHS Pharmacy First Scotland service was introduced on 29 July 2020 in community pharmacies which contributes to urgent care delivery being the first contact for patients for a range of common clinical conditions. Patients who may have previously needed to see a GP or attend out of hours services can access appropriate care through this service which is available to all patients resident in Scotland or registered with a Scottish GP. Currently, all 97 pharmacies in Ayrshire and Arran deliver this service providing advice and treatment (if appropriate) which includes urinary tract infections for women aged over 16, impetigo, shingles, skin infections and a hay fever service where treatments that were previously only available via prescription can be provided from community pharmacy. In addition, 48 of the 97 Community Pharmacies in Ayrshire and Arran now have Pharmacist Independent Prescribers which allows them to offer the Pharmacy First Plus service. This enhances the Pharmacy First service to include assessment and treatment of acute common clinical conditions thus reducing the need for onward referral of patients to other healthcare providers even further. 36
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The number of Community Pharmacies able to offer this enhanced provision continues to grow as more pharmacists undergo the training and gain the independent prescribing qualification. In addition to the national services available, locally negotiated services are also available which have been specifically developed with the needs of the local population in mind. Not only are community pharmacy able to treat common ailments, they are also a great source for patients to get information and guidance to help prevent illness, keeping the population of Ayrshire and Arran as healthy as possible. Protected Learning Time (PLT) Working with the local NHSAA Community Pharmacy Committee, Ayrshire and Arran successfully launched the first of a rolling programme of Protected Learning Time (PLT) for community pharmacy in 2024. This allows community pharmacies the opportunity to close a half day every three months to deliver staff training in much the same way as our GP colleagues do. This has been well received and will be continuing throughout 2025/26, sharing ideas for learning across the local pharmacy network following each session. 3.7 DENTAL SERVICES Recognising the workforce and access challenges, as well as the opportunity to enhance what we can deliver in Ayrshire and Arran collectively across all dental services, a programme of work was started in 2023/24 and continues to be developed to reset the vision and strategy for dental services. There was acknowledgement that the current challenges being faced with workforce retention and access also provided opportunity to ensure our services are in the right place to deliver care wrapped around individuals. This will allow greater understanding of the population need, the current status of all services within dental and determine what a future delivery model for dental services could look like. Following this in-depth review, the delivery plan is in progress through the appropriate governance arrangements. The Senior Dental Management Team are working towards the aims of the plan. Once formally approved, the plan will be the focus of work for the Dental Team throughout 2025/26. General Dental Services (GDS) Access to dental services has remained stable with no significant changes. The number of General Dental Practices (GDPs) accepting new NHS patients fluctuates monthly but is overall consistent. Access in some specific areas remains a challenge however this is kept under close review. South Ayrshire has remained an area of concern due to the low numbers of practices accepting NHS patients however the situation has now improved due to two new practices opening in Troon and Ayr who are currently registering NHS patients. 37
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As at 5 September 2025, 22 Dental Practices across Ayrshire were accepting new NHS patient registrations: • East Ayrshire – 5 • North Ayrshire – 11 • South Ayrshire - 6 The Dental Team continue to keep in regular contact with GDPs to understand in detail the status of their service delivery to be aware of any issues early to be able to resolve and support where possible. The service also continues to prioritise prevention and oral health improvement to reduce the possible burden of dental disease and mitigate the impact of reduced dental access. Public Dental Service (PDS) The PDS core function operates Monday to Friday with emergency appointment slots available as a safety net for practices who are unable to offer emergency appointments. The Emergency Dental Service (EDS) service operates Out of Hours (OOH) Saturday and Sunday 9 am – 3 pm with 44 appointment slots available. Some weekends the service will get near to capacity but has not exceeded capacity. Following an initial trial period, the EDS has been further enhanced with a weekday service along with the weekend provision. Following a recent analysis of activity, the EDS now offers two full day and three half day sessions Monday to Friday. The EDS service has contingency arrangements in place for a stand by team should the reach capacity. The OOH service is accessed via NHS 24 and on review of the national reporting, demand has not increased to NHS 24 from Ayrshire and Arran. In 2024 8% more patients attended the PDS for emergency care appointments compared to 2023. Although the rate of increase in patients accessing emergency care is slowing, the cumulative effect of previous years mean that the service demand has increased by 28% since 2022. PDS Referrals The overall number of referrals to the PDS remains above pre-pandemic rates, although adult referrals are slowly returning to normal. During 2024, paediatric referrals were still 28% higher than in 2019. Both Adult and Paediatric waiting times are currently over 20 weeks for assessment appointments and due to capacity issues, treatment plans are taking over a year to complete. 38
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Dental provision within the Prison Service Due to HMP Kilmarnock implementing changes to their service model, the number of prisoners on the dental waiting list has increased significantly resulting in compliance with the 18 week referral time dropping from 90% in August 2024 to 38% in May 2025. The Primary Care Dental Management Team are working with the Scottish Prison Service to improve this and increase the numbers of patients being seen. Current waiting time for assessment is around one year. Dental Sessions are provided three times per week but are underutilised by the prison and not running to full capacity. An increase of population numbers would further impact on treatment waiting times. Childsmile Programme The Childsmile Toothbrushing Programme is a supervised programme aimed at helping children develop an important life skill at an early age, supporting positive development in their immediate social and physical environment. Across Ayrshire the programme is delivered in:- • 134 Early Years/nursery schools • 14 Additional Support Needs (ASN) schools • 98 Primary 1 & 2 classes in all priority primary schools. The Childsmile team also have a dedicated team of Dental Health Support Workers who support family’s additional support and oral health advice. In total 7,642 children have received one fluoride varnish application between August 2024 and June 2025. A breakdown of the number of schools visited is noted below: • 34 in East Ayrshire • 40 in North Ayrshire • 26 in South Ayrshire A total of 213 children receiving fluoride varnish were then offered additional support from the Childsmile team. Oral Health Improvement Oral Health prevention 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 practices 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 training programmes. The training programmes are tailored to individual needs of the population within each of the priority groups. 39
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At a population level this includes: • Providing training materials for nursery, primary and secondary schools (these can be borrowed free of charge) • Promoting how the benefits of good oral health can improve general health via training and social media • Actively participate in National Oral Health Improvement initiatives such as National Smile Month and Mouth Cancer Action Month. In addition, directed support targeting priority groups in greatest need through: • Deliver the Caring for Smiles programme to every care home in Ayrshire • Provide Caring for Smiles training for care home staff • Provide Mouth Matters training and interventions for prisoners and prison staff • Provide Open Wide training and interventions for adults with additional needs • Provide Smile4Life training and interventions for homeless/addictions • Facilitate a referral service (Dental Access Programme) for homeless/addictions to the Public Dental Service • Deliver bespoke training and interventions for children with additional needs 3.8 KEY PRIORITIES / DELIVERABLES 2025/26 A number of priorities have been agreed for 2025/26 across the Primary Care Leadership Team: • General Practice Clusters will continue to be supported to undertake quality improvement initiatives identified through local data analysis. • Review the GMS Contracts of Independent Contractors to help identify any improvement work and understand key themes. • Continue to review the local and national Enhanced Service specifications being delivered across General Practice to ensure they are fit for purpose. • Continue to work with Digital Services to enhance digital telephony within General Practice and move to a single resilient digital telephony platform. • Deliver the Primary Care Phased Improvement Programme to demonstrate what a model of full implementation of the MDT (focussing on CTAC and Pharmacotherapy) can look like in General Practice. • Continue to develop Openeyes for roll out in primary and secondary care so the Community Glaucoma Service can be implemented. • Investigate the feasibility of establishing a low visual aid service for children. • Transition from the Community Uveitis Service to the National Specialist Supplementary Service covering 10 eye conditions from August 2025. 40
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• Review the provision of hospital contact lenses in the community looking at skill levels, accessibility and training. • Work to improve dental access for patient care within dental practices with the aim to reduce waiting times and provide a greater range of services. • Develop a virtual capacity network by developing a Single Point of contact through AUCS Flow Navigation Centre to encompass Hospital at Home and Community Rapid Respiratory Response programme to ensure a seamless pathway to services for patients. • Evaluate the Test of Change of the urgent care pathway for GPs to refer patients for a home visit during OOH and consider extending the model for pre-bookable appointments at an AUCS Primary Care Treatment Centre. 3.9 QUALITY/ PATIENT CARE Quality improvement within General Practice Clusters has continued to develop and strengthen. A range of improvement work has been carried out by the Clusters with some pieces of work done in collaboration with NHS HIS. Online Continual Professional Development events are hosted fortnightly with an open invite to staff in the whole MDT working in General Practice. Clinical Directors also meet regularly with Stakeholder GPs to understand any barriers for improvement within clusters and ensure they are supported to undertake quality improvement initiatives identified through local data analysis. All GP Practices, and now extended to Community Pharmacy teams, across Ayrshire and Arran are offered regular afternoon sessions throughout the year for Protected Learning Time (PLT). This allows the teams to come together to focus on reviewing service delivery models, staff development, discuss any opportunities for learning or improvements and opportunities for future ways of working. Calls into the GP practices participating in PLT on these afternoons are re-directed to AUCS to support patients during this time. 3.10 Anticipated Outcomes The purpose of the work underway is to help people access the right person, in the right place, at the right time in line with the Scottish Government Primary Care Vision and Outcomes, including: • Maintaining and improving access • Introducing a wider range of health and social care professionals to support the Expert Medical Generalist • Enabling more time with the GP for patients when it’s really needed • Proving more information and support for patients. 41
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3.11 Measuring Impact As we have worked to build our devolved Health and Social Care System in Ayrshire and Arran, the critical role of primary care has been emphasised throughout implementation to date, and is viewed as a core component of an integrated community based care system. This provides a solid foundation for developing a whole system health and care model which focuses on individuals, families and communities with general practice and primary care providing accessible, continuing and co-ordinated care. The aim is to empower people to take control of their own health and care as far as possible, enabling self-management, promotion of wellbeing and prevention of ill- health, use of telecare and telehealth and maximising care provided in and around communities. Continued implementation of the PCIP has created opportunities seen in the context of the aim of the Caring for Ayrshire agenda to design a fully integrated system wide approach to ensure people are able to access the right care at the right time in the right place. Primary care clinicians have more interactions with patients than other parts of the NHS therefore the whole system transformational change relies on sustainable and accessible primary care services. 4. IMPLICATIONS 4.1 Financial Primary Care Improvement Fund – the allocated fund available for the PCIP is not sufficient to ensure full roll out of the wider MDT roles. The projected additionality for CTAC and Pharmacotherapy is captured within the Demonstrator Site bid and funding. This will create an inequity across practices and different populations. There has been a request to NHS HIS to capture the impact of this as part of the evaluation process. Discussions have taken place nationally to baseline the PCIF into core budgets, but there is no agreement on this to date. Until the budget is baselined, the cost pressure associated with agreed pay awards will continue to impact on the number of roles that can be recruited to. Phased Investment Programme Demonstrator Site – the funding associated with this programme of work will continue up until end of March 2026. There is no commitment beyond this time period but discussions with Scottish Government are ongoing for future sustainability of the programme. The detailed work being taken forward as a demo site will inform future investment within Primary Care, however, there is no guarantee of recurring funding. Discussions are taking place as the programme continues to determine staff turnover projections and the risk appetite at an IJB level to determine permanent vs fixed term job roles. 42
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GP Practice Sustainability payments – there has been an increase in the number of practices who have indicated to the primary care team that they have sustainability concerns either relating to practice income or relating to their premises. Historic payments have been agreed with practices operating under a 17C contract which will be reviewed 2025/26 and the primary care team will also be working closely with all practices to understand sustainability concerns in more detail, providing guidance and support with the Local Medical Committee also. There is no dedicated sustainability funding allocation available for practices. The national GP Sustainability Loan Scheme for premises has been in place since 2018 which is open to all GP Practices who own their building to apply for an interest free sustainability loan up to the value of 20% of their property. In 2024/25 Scottish Government paused applications for new GP sustainability loans, however, the loan scheme for tranche 1 applications restarted in April 2026 and this is only available to practices who had already submitted an application. Specifically for 17C practices there is a risk that the current level of payments does not meet the financial sustainability of the practice and therefore puts the practice at risk of resigning from their GMS Contract as the practice no longer becomes financially sustainable to continue in its current form. 4.2 Human Resources GP workforce remains a risk with a number of GPs retiring or choosing to leave the profession. There is ongoing work with current GPs and also trainees to make GP roles as attractive as possible in Ayrshire and Arran to improve workforce retention. 4.3 Legal None. 4.4 Equality/Socio-Economic The aim through the reformed primary care service is not just to extend life, but aim to reduce the time spent in poor health. Continued development to implement the priorities of the 2018 GMS Contract and developments within community optometry to integrate additional treatments from secondary care into a community setting is an opportunity to mitigate health inequalities where possible. There is a risk that those who already experience socio-economic deprivation will be disproportionately affected by dental access issues as they will be unable to pay for private dental care. The financial and social impacts of additional travel to access dental care should not be underestimated. 4.5 Risk Sustainability of GP practices is at risk while the new GMS contract is being implemented. 43
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For those practices who have highlighted risks to service delivery or workforce availability, the Primary Care Managers carry out bi-monthly meetings with the Practice Manager and GP Practice Quality Lead to understand the practice issues and risks. There is a risk of not being able to implement all aspects of the 2018 GMS contract due to financial constraints and the ability to recruit to additional professional roles to either expand the MDT teams, ensuring sufficient resilience for leave or vacancies within each of the services. 4.6 Community Wealth Building The wellbeing of people and communities is core to the aims and successes of Community Planning. The PCIP, delivered as an integral part of the Wellbeing Delivery Plan, Integration Authorities Strategic Commissioning Plan of both the NHS and Council, will contribute to support this wellbeing agenda. 4.7 Key Priorities The strategy and programme outlined in this report will assist the IJB to deliver the following Strategic Objectives from its Strategic Plan to: • Provide early and effective support • Improve mental and physical health and wellbeing • Develop and support our workforce 5. CONSULTATION Consultation regularly takes place through all Primary Care structures involving all stakeholders across each HSCPs and Professional Committees. Ongoing communication with all stakeholders and the population will be critical as implementation and reform progresses. Debbie McGill Head of Primary and Urgent Care Services Debbie.McGill@aapct.scot.nhs.uk Implementation Officer and Person to Contact: Claire McCamon Senior Manager Primary Care Services Claire.McCamon@aapct.scot.nhs.uk 11 September 2025 44
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Integration Joint Board 25 September 2025 Subject : Primary Urgent Care Update Purpose : This report is for awareness to provide an update to the Integration Joint Board (IJB) on the provision of primary urgent care services delivered through the Ayrshire Urgent Care Service (AUCS). This report also updates on innovative pathways developed and tested throughout 2024. Recommendation : IJB Members are asked to: a) Note the progress of the Urgent Care agenda across Ayrshire and Arran b) Note the increased activity within AUCS as a result of the new pathways introduced to ensure patient care is delivered as close to home as possible 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 ANP Advanced Nurse Practitioner AUCS Ayrshire Urgent Care Service COPD Chronic Obstructive Pulmonary Disease ED Emergency Department ESMHP Emergency Services Mental Health Pathway FNC Flow Navigation Centre HSCP Health and Social Care Partnership IJB Integration Joint Board MIU Minor Injuries Unit NHSAA NHS Ayrshire & Arran OOH Out of Hours PCTC Primary Care Treatment Centre PEOL Palliative End of Life PLT Protected Learning Time RRR Rapid Respiratory Response RUC Redesign of Urgent Care Agenda Item 6 45
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SARCS Sexual Assault Response Co-ordination Service SAS Scottish Ambulance Service SPOC Single Point of Contact ToC Test of Change 1. EXECUTIVE SUMMARY 1.1 AUCS operates 7 days per week, 24 hours per day and incorporates a pan Ayrshire GP led Flow Navigation Centre (FNC). During the out of hours period this includes the provision of general medical care incorporating remote assessment and treatment. Further information on this unique joint approach and the development and growth of pathways is outlined in this report. 1.2 This paper provides an overview of the activity of the service, including new innovative pathways in operation to support an improved patient journey, with continued focus on community based services. The data presented demonstrates the impact of the service avoiding hospital attendances or avoidable admission to hospital which has better outcomes for patients. 1.3 The success of the new pathways is a result of good working relationships across Ayrshire and Arran and wider system partners including NHS 24, Scottish Ambulance Service (SAS), Police Scotland, as well as strengthened connections with GP practices and Community Pharmacy. All new service developments are created in partnership across clinical and managerial leadership teams from relevant stakeholders. This report has been presented to: i. East Ayrshire IJB – 27 August 2025 ii. South Ayrshire IJB – 8 October 2025 This report will also be presented to: iii. NHS Ayrshire & Arran Board – 12 December 2025 2. BACKGROUND 2.1 The Public Bodies (Joint Working) Scotland Act 2014 provides a legislative framework for the delivery of Primary Care Services in Scotland with powers and duties delegated variously to both the NHS Board and the IJBs. Through these arrangements the three Ayrshire IJBs commission, through Directions, NHS Ayrshire & Arran (NHSAA) to provide Primary Care Services. This includes provision of Out of Hours (OOH) Primary Care Services through AUCS. This is delivered through the Director of East Ayrshire Health and Social Care Partnership (HSCP) in a lead partnership arrangement. In addition, NHSAA directly commission East Ayrshire HSCP to conduct Primary Care Contracting on behalf of the Board, this being a function that cannot be delegated to IJBs at this time. 46
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AUCS fulfils the vision of developing a multi-disciplinary integrated approach to OOH services in Ayrshire. AUCS continues to build on the unique 24/7 model which incorporates OOH and FNC through continuous review of all pathways to evaluate efficiency and effectiveness to create and sustain fully person centred pathways for all patients, getting the right care in the right place at the right time. 3. PROPOSALS 3.1 There are various services and pathways included within AUCS which are available 24/7 and others during the OOH period (Monday to Friday 6 pm – 8 am and Saturday/Sunday). The OOH District Nursing and OOH Social Work teams are managed through East Ayrshire HSCP and the OOH Mental Health Crisis Team who are managed through North Ayrshire HSCP. All other pathways and services are supported within the current AUCS management structure. The 24/7 pathways and call handling services are: • SAS Call before Convey • Emergency Services Mental Health Pathway (ESMHP) • Palliative End of Life (PEOL) Support line • 111 Emergency Department (ED) /Minor Injuries Unit • National Hub - Sexual Assault Response Coordination Service (SARCS) self-referral service AUCS and FNC Activity - In the first six months of 2025 there have been 54,325 contacts to the AUCS FNC with just 12% requiring onward transfer to hospital. In the same time frame in 2024, there were 58,520 contacts with 11% requiring onward transfer to hospital. Call Handling Service - The call handing service has the highest volume of activity within the OOH service, when acting as the single point of contact (SPOC) for various services across East, North and South Ayrshire HSCPs. It includes direct calls from families and patients to Care at Home, Out of Hours Social Services and District Nursing Services. Throughout January to June 2024, call handling for these pathways reflected an average of 4864 contacts. However, with the additional PEOL Support Line and Palliative Services, we see this average rise to 6426 contacts per month for the first six months of 2025. GP Out of Hours Service – The OOH service is accessed via calls to NHS24 111 which are then passed to AUCS with a priority based on clinical need of one, two or four hours. Throughout January to June 2025 the monthly average of contacts was 7458. Proportionately 42% of workload comes through the NHS 24 pathway: the remaining 58% from the other pathways supported through AUCS. In the first six months of 2024 the average monthly figure was 7910, a slight decrease in the number of contacts. 47
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All patients that are referred to AUCS OOH from NHS 24 go through a full clinical assessment within the triage time set by NHS 24 with an outcome of either: • Self-Care; • A prescription issued for collection at a local pharmacy; • An appointment at a local Primary Care Treatment Centre (PCTC). There are three PCTCs covering Ayrshire; based at University Hospital Ayr, University Hospital Crosshouse and Ayrshire Central Hospital; • A home visit undertaken by GPs / Advanced Nurse Practitioners (ANPs) in dedicated cars with driver support colleagues. The first six months of 2025 reported an average 94% of patients being clinically assessed within the set timeframe from NHS 24. This figure has improved slightly compared to the same period of 2024 when it was 90%. This reflects sustained improvements to pathways and clinical resources with a consistent number of clinicians actively undertaking sessional shifts with the service. Factors impacting this performance includes periods of high demand where clinicians will prioritise the most vulnerable patients, including calls received with one and two hour response times, and patients who are non-contactable for several hours following receipt of the case from NHS24. A non-urgent patient transport service is available to take patients to OOH PCTCs, in Ayr, Kilmarnock or Irvine if they have no other means of transport. All clinicians are aware of the criteria outlined below of this resource which is fully funded by the service: • Those who are deemed to need further clinical assessment at hospital on a non-urgent basis and are not suffering from conditions that are life threatening or deemed as an emergency • Patients who have been assessed face to face, virtually or via telephone by a clinical member of GP practice or AUCS clinical staff • Patients who have no alternative means of transport to the requested destination Ayrshire and Arran covers an expansive caseload due to patients living in rural areas with infrequent / limited access to public transport, who particularly benefit from this element of patient transport. Throughout January to June 2025, there were 822 journeys recorded: a marginal increase from 812 for the same timeframe in 2024. It should be noted that this service also supports GP Practices and both hospital front doors where an ambulance is not required and the patient has no means of transport. The use of patient transport has also reduced the number of home visits required to be undertaken by a mobile clinician. This has allowed the service to adjust and flex the workforce to other areas of demand. 48
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The ‘clinical triage first model’, for all OOH calls from NHS 24, remains in place. This results on an average of 58% of calls closed off remotely throughout the first six months of 2025; a slight decrease from same reporting period in 2024 when the figure was 59%. The majority of remote consultations will relate to pharmaceutical enquiries, a change in symptoms or clinical advice. The remote first model reduces the number of urgent care home visits and centre appointments across the three sites, prioritising face to face assessment time for those most in clinical need. It should be noted that a full clinical remote assessment can still take 15 minutes therefore robust clinical capacity is still required. Through the use of extended data analysis, the AUCS management team altered the service delivery model in 2023 to meet projected clinical demand through the implementation of two seasonal model types, Spring/Summer (1 April to 31 October) and Autumn/Winter (1 November to 31 March). This was closely monitored throughout the year with the assurance of adequate flex and preparedness within the workforce to be able to swiftly respond to any emerging challenges, e.g. alerts from Public Health. The current model relies heavily on GP engagement for service delivery. Throughout 2024, a total of 68 clinicians were approved to undertake sessions from within Ayrshire and Arran, as well as other NHS Board areas, with a further 18 clinicians approved between January to June 2025. 111 Emergency Department/Minor Injuries – patients who think they require to attend the ED are directed to contact NHS 24 (111) for their urgent care needs as a first point of contact. NHS 24 assess the patient’s needs and then route patients who require further assessment to the FNC operational within AUCS over the 24/7 period. The Senior Clinician, usually a GP, will clinically assess the patient remotely and determine the best outcome through the most appropriate care pathway which could include: • Closed as assessment and care provided by a clinician over the phone with self-care advice • Directed to their GP practice (during in-hours) • Scheduled for a home visit by an AUCS clinician (during out of hours) • Appointed to a PCTC (during out of hours) • Onward refer to a community service and • Appointment at the Minor Injury Unit (MIU) OOH District Nursing Team - to provide planned and urgent community based care to patients including palliative care where necessary. Patient referrals in the first six months of 2025 have remained static at on average 1898 per month which is very slightly reduced by seven contacts from the average number of contacts in the same timeframe in 2024. 49
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Pan Ayrshire OOH Social Work team - a range of Senior Practitioners and sessional social work staff ensure the delivery of a professional OOH response to the immediate needs of individuals and families across all social work services, including those considered as vulnerable or at risk. Established links with Police Scotland, health and education services remain a constant with the team. The OOH Social Work team received an average of 781 referrals per month in the first half of 2024. This compares with 822 in the same period of 2025. Our OOH Social Work colleagues report that the complexity and needs of referrals continues to increase. Mental Health Crisis Team - continues to operate as part of AUCS in the OOH period providing urgent access to relevant community mental health services. The Mental Health Crisis Team support a range of services out with AUCS in the OOH period with a consistent average of 140 calls via NHS 24 / AUCS on a monthly basis throughout the first half of 2025. This has decreased from an average of 152 for the same timeframe in 2024. COVID-19 Therapeutic Service - the service has been delivered through AUCS since December 2021 within the Community Clinical Treatment Centre. This supports a specific cohort of patients deemed as very high risk of progression to severe disease and/or death if they develop COVID symptoms and test positive for the virus and therefore require intervention in the form of COVID therapeutics. With the decrease of frequency of COVID outbreaks throughout the past 12 months, resulting in fewer people being referred for treatment, the decision was reached to stand down the regular Multi-Disciplinary Meetings designed to consider eligibility for treatment and agree treatment plans. There remains a facility for patients to self-refer or via their GP if they think they are eligible for treatment with adequate service provision to meet the current level of need. The COVID Therapeutic Service was funded in 2023/2 and 2023/24 on a non-recurring basis utilising bank and vaccination staff. Activity is continuing to be monitored to consider all options of care for these patients. The following table shows a breakdown of referrals throughout 2022, 2023 and 2024. The first six months of 2025 has seen a total of 19 referrals with nine receiving antiviral treatment and none admitted to hospital. Year Referrals Receiving Antiviral Treatment Later Admitted to acute hospital for further Covid-19 related illness 2022 1784 901 10 2023 625 423 6 2024 237 231 0 50
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National Hub - Sexual Assault Response Coordination Service (SARCS) self- referral service – AUCS continues to act as the National Hub for all SARCS self- referrals Scotland wide, working in collaboration with NHS 24 and ensuring that all referrals, regardless of where the person is in Scotland, are managed within agreed timescales. The Hub operates 24/7 and ensures that all referrals from NHS 24 are triaged and directed to the appropriate Board pathway. The Hub delivers a back office function without the need to speak to the person self-referring into the service. Between January to June 2025, a total of 231 referrals were processed by the National Hub (190 x acute; 36 historic; 5 x 13-15yr old). Of the 231, 18 were duplicate referrals bringing the total number of patients supported through the pathway to 213 - an increase of 13 for the same period in 2024. There is no clearly identifiable trend to enable forecasting the volume of self-referrals being received on particular days / times. Strong relationships have been maintained with NHS 24 and national SARCS Policy Unit colleagues within Scottish Government through regular engagement to share learning, identify emerging issues with solution focussed discussions. It was recognised as part of the bid to host this national service that Ayrshire and Arran had a robust infrastructure in place 24/7. The only additionality required were two Agenda for Change Band 2 call handlers to bolster that cohort of staff. Non-recurring national funding has been agreed to fund this. Care and Nursing Home Pathway – as reported previously, this pathway provides direct access to the FNC within AUCS during the OOH period as an alternative to the NHS 24 process, reducing delays by using the NHS 24 route and replicating in hours service by a care home’s own GP practice. Direct calls to the FNC for clinical advice/assessment reached 2525 in the first six months of 2025; an increase of just 70 from the previous year, showing that this pathway is working well and care and nursing homes are using it consistently. This local model has seen 4% of calls through this pathway attending hospital with only 2% going on to be admitted. This compares to attendance/admittance rates via SAS 999 of 26% and NHS 24 17%. The data for the first six months of 2025 is comparable to the 2024 data. Referral process in place for GP Practices - to schedule Minor Injury Appointments via the FNC where patient transport can also be arranged. This has reduced the number of ambulances being requested and the majority of patients are seen within the MIU around their appointment time therefore reducing the crowding in EDs. There were 377 GP Practice referrals to the FNC through the first six months of 2024, which also includes any referrals from GP Practices to request a revisit or patient follow up from a clinician in the OOH period. 51
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In the first six months of 2025 there have been 276 referrals; this pathway has probably been impacted by the GP to AUCS for Home Visit Test of Change (as described later in this report). Emergency Services Mental Health Pathway (ESMHP) - was fully launched on 30 May 2022 following a successful pilot in early 2022. SAS and Police Scotland refer mental health related calls which do not require emergency medical intervention to the FNC. This 24/7 service is a whole life pathway with no upper or lower age limits. This process involves the FNC facilitating the call to the Emergency Mental Health Team for initial assessment which includes conversations with the referrer and the patient, after which a joint decision is made about whether an in-person mental health assessment is needed, either at the patient’s own home or a specific location within the community. This is a more individualised and person-centred approach, providing the right care in the right place at the right time, and reduces pressure and capacity on Police Scotland, SAS and the ED teams as well as the opportunity for ongoing follow up within the community. There have been 997 contacts for ESMHP in the first six months of 2025 in comparison to 1053 in the same period of 2024. Calls are routed via the FNC to the Emergency Mental Health Team from Police Scotland or SAS. These patients would otherwise have formerly been conveyed to the EDs by Police Scotland or SAS which was not always the most appropriate place for the specific care needed by these vulnerable individuals. Ayrshire’s Mental Health Unscheduled Care Assessment Hub was launched on Friday 13 September 2024. Based at Woodland View Hospital in Irvine, the Hub is operated and managed by the Unscheduled Care Mental Health Service and is the first of its kind in Scotland. The Service provides 24-hour access to 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. It can accommodate five patients for a period of up to 72-hours and is delivered by experienced Registered Mental Health Nurses. Scottish Ambulance Service (SAS) Call before Convey Pathway – the pathway for SAS crews attending calls or reviewing calls on their dispatch screens to consider what input and support the FNC could provide has been fully embedded with positive feedback from crews. AUCS clinicians have continued to attend to confirm life extinct for non-suspicious deaths for SAS and Police Scotland which helps our emergency services to prioritise patients with life threatening conditions. 52
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Between January to June 2024 there were 1876 referrals to AUCS from SAS, of which only 9% went on to be referred to hospital as final outcome. Approximately 91% of referrals didn’t require a SAS crew to convey to the hospital front door. In the first six months of 2025 there have been 1544 referrals from SAS with 7% requiring onward transfer from the crew to hospital. It is noted that 30% of the Call before Convey contacts with AUCS are between 8am and 6pm at weekends. AUCS clinicians are able to access hospital clinical systems, emergency care summary, and previous encounters with AUCS. This provides greater insight to the landscape of a patient’s needs and allows more robust assessment of individual risk. SAS contact with patients is not reported back to general practice whereas all referrals logged via the FNC are recorded via the FNC clinical system (Adastra) and reported back to general practice. This allows visibility for the GP Practice to follow up where appropriate. Rapid Respiratory Response Service (RRR) - Ayrshire and Arran has the second highest Chronic Obstructive Pulmonary Disease (COPD) rate in Scotland with emergency COPD admissions in 2022/23 34% longer than other emergency admissions. The vision for this service, which used a targeted and data driven approach to service delivery, is to enable patients to remain at home whenever possible. The aim of this service is to: • Provide specialist respiratory support during exacerbations • Improve patient’s ability and confidence to self-manage symptoms • Support earlier discharge from hospital Over the past two years, the service has continued to support patients to enable them to remain at home wherever possible and now covers 76% of all COPD registered patients in Ayrshire through collaboration with 31 practices. There were 5676 patient contacts from January to June 2025, and the service now has over 1200 registered patients. This is an increase from the first six months of 2024 when there had been 4107 patient contacts with 770 patients registered with the service. The service has introduced alerts via Trakcare to facilitate early supported discharge for this patient cohort; so far this has benefited nearly 200 patients. Palliative End of Life Support Line - PEOL went live early October 2023 and was created to facilitate a SPOC for palliative patients for end of life care through the FNC using existing call handling services. The service is designed to enable timely management of unscheduled care episodes for palliative patients in the community and to address care needs effectively in their normal place of home and prevent hospital admissions which may not be of benefit to them. Between January to June 2024, a total of 93 patients with 290 contacts were referred to the service. In the first six months of 2025 there have been 185 contacts for 66 patients. 53
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AUCS Palliative Support Service - In early 2024, a review was undertaken of the community nursing model and the model of care delivery for palliative and end of life patients. This looked at the future support needs of everyone who may need to receive end of life care, and how this links with our wider whole system approach. The outcome of the review, to ensure best value and sustain continuing care for this cohort of patients, was to move delivery “in-house” seamlessly migrating it into AUCS at the end of May 2024. From June 2024 to the end of June 2025, a total of 181 patients have benefited from the service with a total of 618 contacts with these patients. 76% of patients requested a seven night per week cover with 72% of patients requiring this cover for one week or less. To date, 97% of patients have also been kept in their preferred place of care. GP to AUCS for HV Test of Change (ToC): Support to GP Practice Home Visits 4pm to 10pm weekday evenings – it was highlighted that GP practices required additional support for patients who contacted them after 3pm and had been clinically assessed as requiring a home visit and were safe to wait a maximum of four hours to speak to a clinician. AUCS facilitated a ToC for eligible patients initially with only four GP practices. The scope gradually expanded and now includes a total of 51 of the 53 Ayrshire GP practices (all mainland practices). During the first six months of 2024, a total of 243 patients were seen by an AUCS clinician as part of the ToC with only 17% of these referrals requiring onward admission to hospital. In the same timeframe in 2025 there have been a total of 745 referrals with 19% of patients requiring an admission to hospital. Protected Learning Time (PLT) – throughout 2024 AUCS provided clinical and operational support for 12 x five hour sessions of PLT. Each block of three sessions enabled an average of 50 Ayrshire and Arran GP Practices to deliver PLT for primary care staff, safe in the knowledge that urgent contacts were managed by AUCS. This has proved to be a valuable service to primary care colleagues and arrangements have continued throughout 2025. 3.2 Additional Improvement Projects Virtual Capacity - Develop a virtual capacity network by developing a SPOC within the AUCS FNC to encompass the Hospital at Home, Community RRR programme to ensure a seamless pathway to all services for patients. This will require the AUCS management team to develop and embed a referral pathway from AUCS FNC to Hospital at Home Team; develop a referral pathway from AUCS FNC to RRR Service and implement organisational change for RRR and Hospital at Home operational staff to bring them under the SPOC model. Plans are in progress to scope the potential for Ayrshire Community Blood Service to be encompassed within the SPOC. 54
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3.3 Quality The further development of reporting mechanisms to provide assurance on the delivery of safe, effective, person centred care in line with the dimensions of the quality strategy has supported processes to fully investigate complaints and adverse incidents. This ensures lessons learned are identified and necessary changes and improvements implemented to mitigate any recurring issues across the service. The FNC supports a number of pathways to wrap the professional services around the patient with an average 1133 calls per month over and above OOH activity. It is noted that only 21% (242) of the calls received via FNC attend hospital within 48 hours. The remaining 891 are assessed and treated via services within AUCS or navigated back to community services. This has also been linked to the sustained reduced level of ED attendances post pandemic. The FNC operates with one clinician and call operator 8am to midnight, seven days per week. The model fully integrates with the wider OOH team during the OOH period. Moving to a 24/7 service with multiple pathways there was also a requirement to increase the number of shift team managers to ensure sufficient management oversight as well as increased clinical support to ensure the pathways operate efficiently and safely. 3.4 Next Steps The teams will continue to build on the core OOH service and create innovative solutions to challenges through engagement with the workforce and stakeholders. Commitment to adopting continued learning, improvement and development to ensure the most efficient and effective service delivery model and services in light of the data informed knowledge that demand, overall activity and patient need for urgent care continues to evolve. 3.5 Anticipated Outcomes The main aim for AUCS is to provide a prompt and seamless experience for citizens across Ayrshire and Arran as well as an opportunity to schedule an appointment or home visit when necessary. Clinicians and administration staff within the service feedback on a daily basis that patients are happy with their outcome either when they receive a scheduled appointment or are directed to the right service first time, and often at home. 3.6 Measuring Impact Continuous review of current and new pathways must be undertaken to evaluate impact and effectiveness to ensure improved patient journeys. Creative and innovative response to emerging challenges within our region should continue to play a part in the service ethos. 55
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Collaborative work with a wide range of individuals and agencies, including acute and community professionals, stakeholders including patients, their families and carers, will continue in order to achieve the vision of providing the right care in the right place at the right time. 4. IMPLICATIONS 4.1 Financial The AUCS budget was originally set in 2016/17 based on activity at that time. Despite the gradual increase of activity, which has been consistently 20% in 2022 and 2023, the service has continued to manage to work efficiently re-designing where possible using data and trends to match the required workforce to demand. A review of the COVID-19 Therapeutics Service is currently ongoing nationally to understand future resource requirements. 4.2 Human Resources A range of staff engagement sessions sharing data and themes in relation to the AUCS service delivery model and resources successfully informed changes which were tested during 2024/25 to ensure best practice and best value. A programme of opportunities to continue staff engagement is ongoing. Throughout the first six months of 2024, AUCS consistently improved on the projected shift cover reported to the Scottish Government on a weekly basis. The average shift cover has not dipped below 95% throughout this period with the average for 2025 seeing an increase to 98% for the same period. This reflects significant and consistent improvement in take-up of shifts with commitment from the spectrum of clinicians working within AUCS. In previous years this was as low as 43% at times. The strengthened senior management workforce along with a wider multi-disciplinary team approach to deliver core urgent care services to patients is now fully embedded within the service. 4.3 Legal None. 4.4 Equality/Socio-Economic Changes to how urgent care services are accessed may positively impact patients who have reduced mobility or multi co-morbidities where travel can be difficult as there will not be a need to travel, and the infection risk will be reduced. Current and future users of urgent care will continue to access all services through NHS 24 / 111 route. This will ensure patients are seen in the right place with the right team at the right time. 56
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Access will remain unchanged for all emergency care needs and access to GPs will remain unchanged. The suite of current and new pathways in response to emerging challenges and issues allow for more seamless care by healthcare professionals for patients who try to access urgent care rather than patients trying to navigate various systems or having various ‘touch points’ across the system. 4.5 Risk Like most other NHS Boards, the ability to fill sessional GP shifts remains a consistent risk to service delivery. By utilising a multi-disciplinary clinical team providing OOH services along with the recruitment of GPs with Extended Roles who work between primary and urgent care, this core workforce mitigates the risk of solely using sessional GPs. There is a risk to the future of the FNC model and impact on the hospital front doors if sustained funding can’t be identified. The AUCS OOH component of the service has seen an increase of 20% in activity and there has been no update to core funding since 2016. Demand and funding associated to match clinical capacity will require close monitoring on an ongoing basis. 4.6 Community Wealth Building The wellbeing of people and communities continues to be core to the aims and successes of Community Planning. Ensuring we deliver the right care in the right place at the right time, is an integral part of the Wellbeing Delivery Plan, Integration Authorities Strategic Commissioning Plan of both the NHS and Council, will contribute to support this wellbeing agenda. 4.7 Key Priorities The strategy and programme outlined in this report will assist the IJB to deliver the following Strategic Objectives from the North Ayrshire HSCP Strategic Plan to: • Provide early and effective support • Improve mental and physical health and wellbeing • Develop and support our workforce The learning to date offers important opportunities seen in the context of the aim of the Caring for Ayrshire programme which is to design a fully integrated system wide approach to ensure people are able to access the right care at the right time in the right place. 57
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5. CONSULTATION 5.1 NHS Ayrshire & Arran has an ongoing commitment to engage with the public through television, radio and social media as well as in a range of community venues. AUCS will continue to participate in appropriate platforms and events to publicise how to access pathways available within AUCS and ensure that people are supported to access the right care at the right time at the right place. AUCS will continue to actively engage with and seek the assistance of the wider services with pathway design and expand the use of the FNC as a central hub. The management team is fully engaged with the National Urgent and Unscheduled Care Collaborative and work continues to respond to emerging barriers and challenges to the citizens of Ayrshire and Arran. Debbie McGill Head of Primary and Urgent Care Services Debbie.McGill@aapct.scot.nhs.uk 11 September 2025 58
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Integration Joint Board 25 September 2025 Subject : North Ayrshire HSCP & ADP Annual Performance Management Report – 2024/25 Alcohol and Drugs Purpose : To present the annual performance information in relation to the partnership’s Alcohol and Drug services. This report is for :- • Awareness Recommendation : IJB are asked to note the content of the report. 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 HSCP Health and Social Care Partnership ADP Alcohol and Drug Partnership 1. EXECUTIVE SUMMARY 1.1 To present the annual performance report for North Ayrshire Health and Social Care Partnership (HSCP) for the period April 2024 to March 2025. 2. BACKGROUND 2.1 The annual report (please refer to Appendix 1) provides detailed information related to alcohol & drug related performance management targets, standards and outcomes. 3. PROPOSALS 3.1 IJB are asked to note performance in relation to :- • Access to Treatment Waiting Times; • Alcohol Brief Interventions; • Substance Use Target; • Naloxone supply; • Drug Related Deaths; • Prevention & Service Support delivery; Agenda Item 7 59
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• Information Management and Technology information; • Medication Assisted Treatment improvements; • Residential Rehabilitation; • Experiential feedback; • Human Rights Based approach; • The Alcohol and Drug Partnership (ADP) annual report and engagement with Healthcare Improvement Scotland regarding a new Residential Rehabilitation Improvement Action Plan • Finance. 3.2 Anticipated Outcomes Assurance regarding all key performance management information. 3.3 Measuring Impact All targets, standards and outcomes are monitored and evaluated with any learning implemented via quality improvement methodology. 4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources The ADP works across agencies with a wide range of staff 4.3 Legal None 4.4 Equality/Socio-Economic Equality Impact Assessments are carried out where required. Services have used a human rights based approach to service development and improvement utilising the following: PANEL principles (a framework for applying a human rights-based approach in practice, emphasizing Participation, Accountability, Non-Discrimination, Empowerment, and Legality) FAIR model (a practical framework which focuses on understanding the facts, analysing rights at stake, identifying responsibilities, and reviewing actions) AAA approach (a framework focusing on the Accessibility, Availability, and Appropriateness of services and resources, particularly in the context of public health and well-being). 60
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4.5 Risk Risk assessments are completed as and when required – Low risk grading with regard to the information contained within this report. 4.6 Community Wealth Building Improvements will increase community confidence in partnership approaches and raise awareness of the impact of alcohol and drugs and the work of the ADP to reduce and drug related harms. 4.7 Key Priorities Actions and improvements link directly with Ministerial Priorities to support the delivery of local strategic and operational plans across statutory and partner services and support wider actions to prevent drug related deaths in line with the National Mission. 5. CONSULTATION Service users, families and staff from across a variety of services have contributed to the achievement of targets, standards and outcomes Caroline Cameron, Director Peter McArthur, Senior Manager, Alcohol & Drug Services. 01294 317840, peter.mcarthur@aapct.scot.nhs.uk Appendices • Appendix 1 North Ayrshire HSCP & ADP, Performance Management Report Alcohol and Drug information (1st April 2024 to 31st March 2025) 61
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1 NORTH AYRSHIRE HEALTH & SOCIAL CARE PARTNERSHIP and the ALOCHOL & DRUG PARTNERSHIP Performance Management Report Alcohol and Drug information April 2024 – March 2025 Prepared by Denise Brown Prevention and Service Support Team 62
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2 NORTH AYRSHIRE ADP WAITING TIMES April 2024 – March 2025 Alcohol • 90% of clients will wait no longer than 3 weeks from referral to appropriate alcohol treatment that supports their recovery • 100% of clients will wait no longer than 6 weeks from referral to appropriate alcohol treatment that supports their recovery Drug • 90% of clients will wait no longer than 3 weeks from referral to appropriate drug treatment that supports their recovery • 100% of clients will wait no longer than 6 weeks from referral to appropriate drug treatment that supports their recovery Target achieved Q1 Q2 Q3 Q4 97% 100% 96% 98% Q1 Q2 Q3 Q4 100% 100% 100% 100% Target achieved Q1 Q2 Q3 Q4 100% 99% 100% 100% Target achieved Q1 Q2 Q3 Q4 100% 100% 100% 100% Target achieved 63
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3 ALCOHOL BRIEF INTERVENTIONS (ABI) Ayrshire and Arran wide information Annual report: April 2024 – March 2025 Annual target set by Scottish Government in priority settings (2024/25) – 3420 Total ABI delivery in priority settings (as at 31/03/2025) – 5940 Annual target set by Scottish Government in wider settings – 855 Total ABI delivery in wider settings (as at 31/03/2025) – 1325 Note – national reporting on ABI is currently paused. Awaiting further national guidance. SUBSTANCE USE TREATMENT TARGET In 2022, the Scottish Government have created a new ‘Substance Use Treatment Target’ to increase the number of individuals being supported in treatment. North Ayrshire had been set a target to increase numbers in treatment from 882 individuals in April 2020 to 959 individuals by March 2024. This was exceeded. In 2025, no new specific target has been set. As we await further national guidance, the expectation is for services to continue to support as many people into treatment as possible. Baseline from Scottish Government 2022-2025 quarterly reporting East North South 01/04/2020 – 31/03/2021 946 882 561 Target by 2024 by Scottish Government East North South 1029 959 610 Interventions are in place across our community alcohol and drug recovery services to support the achievement of this target. Please note the monthly information supplied is unpublished and has been collected from local prescribing systems to monitor progress. Quarterly period Target Actual Apr-Jun 22 891 898 Jul-Sep 22 900 940 Oct-Dec 22 910 974 Jan-Mar 23 920 1011 Apr-Jun 23 930 1051 Jul-Sep 23 940 1080 Oct-Dec 23 950 1103 Jan-Mar 24 959 1129 Apr – Jun 24 NA 1152 Jul – Sep 24 NA 1178 Oct – Dec 24 NA 1192 Jan – Mar 25 NA 1220 Total 3 Year Increase Figure for IA 77 338 Target achieved Target achieved 64
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4 This report outlines Naloxone kits supplied in the community and reported through the Shared Addictions Management System (SAMS) Locality Q1 Q2 Q3 Q4 Total North 210 162 136 233 741 East 68 95 89 121 373 South 72 90 109 168 439 HMP Kilmarnock 29 18 19 21 87 **North Ayrshire have set a target of 480 kits, as a minimum, to be supplied during 2024/25** Ayrshire and Arran Quarterly Naloxone Report 1st April 2024 – 31st March 2025 Total Naloxone kits 1640 426 Prenoxad + 1214 Nyxoid kits 65
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5 Demographics 70% 30% Gender* *Where this data was recorded Who supplied the kits? Age* Scottish Families supply kits to Ayrshire and Arran residents via their ‘Click and Deliver’ service. 207 kits were delivered within this reporting period. 2% 22% 40% 26% 10% 25 and under 26 - 35 36 - 45 46 - 55 56+ Who received the kits? *Where this data was recorded 139 394 256 27 266 8 24 31 34 87 139 13 6 121 15 47 33 EA RADAR service NADARS START Ward 5 PSST Homeless Nurses We Are With You South Ayrshire We Are With You East Ayrshire Turning Point Scotland (P.E.A.R) HMP Kilmarnock South Ayrshire ADP EA Single Point of Access Alcohol and Drug Liaison Team North Ayrshire ADP NA H&SCP (Kirsty Gibson) East Ayrshire Recovery Matters Harbourside (Pan Ayrshire) 66
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6 There was a minimum of 73 lives saved through community Naloxone use in Ayrshire within this reporting period. Many saves go unreported. Save story - “Residents had alerted staff that the individual was unresponsive in his wheelchair outside. Staff moved him to the reception area onto the floor and administrated naloxone. An ambulance was called, and staff were informed that he had used Heroin, Valium & Alcohol. He was transported to hospital” Saves Number of reports of Naloxone uses in the community to reverse overdose Education 70 individuals completed the Naloxone Learnpro module 1225 individuals received overdose awareness training 428 individuals attended a PSST virtual or face to face Naloxone awareness course 9 Training for trainers’ sessions were delivered Lives saved 67
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7 AYRSHIRE AND ARRAN DRUG RELATED DEATHS INFORMATION 2024 annual summary report National Records for Scotland - Drug Related Deaths In September 2025, the National Records of Scotland published its annual report titled ‘Drug Related Deaths in Scotland 2024’. 1,017 people across Scotland died from a Drug Misuse Death (DMD) in 2024, a decrease of 13% (155 deaths) compared with 2023. Ayrshire and Arran Health Board saw a decrease of DMDs last year, from 83 deaths in 2023 to 64 deaths in 2024. North Ayrshire saw a decrease from 36 deaths in 2023 to 23 deaths in 2024. Published confirmed deaths: East North South Total 2019 41 41 26 108 2020 36 39 31 106 2021 38 39 23 100 2022 30 37 15 82 2023 31 36 16 83 2024 21 23 20 64 Locally services monitor and report all suspected DMDs, with the number being confirmed nationally through verification of the cause of death, hence there is a delay in confirmation of the verified number of DMDs each year. Sadly in the first 6 months of 2025, the locally reported number of suspected (but unverified) DMDs, exceeds the total number of verified DMDs for 2024. Public Health have issued communications in partnership with the ADPs that this may be linked to the presence of Nitazines, a synthetic form of heroin, in the illicit drug supply in Ayrshire. The ADP are working alongside Public Health and addictions services to help reduce risk and harm, with a focus to refreshing our actions to reduce the number of deaths in North Ayrshire. These include but are not limited to: • Continued delivery of the Medication Assisted Treatment (MAT) Standards • Ensure quick access to MAT support (during 2024, the time from point of referral to receiving prescribed medication was 1 day) • Continue to prioritise Blood Borne Virus (BBV) testing, Harm Reduction interventions and mental and physical health assessment and support • Ensure access to staff with lived experience to provide person centred recovery support. • Promote family involvement and offer housing, welfare and advocacy support • Continue to meet and exceed all local and national ‘access to treatment’ waiting times’ targets and standards. • Increase the number of individuals being supported to access Ward 5, Woodland View and external residential rehabilitation support • Continue to offer increased choice across the various Opiate Substitution Therapy medications Please follow this link to access the report: : Drug-related deaths in Scotland, 2024 - National Records of Scotland (NRS) 68
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8 PREVENTION AND SERVICE SUPPORT TEAM Annual summary report: 1st April 2024 – 31st March 2025 Alcohol & Drug training and education sessions Calendar courses with 815 participants Additional Training Requests (ATR) with 3137 participants 135 102 Training Delivery The team continue to provide a wide range of education and training initiatives which focus on improving awareness, competence and knowledge of those affected by alcohol and drug use, and those working in the field. Due to the COVID-19 pandemic the team introduced virtual training; this continues to be offered as well as face to face training. PSST currently issue upcoming training courses on a quarterly basis. What did our participants say? "Loved the whole training, being provided with real life examples is also beneficial" “Enjoyed all of it. It was very well put together; confident presenter made it interesting and maintained people interest” "I have gained knowledge on females and why they take drugs/don't stop some of the barriers to sustaining treatment. This will help me going forward with volunteering with the end goal of getting employment and working closely with females” “I enjoyed everything about the session, I felt the trainer was very informed on the subject matter and this in turn made it an enjoyable training session” “Both trainers were very knowledgeable and delivered the content well. It was clear and concise, and the interactive elements kept you engaged" 52 sessions delivered within Ward 5 Attended 11 stalls/events Additional training requests and health information events by locality area Alcohol Brief Interventions Annual target set by Scottish Government in priority settings (2023/24) – 3420 Total ABI delivery in priority settings (as at 31/03/2024) – 5940 Annual target set by Scottish Government in wider settings – 855 Total ABI delivery in priority settings (as at 31/03/2024) – 1325 Follow our social media pages to keep up to date with our activities in the Prevention and Service Support Team Prevention and Service Support Team – NHS Ayrshire and Arran @PSST_NHSaaa 29% 37% 11% 23% East North South Pan-Ayrshire 69
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9 Ayrshire College Alcohol and Drug Liaison Officer 146 workshops were delivered to 1746 students 46 1-1 supports with students 5 staff supports 7 health events with an estimated 590 contacts Naloxone 70 staff completed the Naloxone Learnpro module Minimum of 73* lives saved in the community *lives saved across Ayrshire and Arran as reported on the Shared Addiction Management System (SAMS). Many saves go unsupported. 9 Train the trainer sessions delivered 35 Naloxone awareness sessions delivered Service Support Service Support facilitate service development activity which supports the implementation and delivery of the quality improvement agenda for Alcohol and Drug Services which meets national, local and strategic objectives. 15 Audit and evaluation activity 9 Guidelines reviewed and updated Get our NHS Ayrshire and Arran Alcohol and Drug App Download the NHS Ayrshire & Arran app from your Apple or Android app store. Then search for Alcohol and Drugs. 28 Drug and Alcohol groups supported Support to implementation of MAT standards and reporting Support to development of local pathways and operational procedures Gathering, collating and presenting client satisfaction and client stories ABI Heat Standard recording and reporting Support to START and RADAR service Support to local Adverse Incident review processes and reporting 70
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10 INFORMATION MANAGEMENT AND TECHNOLOGY (IM&T) Annual summary report: 1st April 2024 – 31st March 2025 The Information Management and Technology Team are responsible for the development, training and monitoring of the Shared Addiction Management System (SAMS) and the training and monitoring of Drug and Alcohol Information system (DAISy). These systems are used to record drug and alcohol information, which enables the team to provide national and local reports. SAMS updates Admin section on SAMS being updated Substitute Prescribing Change Sheet added to SAMS Physical Health section on SAMS was updated. Ongoing updates to Substitute Prescribing Application. DAISy support • Attendance at various DAISy workshops and training • DAISy Quality Checks, Reports and Updates • Working with PEAR to ensure accuracy on DAISy. Training • 50 individuals received SAMS training • 54 individuals received DAISy training Support Approximately 50 SAMS/ DAISy support calls per month IM&T are also responsible for the collation and reporting of Drug Related Deaths and the completion of the National Drug Death database. Drug related death reporting Reporting • Quarterly reports including ASPIRE report, (29 individual performance reports), Naloxone quarterly reports, Scottish Governance reports, ADP reports and local performance and planning reports • Development of reports and audits for MAT standards and submission of MAT 1 – 10 numerical data • Monthly reports including 10 current OST reports, MAT Target Report, SAMS Data Quality Reports and Psychological Therapy Waiting Times • Weekly DAISy quality data checks for Waiting Times, Assessments and Reviews for all Alcohol and Drug services • Monthly substitute prescribing audit • Drug related death report • Various pan-ayrshire residential rehab reports • Approximately 10 – 15 ad hoc report requests per month 71
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11 IMPLEMENTATION OF MAT STANDARDS WITHIN NORTH AYRSHIRE Annual summary report 2024 - 25 In April 2021, the Scottish Government introduced 10 new Medication Assisted Treatment (MAT) Standards for implementation by Alcohol and Drug Services. There is evidence that rapid access to MAT meets the needs of highly vulnerable groups and reduces mortality1, therefore new approaches were required within North Ayrshire to support rapid access to MAT: • A local test of change was carried out to evaluate the new model of care to establish effectiveness prior to roll out • An Improvement Implementation Plan, was implemented, evaluated & updated with regular progress reports submitted to the Scottish Government. • Quarterly Updates on MAT developments were submitted to the national MAT support Team – MIST. • An explicit delivery plan was put in place for delivering trauma informed practice. • Guidelines and clinical & care pathways of support were put in place to ensure consistency and support the staff to deliver the interventions. Results/outcomes (2024/25) • Improvement in the waiting time from referral to commencement of appropriate Opiate Substitution Therapy medication - 75% of individuals were offered a first MAT assessment on the same day as engagement with the service (improvement from previous year) • 100% of individuals were supported to make an informed choice on MAT medication and the appropriate dose • 75% of notified high risk events to the multi-agency assessment team for assertive outreach were contacted on the same day (improvement from previous year) • 86.49% of individuals were retained in service for more than 6 months (improvement from previous year) • 186 individuals have shared care with Primary Care (improvement from previous year) • 100% of individuals received a mental health assessment • 100% of individuals were offered BBV testing, Harm Reduction interventions and a physical health assessment • Improvement in satisfaction and experience of clients (improvement from previous year) A RAGB self-assessment was completed, and evidence (numerical, experiential and process information) was submitted to the MIST team for analysis and benchmarking. The table below highlights a very positive final RAGB score for the implementation of MAT standards 1 - 10 across North Ayrshire Plan during 2025/26 • Sustain a green RAG rating for standards 6 to 10 • Move to a RAG rating of blue during the next year for MAT Standards 1 to 5 (as the definition of a final blue RAG rating is to be able to evidence 2 years of sustained implementation of a green RAG rating and evidence of benefit to people plus ongoing monitoring of the standard across all MAT services) 72
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12 RESIDENTIAL REHABILITATION EXPANSION • Ward 5 - Access to residential support across Ayrshire and Arran Ward 5 has 10 beds for residential care: Seamless pathways of support are in place with the local community team supporting individuals before, during and after their placement (extra support in place for NA residents e.g. in addition to ongoing NADARS support, everyone is also provided with daily follow up support from the P.E.A.R service for the first week following discharge). During 2024/25 • Access to additional local residential rehabilitation Harper House The NA H&SCP was instrumental in supporting Phoenix Futures, Scotland, to open ‘Harper House’ in November 2022. It is located in Saltcoats and is a Care Inspectorate registered service, funded by the Scottish Government – it offers specialist support for the ‘whole family to recover from the harms of problematic drug and alcohol use’. Their family-focused programme of interventions is ‘designed to benefit each member of the family and the family unit as a whole’. Referrals are accepted from across Scotland, with enhanced local access available for residents of North Ayrshire. These pathways continue to be improved with a local oversight group meeting regularly to support the identification and suitability of families. In 2024/25 NADARS supported 3 applications into Harper House with all 3 starting the programme. Additionally NADARS supported 4 families who relocated to North Ayrshire from other areas in Scotland following completing the Harper House residential programme • Access to External Residential Rehabilitation (ERR) Individuals wishing to access external residential rehabilitation support can do so via NADARS who will support the development of a care plan, identify a residential rehabilitation provider, seek funding and then support individuals into, through and after their external residential rehabilitation placement. In 2024/25, 57 referrals were received for ERR. Following assessment, 16 individuals were suitable for ERR and funding was approved, 41 individuals were not suitable or declined further ERR intervention at this time and were offered alternative community supports. 10 individuals commenced ERR with 9 completing the agreed programme. 5 5 Detoxification Rehabilitation 135 individuals (NA = 72) 87 individuals (NA =51) Detoxification support Rehabilitation support 73
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13 Utilising client and family/carer feedback for continuous service improvement within North Ayrshire Drug and Alcohol Recovery Service (NADARS) A robust process is in place within NADARS to gather client and family/carer feedback within the service. Feedback is collected via various methods, such as: • Structured questionnaires for clients/family/carers • Attendance at focus groups • Formal comment cards – client and family/carer • Remote feedback tools such as the NHS Ayrshire and Arran Alcohol and Drug App • External platforms such as Patient Opinion • Unsolicited feedback such as thank you cards and letters Feedback is collected throughout the financial year and collected by: • Staff members gathering feedback from active clients within their caseload who they have provided any treatment or support to within the reporting period • Service Support staff attending various recovery groups within the community to gather individual views on the service and ways in which it could be improved • Service Support staff attending inpatient areas, such as Ward 5, Woodland View to facilitate focus groups with individuals who are currently receiving this service • Targeted approach feedback for specific interventions such as MAT Standards, Non- Fatal Overdose pathways Prior to any intervention, individuals should be made aware how they can give feedback, what the feedback will be used for and that the feedback provided will be anonymous when written into feedback reports. Results provided via feedback are collated, analysed and shared via appropriate platforms within the “you said, we did” format. Any improvements identified for the service are populated within a local improvement plan, evidenced appropriately and updated through the continuous improvement cycle. ADP experiential feedback The MAT programme requires ADPs to gather experiential feedback to ensure that services are responsive to the needs and experiences of individuals who are accessing them. To compliment existing data collection methods, semi-strucutred interviews are carried out with individuals accessing services and lived and living experience panels. Patient stories and short conversations are captured within clinical settings to ensure real-time experiencies fit into service improvement. A thematic analysis is carried out on all data collected to identify areas of good practice, identify areas for improvement and inform improvement plans for continuous service delivery 74
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14 Charter of Rights for People Affected by Substance Use The Charter of Rights has been created by individuals who are affected by substance use, including family members and carers, service providers and national organisations. The charter aims to help people know their rights and to know what support they can expect to receive. The Charter sets out some of the most important rights for people affected by substance use. Right to life – everyone’s right to life is protected by law. Right to the highest attainable standard of physical and mental health – everyone has the right to get health and care services that are available, accessible, acceptable and are of sufficient quality. Everyone should be treated fairly and equally, without stigma and discrimination. Right to an adequate standard of living - the right to adequate food, clothing and housing with the goal to keep people out of poverty, ensure that their basic needs are met and that they are able to take part in the life of their community. Right to private and family life - Everyone has the right to respect for their private and family life. This protects people’s dignity and right to make decisions about their own life. Right to a healthy environment - This right means that you should have access to clean, safe air, water, land and soil free from pollution. It also means the place you live should make you feel safe. Freedom from torture and other cruel, inhuman & degrading treatment or punishment - This right protects people from treatment that causes them a lot of pain, physical or mental suffering or which makes them feel worthless or hopeless. Freedom from arbitrary arrest or detention - People should not be detained solely based on their substance use. Diversion from prosecution should be prioritised for minor substance related offences. Advocacy Advocacy services provide information, support and representation. Advocacy can support you to get your voice, views and wishes heard and explain more about your rights. If you need support in North Ayrshire, contact Voiceability on 0300 303 1660 or visit www.voiceability.org/in- scotland/northayrshire The full version of the charter can be found by scanning the QR code. 75
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15 Applying the FAIR model approach to MAT implementation in North Ayrshire In order to provide continuous quality improvement and to align the implementation of the MAT programme with the Charter of Rights for People affected by Substance use. The FAIR model, AAAQ framework and Panel Principles were used to appraise the experiential component of the standards. A more systematic analysis of the effectiveness of implementation was undertaken using the AAAQ framework to ensure that services are provided in a way that respects human rights and promotes equality. AAAQ sets out the 4 essential elements of the right to health: • Availability • Accessibility • Acceptability • Quality The PANEL priniciples framework was used to ensure that individuals rights were central to policies and practices, the five key human rights principles underpinned by the framework are: Participation: People should take part in decision making and have a voice. Policies and practice should support widespread participation. Accountability: Organisations and people are accountable for realising human rights Non-Discrimination and Equality: Everyone has the same rights (regardless of their ethnicity, gender, income, religion etc) Empowerment: People, communities and groups should have power. They need to know and claim their righs in order to make a difference. Legality: Rights must be legally enforceable. All decisions should comply with human rights legal standard. In North Ayrshire the FAIR model approach has been carried against 6 of the 10 MAT standards with improvement actions identified. What is the experience of individuals involved and what are the important facts to understand? FACTS ANALYSIS Analyse rights: Develop an analysis of the human rights at stake. Identify responsibilities. IDENTIFICATION FAIR REVIEW Identify what needs to be done and who is responsible for doing it Make recommendations for action and later recall and evaluate what has happened as a result 76
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16 ADP Annual Reporting Survey to the Scottish Government The ADP Support Team received, collated and submitted the annual reporting to survey to the Scottish Government on the 13th June 2025. The report covered a range of topics in relation to treatments services, residential rehab, support to children and families, justice, and developing recovery communities. If anyone would like more information on the reporting survey, please get in contact with the ADP Support Team on: adp@north-ayrshire.gov.uk South West of Scotland Residential Rehabillitation Hub North Ayrshire (NA) ADP have engaged with other local ADPs to be part of a South West of Scotland collaborative with a focus on residential rehabilitation. The NA ADP, with support from Health Improvement Scotland (HIS) have completed a self- assessment and have then developed an action plan to further improve our external residential rehabilitation pathways and support. The action plan aims to address four high level themes: 1. Certain demographics are disproportionately affected by substance use 2. Vulnerable communities have higher rates of unmet need in relation to substance use 3. Lack of integration within the wider health and social care system means that individuals do not receive the rights care at the right time to support their recovery from substance use. 4. Detrimental effects on families/carers and friends in relation to (their loved ones) alcohol and/or drug use. A working group has been formed to support the implementation of the action plan over the next 2 years. The ADP, SMT and IJB will receive a progress report at the end of year 1. 77
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17 FINANCIAL INFORMATION ADP 24-25 Forecast Spend 78
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18 Additional funding streams Agreed Projects 24/25 MAT Standards £489,252.99 Other Projects £5,871.94 Residential Rehab £140,335.78 Whole family Approach framework £109,763.46 Grand Total £745,224.17 The ADP has accumulated a reserve balance due to underspend in previous financial years. There are plans in place to utilise the reserves and they are committed in future years. 79
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Integration Joint Board 25 September 2025 Subject : North Ayrshire HSCP & ADP Medication Assisted Treatment - Annual Report Purpose : To present the annual report in relation to the continued implementation of the Medication Assisted Treatment Standards. This report is for :- • Awareness Recommendation : IJB are asked to note the content of the report. 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 MAT Medication Assisted Treatment HSCP Health and Social Care Partnership ADP Alcohol and Drug Partnership RAG ‘Red, Amber & Green’ – scoring system 1. EXECUTIVE SUMMARY 1.1 To present the 2024 to 2025 annual report regarding the continued implementation of the Medication Assisted Treatment (MAT) Standards. 2. BACKGROUND 2.1 The annual report (please refer to Appendix 1) provides detailed information relating to implementation of the MAT Standards, achievements, outcomes and priorities for the year ahead. 3. PROPOSALS 3.1 IJB are asked to note information in relation to :- • Effects of change during the past year; • Statistical data; • Developments and future priorities; Agenda Item 8 81
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• Experiential feedback; • Benchmarking scoring tracker and RAG ratings; • Plan for the year ahead. 3.2 Anticipated Outcomes Assurance regarding positive progress in the delivery across all 10 MAT Standards. 3.3 Measuring Impact All targets, standards and outcomes are monitored and evaluated with any learning implemented via quality improvement methodology. More detailed outcomes and positive impact measures are evidenced via regular reporting to the Scottish Government. 4. IMPLICATIONS 4.1 Financial There is a risk of being unable to sustain implementation of MAT Standard 7 (Primary Care) unless on-going funding can be identified (currently the ADP has provided non- recurring funding to implement a new model of care which will be evaluated by March 2026). 4.2 Human Resources The implementation of the MAT Standards involves a wide range of staff across a variety of partner organisations 4.3 Legal None 4.4 Equality/Socio-Economic Equality Impact Assessments are carried out where required. Services have used a human rights based approach to service development and improvement utilising the following: PANEL principles (a framework for applying a human rights-based approach in practice, emphasizing Participation, Accountability, Non-Discrimination, Empowerment, and Legality) FAIR model (a practical framework which focuses on understanding the facts, analysing rights at stake, identifying responsibilities, and reviewing actions) AAA approach (a framework focusing on the Accessibility, Availability, and Appropriateness of services and resources, particularly in the context of public health and well-being). 82
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4.5 Risk Risk assessments are completed. There is a Low risk grading with regard to full implementation of 9 of the 10 Standards. There is a Medium risk grading with regard to the full implementation of MAT Standard 7 (Primary Care) due to the absence of recurring funding. 4.6 Community Wealth Building Improvements will increase community confidence in partnership approaches and raise awareness of the impact of alcohol and drugs and the work of the ADP & HSCP to reduce drug related deaths. 4.7 Key Priorities Actions and improvements link directly with Ministerial Priorities to support the delivery of local strategic and operational plans across statutory and partner services and support wider actions to prevent drug related deaths in line with the National Mission. 5. CONSULTATION Service users, families and staff from across a variety of services have contributed to the achievement of MAT delivery. Caroline Cameron, Director Peter McArthur, Senior Manager, Alcohol & Drug Services. 01294 317840, peter.mcarthur@aapct.scot.nhs.uk Appendices • Appendix 1 Medication Assisted Treatment – Annual Report 83
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IMPLEMENTING MEDICATION ASSISTED TREATMENT (MAT) NORTH AYRSHIRE DRUG AND ALCOHOL RECOVERY SERVICE (NADARS) Reporting period: 1st April 2024 - 31st March 2025 Quality issue: In 2023, there were 1,172 drug related deaths registered in Scotland - 121 deaths higher than 2022. Whilst drug deaths in Scotland have been increasing over the last two decades, this is the second lowest number in the last six years. Ayrshire and Arran continues to have higher rates of drug deaths than the Scotland average. Evidence suggests quick access to treatment is crucial and being in treatment can be a protective factor for majority of individuals. The Scottish Drug Deaths Taskforce (SDDTF) has prioritised the introduction of the MAT standards to help reduce the number of drug related deaths. There is evidence that rapid access to MAT meets the needs of highly vulnerable groups and reduces mortality. Aim: To have no barriers to accessing treatment and care that supports an individual’s recovery. This project focussed specifically on improving access to appropriate Medication Assisted Treatment (MAT) within the North Ayrshire Drug & Alcohol Recovery Service (NADARS) in order to prevent deaths, reduce harms and promote recovery opportunities. Effects of change during 2024/25: • Improvement in the waiting time from point of referral to commencement of appropriate Opiate Substitution Therapy (OST) medication - average time from assessment to prescribed medication - 1 day. • Increased choice in OST medications • Improvement in satisfaction and experience of clients. • All individuals received a mental health assessment and support as required. • All individuals were offered Blood Borne Virus (BBV) testing, Harm Reduction interventions, physical health assessment and referred on for further support where required. • All individuals had the opportunity to access Recovery Development Worker's with lived experience to provide person centred recovery support. • All individuals had the opportunity of family involvement. • All individuals were offered housing, advocacy support and were referred for social care support where appropriate. Tests of change: Cycle 1: Implement and test the MAT clinic pathway on a Monday and a Thursday in one locality (Three Towns). Cycle 2: Secure funding to recruit staff to support the implementation of the full model. Cycle 3: Refine project charter to facilitate full model Cycle 4: Expand service to 5 days per week across 6 localities of North Ayrshire (NA). (Test of change is complete and now working towards sustaining full model during 2025/26) 0 2 4 6 8 10 Average number of days from assessment to prescription Median = 1 day 0 5 10 Average number of days from referral to prescription Median = 1 day 84
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IMPLEMENTING MEDICATION ASSISTED TREATMENT IMPLEMENTING MEDICATION ASSISTED TREATMENT 361 REFERRALS BY GENDER FEMALES MALES 127 234 (35%) (65%) REFERRALS BY GENDER & AGE GROUP 0 20 40 60 80 100 0 - 24 25 - 34 35 - 44 45 - 54 55+ COMMENCED SAME DAY/NEXT DAY (where clinically safe and appropriate) 93% of clients commenced MAT on same day or next day from assessment INTERVENTIONS OFFERED AT POINT OF MAT DELIVERY 100% of clients were offered Mental Health Support and Harm Reduction interventions BBV testing, IEP and Sexual Health 331 individuals chose this pathway of MAT related support. The reasons given for not commencing the pathway were: • clients went to prison • not ready to commence MAT but continued to receive support from the wider service NALOXONE AND OVERDOSE AWARENESS 100% 65%* of clients were of clients were supplied offered Naloxone with Naloxone or already had a kit *The remaining 35% declined* CLIENT SATISFACTION Of clients rated their initial waiting time either “excellent” or “very good” 92% 100% Of clients rated the communication from NADARS either “excellent” or “very good” Of clients who were able to commence medication at their initial appointment stated that there were no delays in getting their prescription 100% 100% Of clients felt that they were given sufficient information to make an informed choice on their treatment options 100% Of clients felt that the NADARS worker explained all the care and treatment options in a way that they understood 92% Of clients rated the overall service either “excellent” or “very good” OPIOID SUBSTITUTION THERAPY (OST) MEDICATIONS PRESCRIBED FOLLOWING ASSESSMENT 48% 44% 8% Methadone Espranor/ Buvidal Suboxone This evidences increased patient choice of OST 85
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IMPLEMENTING MEDICATION ASSISTED TREATMENT Developments during 2024/25: • Quarterly reports have been submitted to the Scottish Government evidencing progression across each of the 10 standards from the previous year. • An explicit delivery plan was put in place for delivering trauma informed practice • LOPs, SOPs, guidelines and clinical & care pathways of support were reviewed & updated • MAT availability was increased at Caley court and expanded to 5 days per week. MAT is now available across all 6 localities with immediate support available to all from Caley Court alongside remote (low threshold) access in more rural areas including the islands. • 186 individuals currently have ‘shared care’ support with Primary Care colleagues (increase of 95 from the previous year). • 126 referrals were made to advocacy for support from North Ayrshire substance use services (highest referring ADP across Scotland) • A workforce training plan is in place to ensure all staff offering MAT & OST can provide the core harm reduction services at the same time and place as MAT delivery • A robust wide reaching experiential process was implemented by the NA ADP, to capture, analyse and utilise feedback from clients, families and staff to inform service improvement • Appropriate recording information systems were updated to collect and analyse data • In the absence of additional national funding being able to be accessed, the NA ADP committed non- recurring funding to implement initial MAT 7 (Primary Care) developments at pace. • A new staff guidance document was approved for implementation to provide an ‘interface protocol’ as to how secondary care mental health services & alcohol & drug services can better support individuals with co-occurring mental health and alcohol and/or drug use. • A human rights based approach has been carried against 6 of the 10 MAT standards with improvement actions identified. Priorities for 2025/26 • Sustain a ‘solid green’ RAG rating for standards 6 to 10 • Move to a RAG rating of ‘blue’ during the next year for MAT Standards 1 to 5 (as the definition of a final ‘blue’ RAG rating is to be able to evidence 2 years of sustained implementation of a green RAG rating and evidence of benefit to people plus ongoing monitoring of the standard across all MAT services) • Conduct a local analysis of our experiential data to identify themes for further improvement. • Based on national feedback/approval we will update the NA MAT 7 model & explore options to secure ongoing funding. • Work underway, with all ADP partners, to scope out requirements and system change to support MAT delivery for individuals using Stimulants and Benzodiazepines; • Engage with service users, families and staff to evaluate and learn from the recently implemented MAT 9 related multi-agency ‘operational interface protocol’ to better support individuals presenting with co- occurring mental health and alcohol and/or drug use INFORMATION AND FEEDBACK 361 referrals were received between 1st April 2024 and 31st March 2025 331 clients commenced MAT support (the others declined service, required preparatory support or disengaged from service) 93% of clients commenced MAT on the same day or next day from assessment (where clinically appropriate and safe) 126 individuals were referred for and received Advocacy support Reasons for timescales over 7 days include initial non- attendance with follow up in place, required additional preparatory support Detailed numerical data on referrals, timescales, interventions etc was submitted to MIST in April 2025, which is now being analysed to identify good practice and learning. 86
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IMPLEMENTING MEDICATION ASSISTED TREATMENT EXPERIENTIAL FEEDBACK • To gather feedback and data in a consistent and impartial way, the ADP adopted a multidisciplinary approach by identifying a mixture of service staff and individuals with Lived & Living Experience (LLE) to gather experiential feedback from service users, families/carers of people on MAT, and staff delivering the service. • Individuals identified to carry out the interviews attended a 3-session training course delivered by MIST (national MAT Implementation Support Team). • A mixed methods approach was applied to gather data e.g. 1-1 interviews, smaller engagement events. • The ADP Support Team collated, analysed, and themed the data for submission to MIST (with full involvement of the Experiential Engagement Team and people with LLE). The feedback received was mainly positive and demonstrates the ease of access, increased choice of medications and no barriers to the overall support received. “They made me aware of the different choices...The prescriber fully explained each option to me and the pros/cons of each medication” “We spoke about all the available options to me, and I felt well informed” MIST BENCHMARKING 2025 – SCORING TRACKER Plan during 2025/26 • Sustain a ‘solid green’ RAG rating for standards 6 to 10 • Move to a RAG rating of ‘blue’ during the next year for MAT Standards 1 to 5 (as the definition of a final blue RAG rating is to be able to evidence 2 years of sustained implementation of a green RAG rating and evidence of benefit to people plus ongoing monitoring of the standard across all MAT services) IMPLEMENTING MEDICATION ASSISTED TREATMENT 87
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Integration Joint Board 25th September 2025 Subject : 2024/25 Audited Annual Accounts Purpose : The Board is required to approve the audited annual accounts for 2024-25 for issue and to consider the report from External Audit. Recommendation : That the Board: (a) Note that Audit Scotland have completed their audit of the annual accounts for 2024-25 and have issued an unqualified independent report auditor’s report; and (b) Approve the Audited Annual Accounts to be signed for issue. 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 1. EXECUTIVE SUMMARY 1.1 The Integration Joint Board (IJB) was required to produce a set of annual accounts for 2024-254. These accounts were produced within the statutory timescale and have been subject to independent audit by the Integration Joint Board’s external auditors, Audit Scotland. 1.2 The external auditor is required to report on certain matters arising to those charged with governance in sufficient time to enable appropriate action to be taken before the financial statements are approved and certified. The audit process has been completed and Audit Scotland have issued an unqualified independent auditor’s report. 1.3 As part of the independent audit there were some minor presentational changes required and these have been updated in the final accounts. There are no changes to the overall financial position reported to the Performance and Audit Committee in June. Agenda Item 9 89
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2. BACKGROUND 2.1 The Integration Joint Board is subject to the audit and accounts provisions of a body under section 106 of the Local Authority Government (Scotland) Act 1973. This requires annual accounts to be prepared with the reporting requirements specified in the relevant legislation and regulations. The requirements are proportionate to the number of transactions of the Integration Joint Board whilst complying with the requirement for transparency and true and fair reporting in the public sector. 2.2 The audited annual accounts have been prepared in accordance with the Code of Practice on Accounting for Local Authorities in the United Kingdom 2024-25. Additional guidance was issued by the Scottish Government Integrated Resources Advisory Group (IRAG) and CIPFA LASAAC and this guidance has been followed to produce the unaudited accounts. 2.3 The Audited Annual Accounts for 2024-25 are included as Appendix 1, these incorporate the independent auditors report. Audit Scotland are able to conclude that the Integration Joint Board’s accounts present a true and fair view of the IJB’s financial position. 2.4 Appendix 2 includes a letter of representation signed by the Head of Service (Finance and Transformation) as responsible officer. Audit Scotland’s External Audit Annual Audit Report to members, which summarises the findings of the audit, is a separate item on the agenda. 2.5 Audit Scotland have given an unqualified opinion that the 2024-25 financial statements give a true and fair view of the financial position and expenditure and income of the IJB for the year, concluding that the accounts have been properly prepared in accordance with relevant legislation, applicable accounting standards and other reporting requirements. The overall financial position remains as reported to the Performance and Audit Committee in June 2025. 2.6 The Integration Joint Board are required to formally approve the Audited Annual Accounts and thereafter they will be published on the partnership website. 3. PROPOSALS 3.1 The Board is invited to: (a) note that Audit Scotland have completed their audit of the annual accounts for 2024-25 and have issued an unqualified independent auditor’s report; and (b) approve the Audited Annual Accounts to be signed for issue. 90
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3.2 Anticipated Outcomes The annual accounts are a key statutory reporting requirement and can be a useful way to join up financial and service delivery performance information in a readily available public document. 3.3 Measuring Impact Progress against the recommendations will be reviewed by the Performance and Audit Committee during 2025-26. 4. IMPLICATIONS 4.1 Financial The IJB are required to consider and approved the Audited Annual Accounts for 2024- 25. 4.2 Human Resources None. 4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk The report falls in line with the agreed risk appetite statement which is 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. 4.6 Community Wealth Building None. 4.7 Key Priorities None. 5. CONSULTATION 5.1 The unaudited annual accounts were advertised and made publicly available for inspection. There were no objections noted from the public inspection. The Chief Officer, Chief Finance Officer and other officers of the IJB have been consulted during the audit process as required. Caroline Cameron Director, Health and Social Care Partnership For more information please contact Eleanor Currie (Principal Manager, Finance/ Chief Finance Officer) (eleanorcurrie@north-ayrshire.gov.uk) 91
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Appendices • Appendix 1, Audited Annual Accounts 2024-25 • Appendix 2, Letter of representation 92
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 1 North Ayrshire Integration Joint Board Annual Accounts for the period ended 31 March 2025 93
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 2 Table of Contents Management Commentary 3 A snapshot of achievements during 2024-2025 7 Organisational Performance 12 Annual Accounts 16 Statement of responsibilities 33 Responsibilities of the Chief Finance Officer 34 Annual Governance Statement 35 Remuneration report 44 Financial statements 46 Notes to the financial statements 49 Glossary of Terms 59 Independent auditor's report 59 94
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 3 Management Commentary This publication contains the Annual Accounts of North Ayrshire Integration Joint Board (IJB) for the period ended 31 March 2025. The Management Commentary outlines the key messages in relation to the IJB’s financial planning and performance for the period 2024-2025 and how this has supported delivery of the IJB’s strategic priorities. This commentary also looks forward, outlining the future financial plans for the IJB and the challenges and risks that we will face as we strive to deliver services that continue to meet the needs of the people of North Ayrshire. North Ayrshire IJB North Ayrshire Council, alongside East and South Ayrshire Councils and NHS Ayrshire and Arran established the 3 Ayrshire Integration Joint Boards on 1 April 2015. The purpose of an IJB is to improve the health and wellbeing of local people, create support within our communities and deliver joined-up care pathways for people who use health and social care services, particularly those who have complex care needs. North Ayrshire Council and NHS Ayrshire and Arran delegate responsibility for the planning of community health and care services to the IJB. The IJB commissions services and staff from the Council and NHS and is responsible for the operational oversight of integrated services. The Chief Officer of the Health and Social Care Partnership is responsible for the operational management of integrated services. North Ayrshire Health and Social Care Partnership (NAHSCP/the Partnership) is the service delivery organisation for functions delegated to the IJB, which is comprised of staff from both North Ayrshire Council and NHS Ayrshire and Arran, though sits as its own organisation for carrying out these delegated functions together. The Chief Officer is supported by heads of service for each service area, including the statutory roles of the Chief Finance Officer and Chief Social Work Officer, and the wider partnership management team. NAHSCP senior management structure 95
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 4 Strategic Commissioning Plan Each Health and Social Care Partnership produces a strategic plan for carrying out integration functions over the plan period. In April 2022 the Partnership published ‘Caring Together 2022- 2030’, which is the first long-term strategic commissioning plan published by the Partnership. It was developed using a local health and care needs assessment and a period of public engagement, which took place online due to Covid-19 restrictions at the time. The Strategic Planning Group and other key stakeholders were actively involved in the development of the plan, reinforcing the partnership nature of local health and care services. The Partnership undertook a review of its vision, values and strategic priorities, and agreed: ‘People who live in North Ayrshire are able to have a safe, healthy and active life’. The values that people accessing Health and Social Care Services across North Ayrshire can expect to experience: Care, Empathy and Respect. In order to embody these values and achieve this vision, the plan sets out five strategic priorities: These priorities are interlinked, and by achieving them together, the partnership aims to achieve its vision for and with the people of North Ayrshire. Delivery of the Plan has included the development of enabling plans, including the Medium-Term Financial Outlook, a Transformation Plan agreed in March 2024, a new Digital and Data plan developed in 2024. Refreshing the Plan The current plan was developed to be a longer-term strategy in place until 2030. However, the Partnership recognises the very different situation it is in since the plan was developed in 2021, particularly in relation to finances, demographics, and the move from immediate covid recovery to longer-term organisational recovery. The Partnership is currently undergoing a programme of research to understand the current and future needs of residents and service users, including a Strategic Needs Assessment, Review of national and Local Policy, analysis of local engagement, and mapping of existing service. Following the drafting of a new Strategic Plan, the Partnership plans to revise its Performance Management Framework to ensure that the plan is being monitored effectively, and to revise its Participation and Engagement Strategy to ensure that service reviews are informed by service- users. The refreshed plan will also reflect further work being carried out at a locality level to reflect the differing needs of different communities across North Ayrshire. 96
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 5 Implementation of the strategic plan is key for the Partnership to achieve the nine National Health and Wellbeing Outcomes as set by the Scottish Government, and refreshing the plan will ensure our services are targeting our community needs. More information about the current Strategic Plan 2022-2030 can be found at: NAHSCP Strategic Commissioning Plan North Ayrshire Today North Ayrshire is home to a, estimated total population of 133,570 (NRS, 2023). The local area covers approximately 885 square kilometres and has a population density of c.151 persons per square kilometre. The National Records of Scotland (NRS) provides a population projection estimate using 2018 as a baseline year. Between 2013 and 2023 the population is estimated to have fallen from 137,100 to 133, 570, or 2.6% over the 10-year period. It also estimated that by 2043 it will fall to 122,334, a further decrease of 8.4%, or an almost 11% decrease over the 30-year period. Not only is the overall population projected to change, but the demographic spread is also projected to change over time with a steady reduction in the working age population. Current population estimates show that 60% of the population is aged 16-64 which is projected to decrease to 54.1% in 2043. Conversely, the 65+ population is currently 24.2% and is expected to rise to 30.7% in 2043 (NRS). This demographic change has significant implications for local funding and spending as the number of working aged people paying taxes is decreasing, while the number of dependents, and therefore pressure on our health and care services is increasing. Currently, 29.1% of local people are known to have some form of long-term condition. It is recognised that the prevalence of people with a long-term condition increases by age. For example, 1.7 people in every 10 under the age of 65 has a long-term condition, whereas 8.7 people in every 10 over the age of 85 has a condition. In contrast to the growth in the older population, the life expectancy figures for North Ayrshire have dropped in recent years. To measure life expectancy, averages are taken over a 3-year period, and for 2021-2023, female life expectancy was 79.3 years, compared to its highest point over the previous 10 years of 80.99 in 2012-2014. Current male life expectancy is 74.9 compared to its high of 76.47, also in 2012-14. For both females and males, life expectancy is lower when compared to the Scottish Average. In the latest time-period available (2019-2021), the average healthy life expectancy in North Ayrshire was 56.51 years for men and 52.07 years for women. Healthy life expectancy data is only available from 2015, and the highest for females was 57.13 in 2015-17, and for males was 58.52 in 2017-2019. For women, healthy life expectancy has been steadily falling, but for men it was rising to that high point when it began to fall in recent years. When compared against life expectancy this suggests that, while women in general will live longer than men, they will spend a greater proportion of their life in ill health. Additionally, in North Ayrshire and nationally, over the last 20 years life expectancy for males has increased more than for females, so the gap between life expectancy is gradually reducing over time. 97
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 6 Socio-Economic Profile The Scottish Index of Multiple Deprivation (SIMD) 2020 (the last available year), reports that 74 of North Ayrshire’s 186 data-zone areas are ranked in the 20% most deprived, or 39.8% of data zones in the area. An estimated 55,069 people live within these data zones which is around 41% of North Ayrshire residents. The last reported employment figures for North Ayrshire cover the period of October 2023 to September 2024, which shows that 67.6% of the population is economically active which represents a steady drop over the last few years and the lowest it has been in available records which date back to 2004. This compares to 76.6% of Scotland’s population which has retained a consistent rate. The unemployment rate in North Ayrshire is currently 4.1%, which although is higher than the previous year, is still relatively low for the area and over time and compares to 3.3% in Scotland. This implies there is increasing economic inactivity in the area, which may be indicative of the older population across North Ayrshire. During that time period, 15.7% of the economically inactive population was retired compared to 14.4% in Scotland, and 41.6% were long-term sick compared to 33.5% of Scotland. The dependency ratio indicates the number of working aged people compared to dependents, or those under 16 and over working age. Historically 16-64 has been used as the working aged population despite recent changes to pension age and, although many people over 65 work, the ratio is worked out based on the population alone which is a ratio recognised internationally to allow for comparisons. Currently, the dependency ratio in North Ayrshire is 66.6. which means that for every 100 working aged people, there are almost 67 dependents, compared to Scotland’s ratio of 57.8. In 2011, the dependency ration in North Ayrshire was 57.6 and it is projected to increase to 80 by 2033, whereas in Scotland the change is projected to change from 52 in 2011 to 60.6 in 2033 – which is still lower than the current North Ayrshire figure. More rural areas tend to have a higher ratio than other areas, due to the smaller working age population which is an important factor for planning and funding health and social care services that meet the needs of this population. 98
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 7 A snapshot of achievements during 2024-2025 Enable Communities • North Ayrshire Alcohol and Drug Partnership - invited applications for grants of up to £15k for projects that can reduce alcohol and drug-related harms in North Ayrshire. The grants have a particular focus on: recovery-based activities in the evenings and at weekends, developing opportunities for people to take part in activities that could help to develop their skills, proposals that focus on engaging with young people about alcohol and drugs, and challenging stigma in an innovative way and the provision of community-based activities for children who may be impacted by substance use. • Unpaid Carers Roadshow - North Ayrshire Carers Gateway and the NAHSCP Carers Team held a series of roadshows to share information on benefits, fuel poverty, cost of living, training and education, health and wellbeing, community organisations and support groups. • NAHSCP Locality Planning - the first cycle of the HSCP locality planning process has now been completed, after an initial period of engagement with the public in April 2024. The Locality Conversation events enabled us to hear from our communities on three key areas of health and social care: Places and Spaces, Healthy Living and Services. The themes that came out of these sessions will be used to identify issues within our localities and feed into other planning processes, such as our next Strategic Plan. The Strategic Planning and Equalities Team is also looking to do some targeted engagement with groups with shared characteristics (for example, LGBTQ+, disability, carer, gender, age, religion, ethnic minority) for both a revised Equalities Outcomes Plan and the NAHSCP locality planning process. • North Ayrshire Community Mental Health and Wellbeing Fund - For the 4th year running, the North Ayrshire Third Sector Interface (comprising Arran CVS and The Ayrshire Community Trust) delivered the Community Mental Health and Wellbeing Fund. The fund is provided by Scottish Government to TSIs across Scotland, to support the development of grassroots activity within communities. A variety of partners from NAHSCP services supported this work, including being involved in the scoring of applications. In total, £402,148 was distributed by the fund across 41 successful applicants. • Trindlemoss Community Christmas 2024 - the festive season at Trindlemoss was filled with joy and community spirit, thanks to the dedicated efforts of our Care at Home team. A special Christmas lunch was organised in the Club Room at Trindlemoss Day • 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. 99
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 8 Develop and Support our Workforce • Mentoring Newly Qualified Social Workers Training - North and South Ayrshire Health and Social Care Partnerships have teamed up with the Scottish Mentoring network to deliver mentoring training to align with mentors supporting Newly Qualified Social Workers during their supported year. • Partnership Awards - the winners of the 2024 Partnership Awards were announced at our ‘Promoting Wellbeing Together’ event on 25th October 2024 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. • 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 a sunny 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. • Arran Services: Activity Coordinator - the Arran team welcomed a new Activity Coordinator at Montrose House, our nursing/residential care home. This role focuses on developing person-centred activities for residents. The Care Inspection commended this role for enhancing the quality of social stimulation and activities for residents. 100
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 9 • Arran Services: Emergency Department Nurse Practitioners - the Partnership’s Executive Team, along with NHSAA Chief Executive and Board members, visited Arran to receive an update on progress. They toured the Emergency Department of Arran War Memorial Hospital and met with new Emergency Department Nurse Practitioners. The team discussed plans to develop the Single Point of Contact on Arran and demonstrated the Netcall telephone system, which allows digital triage of patient requests. The IT infrastructure work for Netcall is expected to be completed by the end of August. The team also noted excellent national primary care survey results for Arran, indicating higher patient satisfaction compared to other areas of Scotland. Provide Early and Effective Support • Relaunch of the North Ayrshire Perinatal Wellbeing Team - Following increased demands upon the service, the former North Ayrshire Perinatal Mental Health Nursing team within Universal Early Years, has rebranded to the Perinatal Wellbeing Team. The service continues to provide mental health support to expectant and new mums with low level mental health and wellbeing concerns and at any one time, can be supporting between 50 and 60 women. The expansion of the team means that all of North Ayrshire now has support from the team. The team also works closely with the Ayrshire and Arran Perinatal Mental Health service which supports mums with more severe mental health concerns • Partnership with National Charity Dads Rock - The Universal Early Years service has partnered with national charity Dads Rock through the Whole Family Wellbeing Fund to bring a dedicated Dads Worker into the existing integrated early years’ service. This is the first role of its kind in Scotland. Later in the year support for dads has received a boost after it secured funding from the Scottish Government’s Whole Family Wellbeing Fund to expand the service. The service works with dads from a wide range of backgrounds who have been referred by their health visitor, family nurse, midwife or perinatal wellbeing team, providing one-to-one support that impacts on the whole family and improves outcomes for children, whether that be parenting advice, confidence building or support with general wellbeing. • Transition Support group - A new North Ayrshire support group led by parents or carers who support a child or young person aged 13 to 26 through a transition was held on 29th May 2024 at the William Love Memorial Hall, Kilwinning. The group is supported by NAHSCP, NHS Ayrshire and Arran and Unity Carers Gateway. • 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 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. 101
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 10 • 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. • Drone Delivery of Lab Specimens - In a groundbreaking achievement, NHS laboratory specimens were successfully delivered 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 our 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. • 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. • Post Diagnostic Support (Dementia) - 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 designated CPNs provide timely emotional and practical support, helping individuals understand their illness, manage symptoms, stay connected to their community, and plan for future care. Since April 2024, 169 people have been offered post-diagnostic support, with 118 appointments arranged to review medications and address stress and distress. • 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-users, whose primary priority was her family, was resident in the centre. The feedback from her family 102
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 11 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. Improving Mental and Physical Health and Wellbeing • Digital Community Alarms - North Ayrshire Health and Social Care Partnership has been awarded the Bronze Digital Telecare Implementation Award in recognition of the progress they have made on their analogue to digital telecare transition project. 17 Bronze status is achieved when a Telecare Service provider has 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 for the remainder of the digital telecare transition. • Learning Disability Health Check Plans - ongoing successful delivery of Annual Health Checks for people with learning disabilities. The Scottish Government issued a new specification for the delivery of Annual Health checks for adults with learning disabilities in 2022. The checks were initially rolled out in North HSCP in November, and in Late Spring they were rolled out to East Ayrshire with a roll out to South Ayrshire in the summer of 2024. Up to 5th March 2025 Pan-Ayrshire a total of 1247 (61%) health checks have been offered to the identified population and 826 (41%) health checks have been completed. In North Ayrshire to date, 85% (572) of the identified population have bene offered a health check and 68% (444) health checks have been completed. NHS Ayrshire's progress in relation to delivery of the new checks represents a significant proportion of the progress made so far nationally. This represents an immense amount of work on the part of the Nurses and senior staff who have led the work, and highlights Ayrshire's long- standing good practice with regard to the delivery of a pre-existing enhanced service for people with learning disabilities in Primary Care. • Mental Health Unscheduled Care Assessment Hub – Official Opening the Mental Health Unscheduled Care Assessment Hub was officially launched on Friday 13th September 2024 with full operational opening from 5pm that day. 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. • NDD Support NAHSCP- ran a series of events that provided an opportunity for parents and carers of a child or young person with a diagnosed or suspected neurodevelopmental difference (NDD). These sessions offered a chance to hear more about the work being undertaken across North Ayrshire and provide further feedback. • 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 103
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 12 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. • Improved Care Inspectorate Grades at Montrose House Care Home - 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 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. • Holly Health App - the Holly Health app, available to all GP Practice patients and HSCP staff across North Ayrshire for 12 months, has shown promising results in improving health outcomes. Over an 8-week study period, users with low-to-medium baseline scores reported a reduction in GP appointments, with frequent attendees seeing a significant decrease. Tackle Inequalities • School Welfare Rights Officers - welfare rights advice in schools is expanding 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. The project is now expanding, 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. • Collaborating to Reduce Health Inequalities (CHES) North Ayrshire is embarking on a new and innovative collaboration to improve health equity in partnership with Public Health Scotland and the Institute for Health Equity, led by Professor Sir Michael Marmot, at University College London. North Ayrshire has some of the lowest healthy life expectancies across Scotland, with significant health inequalities across our communities. North Ayrshire Council are partnering with the Integration Joint Board to be one of the 3 local authority areas in Scotland to take this work forward. The Collaboration for Heath Equity in Scotland (CHES) programme focuses on using the eight ‘Marmot principles’ to deliver better health outcomes through improving the conditions in which people are born, grow, live, work and age. The North Ayrshire CHES programme will officially launch on 25th February and the IJB will be included and kept informed of progress. • Dementia Connect Event - earlier this year, North Ayrshire's first ever Dementia Connect event brought 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 to hear guest speakers including Professor Elaine Hunter, National AHP Consultant for 104
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 13 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. • 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. 105
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 14 Organisational Performance Our 2022-2030 strategic plan set of performance measures reflect the transformation of services to meet continual service improvement and demand. Where an indicator presents as being off track, commentary with proposed resolution and future mitigation is provided on how to improve future performance. Performance reporting comprises of a series of key performance indicators and key actions, which link directly to our strategic plan. Performance is reported at a number of levels within the organisation including the Integration Joint Board Performance and Audit Committee, the Integration Joint Board (IJB), the Joint Review with North Ayrshire Council and NHS Ayrshire and Arran Chief Executives, and service performance reviews within each service area. For 2024-2025 the set of performance measures were agreed and presented to the Performance and Audit Committee highlighting service defined changes. These included: • Target resetting • Removal of measures that are no longer reflective of the service improvement • The inclusion of new measures to meet service improvement and current operational demand For the year ending 31st March 2025, the Partnership ended the period reporting 26 performance measures across all service areas. At the time of writing, 25 out of 26 measures have been collated comprising 96% of all measures reported to the end of 2024-2025. Due to the time for collation and verification of the outstanding Quarter 4 measure update, we have included the RAG status as ‘On Target’ based on the annual performance to date which has been Green for all quarters. The latest Performance and Audit Committee Report shows progress against the key measures, and this is represented in the chart below. 106
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 15 As part of our commitment to continuous improvement, we recognise areas where we could do more and by monitoring indicators which present as significantly adrift enables us to identify and target plans to address performance issues. The key areas off target for 2024-2025 were: • Support more children and young people into kinship care placements each year • Increasing foster carer support. • Reducing the number of people on the waiting list for a Care at Home service in the Community and Hospital. • Reducing the number of people waiting for assessment. • Absence levels remain an area of review. The continual review of Foster Carer availability within our Children and Families Service has revealed that our foster carers are becoming older and unfortunately have succumbed to health issues, and as such we have lost a high number of foster carers. We have seen more interest within our Short Break Schemes, which operate over evenings and weekends, as this enables people to continue to work and also allows them to take on the fostering role ‘part time’. Our Fostering and Adoption Teams continue to actively recruit and given that most people today make use of social media, we have investigated options in relation to this and have chosen the organisation ‘Can Digital’ to assist us raise our digital profile. Through this medium we have noted a rise in enquiries, which hopefully will translate into applications and ultimately new foster carers, Throughout the year our Health and Community Care services continue to experience ongoing and sustained challenges in delivering frontline Care at Home Services although Quarter 4 saw the greatest improvement in performance during 2024-2025. There remain ongoing workforce challenges related to sickness absence rates and vacancies. As part of the financial recovery plan submitted to IJB in September 2024 there was a requirement for a reduction in last year’s spend with further savings required for 2025-2026. As a result, a recruitment freeze was implemented and continues, with a review of existing vacancies ongoing. This has resulted in an increase in vacancies and overall reduction in service capacity. Wellbeing action plans around sickness absence levels within the Care at Home workforce to ensure the impact of high absence levels is being robustly managed and supporting staff to maintain attendance/return to work. A reablement focussed review of low-level care packages is underway to ensure signposting and use of technology and community resources where applicable. An additional review of double handling cases is being completed in conjunction with our Moving and Handling team colleagues. It is anticipated these reviews may create additional capacity for new referrals to meet the ever- increasing demand for services from our acute sites and communities. These works are being undertaken under the umbrella of a further increase in community referrals for Care at Home support together with a rise in both hospital and emergency service requests. 107
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 16 Annual Accounts The Annual Accounts set out the financial statements of the IJB for the period ended 31 March 2025. The main purpose is to demonstrate the stewardship of the public funds that have been entrusted to the IJB for the delivery of its vision and strategic priorities as outlined in the Strategic Plan. The requirements governing the format and content of the Annual Accounts are contained in The Code of Practice on Local Authority Accounting in the United Kingdom (the Code). The Annual Accounts for 2024-2025 have been prepared in accordance with this Code. The Financial Plan 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 2022-2030 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 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 Performance The IJB set a balanced budget for 2024-2025 on 14th March 2024. This did not require any draw on reserves but did include the approval of £10.290m of savings to achieve financial balance. 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 2023-2024 outturn position, the IJB agreed some initial recovery actions at the meeting in June and a more detailed financial recovery plan was developed and approved by the August 2024 IJB. 108
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 17 Other management actions which have been implemented include: • 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 2024-2025, 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 FWG 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. To date the Finance Working Group has covered: • Care at home • Care homes • Charging income • Financial inclusion • An overview of the 2024-2025 budget • Brighter Pathways project • Addictions Prescribing • Medium-Term Financial Outlook • 2025-2026 Budget Outlook • Delayed discharge performance and improvement actions • Community OT – Aids and Adaptations Since the initial recovery plan was agreed in June 2024 there was a £4.002m reduction in costs. The outturn is an overall year-end overspend of £1.212m on an IJB basis, which when adjusted for new earmarked reserves of £2.381m is increased to £3.593m (1.1%), which is a favourable movement of £1.387m from month 10. 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 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: 109
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North Ayrshire Integration Joint Board Audited Annual Accounts to 31st March 2025 18 Social Care element – overspend of £2.036m. 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 £1.557m. NHS Ayrshire and Arran have funded this, previous discussions with NHS AA colleagues in relation to repayment indicated the Health Board would wait to consider this following North Ayrshire Council’s consideration. The outcome of the decision by North Ayrshire Council has been communicated to NHA AA Director of Finance for consideration. Following these additional funding contributions the final position is on-line. The table below reconciles the deficit on the provision of services of £2.349m as noted in the Comprehensive Income and Expenditure Statement to the financial outturn position of on-line. Reconciliation Table 2023-2024 2024-2025 (Surplus) / Deficit on provision of services 11.218 2.349 Earmarked reserves released to services during the year (8.736) (4,730) Sub Total 2.482 (2.381) NEW Earmarked Reserve Balances 2.982 2.381 Financial Outturn (underspend) 5.464 0 The table below summarises the financial performance for 2024-20256 and 2023-2024. This notes the budget outturn on a managed basis (including the full allocation for North HSCP lead partnership services) and adjusts this for the net impact of lead partnership allocations across North, South and East Ayrshire and also for new earmarked balances. The table includes the financial performance for services managed by the IJB during the period, therefore it excludes the large hospital Set Aside Budget of £39.966m which was allocated at the end of the period to the IJB. The set aside budget is included within the financial statements. 2023- 2024 Budget £000 2023- 2024 Actual £000 Variance (Fav) / Adv £000 Service 2024- 2025 Budget £000 2024- 2025 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 1 110
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 19 2023- 2024 Budget £000 2023- 2024 Actual £000 Variance (Fav) / Adv £000 Service 2024- 2025 Budget £000 2024- 2025 Actual £000 Variance (Fav) / Adv £000 12,740 11,287 (1,453) Management and Support Costs 13,970 10,186 (3,784) 1,852 1,317 (535) Chief Social Work Officer 1,635 1,725 90 1,671 1,630 (41) Financial Inclusion 1,710 1,773 63 3 3 0 National Commissioned Service 4 4 0 311,528 314,893 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 0 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 0 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 0 The main areas of variance during 2024-2025 are noted below: Health and Community Care – overspend of £5.632m 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 £0.898m 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 2025-2026. Children, Families and Justice – overspend of £0.577m 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 2025-2026. 111
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 20 Management and Support Costs – underspend of £3.721m 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. Movement in Projected Outturn Position: The overall movement in the projected outturn during the period is illustrated below: Lead Partnership Services The final outturn is adjusted to reflect the impact of Lead Partnership services. In the absence of detailed service activity information and alternative risk sharing arrangements, it was agreed that the outturn for all Lead Partnership services would be shared across the 3 partnerships on an NRAC (NHS Resource Allocation Committee) basis. The outturn of the lead partnership services for each IJB is provided below, the adjustment to the North IJB outturn reflects the impact of reallocating a share of the North lead partnership services underspend to the other two areas and receiving an NRAC share of the outturn for the South and East partnerships. In addition, any allocations of ring-fenced funding are returned to each IJB in line with allocations and expenditure to allow each IJB to carry forward for future use. IJB £000 Over/Under Explanation of Outturn North 658 Overspend Mental health services, mainly due to overspends on UnPACs, elderly inpatients, psychiatry and mental health pharmacy offset by vacancy savings. South 598 Overspend Pressures from the community equipment store and continence service offset by underspends in the Family Nurse Partnership East (2,119) Underspend Underspends in the Primary Care Improvement Fund, Dental Services and AHP services. 112
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 21 Set Aside Budget The Integration Scheme establishes that pressures in respect of large hospital set aside budgets will be managed in-year by NHS Ayrshire and Arran. 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 this compares to the NRAC “fair share” of resources. Ayrshire Finance Leads have now agreed a baseline methodology for set aside budgets which involves using the average of the four full years prior to the pandemic, 2016-2017 to 2019-2020 inclusive. The 2024-2025 actual usage information is not known until after the IJB date, so the info used is the baseline at 2024-2025 prices. IJB Set Aside 2024-2025 £m Baseline Bed Days % Baseline Budget Share 2024-2025 £m Over / (Under) Baseline Share £m East Ayrshire 31.87 28.90% 28.183 3.687 North Ayrshire 39.966 38.60% 37.807 2.159 South Ayrshire 34.488 32.50% 31.247 3.241 Total 106.324 100.00% 97.237 9.087 Climate Change The Climate Change (Duties of Public Bodies: Reporting Requirements) (Scotland) Order 2015 came into force in November 2015, as secondary legislation made under the Climate Change (Scotland) Act 2009. The Order requires bodies to prepare reports on compliance with climate change duties. This includes Integration Joint Boards established by order under section 9(2) of the Public Bodies (Joint Working) (Scotland) Act 2014. Scottish Government guidance was issued to IJBs in May 2017, setting out detail of the new duty to produce an annual climate change report. The report requires to be approved by the IJB, with returns to be submitted on the Sustainable Scotland Network (SSN) online portal by 30 November each year. The report was submitted on 12th November 2024, but the IJB haven’t been asked to approve as the IJB don’t have staff, fleet vehicles or property so the return refers to the North Ayrshire Council and NHS Ayrshire & Arran climate change reports. Both North Ayrshire Council and NHS Ayrshire & Arran submit separate reports to the SSN and these are published online. As the parent bodies of the IJB, both North Ayrshire Council and NHS Ayrshire & Arran retain responsibility for employees who are managed within the Health and Social Care Partnership. The employees, therefore, contribute to support the implementation of both bodies’ Climate Change Plans. North Ayrshire IJB has no direct responsibility for employees, buildings or vehicles, which are contained within the parent bodies’ reports, however full consideration of climate change implications will form part of future IJB service redesign, as part of the transformational change programme. 113
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 22 Overall position It is essential that the IJB operates within the delegated budget and commissions services from the Council and Health Board on that basis. The 2024-2025 outturn has depleted the general reserves and additional funding was made available from North Ayrshire Council and NHS Ayrshire & Arran. Some areas of current overspend have been invested in as part of the 2025 to 2026 approved budget but many of the underlying overspend areas will continue into 2025 to 2026. Services require to address these or there will continue to be a reliance on other budgets underspending and a risk of having to seek additional funding from North Ayrshire Council and NHS Ayrshire and Arran. The current Transformation Plan 2024 to 2027 will be refreshed, and the Partnership is currently undergoing a programme of research to understand the current and future needs of residents and service users, including a Strategic Needs Assessment, Review of national and Local Policy, analysis of local engagement, and mapping of existing service to inform this. 114
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 23 Financial outlook, risks and plans for the future 2025-2026 and beyond The Scottish Government published an updated Medium-Term Financial Strategy (MTFS) in May 2023 which covers the period to 2027 to 2028. It compares the funding and spending scenarios to assess the scale of the challenge. The role of the MTFS is to set out Scotland's fiscal outlook over the coming years, including financial opportunities and risks that may impact on the fiscal position. In line with the recommendations of the Budget Process Review Group, the document does not set out new spending plans or explain how prioritisation decisions will be made to meet policy objectives. These decisions are made in the Scottish Government budget. The Scottish Government’s funding is comprised of five high level categories: 1. The Block Grant – this is the single largest source of funding for the Scottish Government. The Barnett Formula determines the Block Grant and annual growth is dependent on the UK Government’s overall fiscal plans and its spending priorities. 2. Devolved taxes – the Scottish Government receives the revenue from these taxes, the largest of which is Scottish Income Tax. The Scottish Budget is then reduced based on how quickly revenues of the corresponding tax have grown in the rest of the UK (rUK) on a per head basis. 3. Non-domestic rates (NDR) – this revenue is raised by Local Authorities on non-domestic properties. All revenue raised is ultimately returned to Local Government via the Local Government Settlement. 4. Social Security Block Grant Adjustments – this is funding provided by the UK Government for devolved social security payments, based on the growth in expenditure on the corresponding payment in UK on a per head basis. 5. Other income and expenses – other revenue and costs including resource borrowing and associated costs as well as revenues from the Scottish Crown Estate The Scottish Government MTFS models three scenarios (a central resource funding outlook and an upside and downside scenario, indicating plausible alternative funding paths) and outlines the immediate and longer-term pressures on public spending which need to be considered when developing spending plans to ensure that they meet the needs of a changing population and build resilience for the future. The Scottish Government intended to publish an updated Medium-Term Financial Strategy during 2024, alongside a refreshed Medium-Term Financial Framework for Health and Social Care. These documents were scheduled for publication in June 2024 but were delayed due to the General Election in July 2024. These will form the basis of the funding assumptions in the next update of our Medium-Term Financial Outlook which will cover the period 2025-2028. Since the unaudited accounts were submitted in June 2025 the Scottish Government have published their seventh Medium-Term Financial Strategy. It provides the economic and fiscal context for the Scottish Budget and sets the medium-term strategy for sustainable public finances. The three pillars of the 2025 Medium-Term Financial Strategy are: Pillar 1: Ensuring public money is focused on delivering government objectives, underpinned by reform and prioritisation to maximise impact. Pillar 2: Supporting sustainable, inclusive, economic policies with the greatest potential to grow Scotland's economy, expand and broaden the tax base to fund public services. 115
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 24 Pillar 3: Ensuring a strategic approach to tax revenues, which considers the longer-term impact of our tax choices and competitiveness. This Strategy will be considered in the next update of the Medium-Term Financial Outlook in 2025-26. 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. 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 2025-2028. This was presented to the December 2024 IJB. 2025-2026 Budget As part of the Scottish Government budget and finance settlement funding letters were issued to NHS Boards and Councils, these detailed the requirements in relation to the level of funding to be delegated to IJBs in 2025-2026. The specific requirements and funding provision is as follows: NHS Ayrshire and Arran • NHS Ayrshire and Arran are required to passport the 3% through to IJBs (£4.040m to North Ayrshire) – “In 2025-2026, NHS payments to Integration Authorities (IA) for delegated health functions must pass on an uplift of 3% over 2024-2025 agreed recurring budgets.” • Additionally, there is funding of £150m nationally for Agenda for Change Pay Reform. A share of this funding will be allocated to the IJB to meet the associated costs for NHS staff. This is being followed to ensure the correct roll-forward into 2025-2026 and it is anticipated at this stage that the costs of the pay reform will be fully funded. • Moving into 2025-2026, brokerage will no longer be available to NHS Boards and all Boards must work towards break-even. Should financial balance not be achieved this 116
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 25 would be shown as an overspend in financial statements, leading to potential qualification of accounts and Section 22 report, as well as consideration of escalation status. • The NHS budget includes a commitment of additional funding to reduce waiting lists and to help support reduction of delayed discharge; as well as a commitment to renew primary care enhancements, including new core funding to GMS to deliver enhanced frailty, cardiovascular disease and other essential services in General Practice, a critical dental workforce and training package and a community eye care programme to transfer patients from waiting lists. Further details of the allocation of funding is to follow but a submission from NHS AA incorporates the request for funding from North Ayrshire IJB and this was submitted to the Scottish Government early March 2025. • Similarly to Local Government NHS Boards have also been advised to plan on the assumption of 60% funding for the Employers National Insurance Increase. North Ayrshire Council • Based on the 2025-2026 Finance Settlement the Health and Social Care Portfolio will transfer additional funding of £140 million to Local Government to support social care and integration for 2025-2026. • The funding allocated to Integration Authorities should be additional and not substitutional to each Council’s 2024-2025 recurring budgets for services delegated to IAs and therefore, Local Authority social care budgets for allocation to IAs must be at least £140 million greater than 2024-2025 recurring budgets. • The increase in Employers National Insurance from April 2025 has not been fully funded for the public sector in Scotland and has created a significant financial pressure. For Local Government funding of around 60% of the cost will be provided by Scottish Government for directly employed staff. There is zero funding being provided for any commissioned services. • Specific funding for the IJB was received for the following areas: • Real Living Wage • Free Personal and Nursing Care • Additionally, North Ayrshire Council have passed through a share of the Local Government Grant uplift of £2.114m and have fully funded the increase in Employers’ NI costs of £1.898m for NAC contracted staff. This has resulted in a net increased contribution to the Partnership of £13.280m through the NAC budget setting process. Some elements of this relate to previous years and were already assumed in the Partnership base budget and this is shown in the tables below. Area £m Adult Social Care RLW 3.388 Children’s SW Services RLW 0.490 FPNC 0.213 117
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 26 Area £m MH Recovery & Renewal (MHO funding element) (0.091) 2023-2024 Pay Award Adjustment (0.178) Employers NI Increase 1.898 Additional Funds – share of grant uplift 2.114 Per the HSCP budget plans 7.834 Reconciling Items to the Council Budget Paper Amounts already included in HSCP base budget: Area £m Adult Social Care RLW 2024-2025 6.477 Scottish Disability Assistance 2024-2025 0.134 Children’s SW Services RLW 2024-2025 0.569 Additional 2024-2025 Pay Award 1.057 Justice Services Grant - not yet in settlement (2.657) Scottish Disability Assistance – not yet in settlement (0.134) Per Council Budget paper 13.280 Moving into 2025-2026 the Partnership is proactively working to provide safe and effective services for the residents of North Ayrshire within the financial envelope, this is supported by approving a balanced budget and a focus on the delivery and alignment of financial plans through the transformation plan. The IJB approved a one-year balanced budget for 2025-2026 on 20 March 2025. More information about the 2025-2026 Budget This budget included new budget pressures for health and social care services totalling £14.943m. These were developed in partnership, with Finance supporting front line services to identify current and emerging financial pressures considering historic demand and costs and potential future variations. The provision of funding for pressures has the impact of increasing the budget gap to be addressed through savings, therefore the pressures are only included in budget plans where these are absolutely unavoidable. The new cost and demand pressures resulted in a requirement to identify and approve additional savings of £4.019m, as noted in the summary below, this includes an over-delivery of in-year 118
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 27 savings to address recurring areas of overspend from 2024-2025 and to seek to accelerate savings plans to support future year’s budget gaps: Description Social Care (NAC) £m Health (NHS A&A) £m Total £m Funding Increase (7.834) (4.040) (11.874) Resource Transfer (0.670) 0.670 0 Service Pressures 10.680 4.263 14.943 In-year Budget Gap 2.176 0.893 3.069 Approved Savings (2.903) (1.116) (4.019) The Integration Joint Board, in common with most Public Sector bodies, is facing a period of significant financial challenge with cost and demand pressures. The most significant financial pressures continue to be pay awards for staff, inflationary cost increases for contracted services and demographic changes driving increased demand for services - funding these unavoidable pressures year-on-year drives our savings requirement. 2025-2026 Opening Position Part of the 2024-2025 overspend will impact on the 2025-2026 opening position. The adjusted opening projection for 2025-2026 is a £1.539m overspend. This reflects the full year impact of part year cost reductions achieved in 2024-2025, including - care at home, Brighter Pathways, care packages, vacancy management and supplementary staffing – targeted improvement in other areas. It assumes all mitigations and controls established in 2024-2025 continue throughout 2025-2026 as it is recognised that the same uncertainty and risks remain into 2025-2026 and there needs to be tight grip and control over expenditure overall. The improvement from the 2024-2025 position to the opening projected overspend for 2025-2026 is predicated on maintaining Financial Recovery Plan Controls, and: • Removing the care home overspend and manging the number of placements in line with the budgeted level • Reduce agency costs at Montrose House on Arran • Significant reduction or removal of overspends on supplementary staffing across wards through focussed improvement work supported by the General Manager, Lead Nurse and responsible Senior Managers • Adult Community Care Packages (Learning Disabilities and Mental Health) breakeven across client groups – net reduction • Eating Disorders and Psychiatry managing within budget • Maintaining payroll turnover over-recovery and therefore same vacancy management controls There are a number of ongoing financial risk areas that may impact on the 2025-2026 budget during the year, these include: • 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. 119
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 28 • Staff recruitment and retention challenges across a number of service areas. • The impact of the increase in Employers National Insurance Contributions, the impact of funding of this increase and also the compounding impact on social care commissioned care providers. • 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. • The Local Government and NHS pay awards are not settled for 2025-2026; as outlined in the report, a 3% increase has been assumed for the social care workforce and for NHS it is anticipated that additional funding will be allocated once the pay award has been settled. 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. • The ability to re-pay funding partners in-year for previous year overspends given continued financial challenges. • Removal of brokerage for NHS Boards. • 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 National Position Overall, the financial outlook for Health and Social Care Partnership is challenging with significant budget gaps across the country to maintain the current service provision (national budget gap of £497.5m for 2025-2026). Budget gaps for IJBs across Scotland range from 1.3% to 12.6% with significant level of variation. Many IJBs also have depleted reserves (national total at April 2025 £55m) and of those with reserves only one meets the best practice contingency reserve level of 2- 4% of revenue budget. Whilst there are variations in the scale of the gap, the areas contributing to the pressures across the system are similar and include: • Increases in demand, complexity and demographics • Prescribing • Recurring deficits/ baseline pressures/ inflation • Pay pressures • Contract inflation for commissioned services These critical financial pressures facing IJBs have been shared by Health and Social Care Scotland with Scottish Government to seek additional financial support for community based health and social care services. Set Aside The Partnership has a responsibility, with our local hospital services at University Hospital Crosshouse and University Hospital Ayr, for planning services that are mostly used in an unscheduled way. The aim is to ensure that we work across the health and care system to 120
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 29 deliver the best, most effective care and support. Service areas most commonly associated with unplanned use are included in the Set Aside budget. Set Aside budgets relate to the strategic planning role of the Partnership. Key areas within this budget are: • Accident and emergency. • Inpatient services for general medicine. • Geriatric medicine. • Rehabilitation. • Respiratory. • Learning disability, psychiatry and palliative care services provided in hospital. The annual budget for Acute Services is £462.6million. The directorate overspent by £36.9 million in the 12 months to 31 March 2025. This was caused by overspends on agency medical and nursing staff, together with medicines expenditure, equipment and supplies. November saw a successful reduction in unfunded beds. Operational challenges in December carried on into the final quarter. Ayr had 24 additional beds open between Station 8 and Station 12 every day and an average of 13 on Station 11. Crosshouse continued with 78 unfunded beds open in March, and in addition 24 full capacity beds were open each day on average. The SAFER programme in Crosshouse is progressing well and early indications show a reduction in Length of Stay (LoS) across two wards by 2.5 days each. The co-horting of patients in the active wards is also demonstrating a reduction in LoS in other areas. There is a material underlying deficit caused by: • Unachieved efficiency savings • 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. Initial work has commenced to develop a joint strategic commissioning plan for the provision of unscheduled care services, which will outline these services will be delivered over the medium-term using the set aside resources available. The ambition being to support a shift in the balance of care into the community and support a reduction in the number of acute beds. The ability to plan with the overall resource for defined populations and user groups and to use budgets flexibly is one of the hallmarks of integrated care. Each Health Board, in partnership with the Local Authority and IJB, must fully implement the delegated hospital budget and set aside budget requirements of the legislation, in line with the statutory guidance published. The full implementation of the set aside arrangements is key to delivering a commitment to planning across the whole unplanned care pathway and partnerships must ensure that set aside arrangements are fit for purpose and enable this approach. Ayrshire Finance Leads have developed and agreed on a new model for costing the set aside arrangements, based on actual bed usage and average costs. A baseline level of usage has been agreed based on the average actual use across years 2016-2017 to 2019-2020, the last four years prior to the pandemic. A pan-Ayrshire Joint Commissioning Plan is currently under 121
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 30 development; this will outline the level of acute unscheduled care provision that each of the IJBs want to commission from the Health Board. The NHS AA Chief Executive has requested the development of a joint strategic commissioning plan to enable the setting of directions to provide to NHS Ayrshire and Arran for Unscheduled Care, aligned with the Set Aside resources. Furthermore, seeking the support from the 3 IJBs in the review, and onward approving and monitoring of the delivery of a Strategic Commissioning Plan in line with the provisions laid out in the Integration Schemes, as outlined below: • The NHS Board will consult with the Ayrshire Integration Joint Boards to ensure that any overarching Strategic Plan for Acute Services and any plan setting out the capacity and resource levels required for the Set Aside budget for such Acute Services is appropriately coordinated with the delivery of Services across the Ayrshire and Arran area. The parties shall ensure that a group including the Director for Acute Services and Chief Officers of the three Ayrshire Integration Joint Boards will meet regularly to discuss such issues. • The initial Set Aside base budget for each Integration Joint Board will be based on their historic use of Acute Services. The actual unit cost which would apply as part of any change to activity or service redesign is dependent on the scale of change planned and requires agreement in advance by all Parties. Any redesign of service requires to be agreed across the three Integration Joint Boards and be reflected in the Strategic Plans. • In year pressures in respect of Set Aside budgets will be managed in year by the Health Board, with any recurring over or underspend being considered as part of the annual budget setting process. In this joint strategic commissioning plan each IJB will consider and outline a clear framework for commissioning, at a strategic level, the urgent and unscheduled care service funded from the ‘set aside’ budget. There is an ambition that the commissioning plan will indicate an expectation of service delivery that will see sustained and affordable improvement in relation to performance outcomes for the citizens of Ayrshire and assure best value to support the financial balance of urgent and unscheduled care provision through a review and system wide redesign of the preferred models of care. Following consideration l by the 3 IJBs, the Plan will be enacted operationally through the mechanism of Directions by the Local Authorities and NHS Ayrshire and Arran. This work remains ongoing and there is an opportunity to refresh this alongside the national focus on NHS Renewal for Unscheduled Care. Directions The Scottish Government issued Statutory Guidance in January 2020 outlining the requirements for the use of Directions from Integration Authorities to Health Boards and Local Authorities. The guidance sets out how to improve practice in the issuing (by IJBs) and implementation (by Health Boards and Local Authorities) of directions issued under the Public Bodies (Joint Working) (Scotland) Act 2014. It supersedes the Good Practice Note on Directions issued in March 2016. The Scottish Government worked closely with IJB Chief Officers to better understand the diversity of practice across Scotland surrounding directions and to identify good practice. They also discussed the use of directions with a range of local systems at regular partnership engagement meetings, including with Health Board and Local Authority Chief Executives. 122
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 31 The three Ayrshire HSCPs worked together to develop a template for the issuing of Directions as a formal mechanism to communicate IJB decisions to the Councils and Health Board, and this was implemented across the system from April 2023. Risks The strategic risks faced by the IJB over the medium to longer term were presented to the March 2025 IJB. There are 12 risks noted on the Strategic Risk Register, with a number of these graded as very high or high risk. While there are a number of controls and mitigations in place there may be further actions required to reduce the risks further in line with the level of risk tolerance. The current Strategic Risk Register is available to view. The risks are summarised below: Ref Title Gross Risk (score pending further controls) Residual Risk (score after further controls) SRR01 Financial Sustainability 25 Very High 16 High SRR02 Infrastructure (ICT Integration) 12 High 9 Moderate SRR05 Transformational Change Programme 12 High 6 Moderate SRR06 Governance 9 Moderate 3 Low SRR07 Demography and Inequality Pressures 16 High 12 High SRR08 Workforce 12 High 9 Moderate SRR09 Local Impact of Scottish Government Policies 16 High 12 High SRR12 Clinical and Care Governance 9 Moderate 9 Moderate SRR13 Provider Failure (commissioned services) 16 High 12 High SRR14 Asylum Arrivals 12 High 12 High SRR15 Risk of Harm 16 High 16 High SRR16 Growth and expansion of specialist complex care developments 25 Very High 15 High 123
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 32 These risks emphasise the importance of effective planning and management of resources. It is therefore crucial that we focus on early intervention, prevention and recovery if we are to work within the total delegated partnership budget. Going forward, we will continue to ensure local people are supported to get the right care in the right place, developing clear health and care pathways for the people of North Ayrshire. To achieve its vision, the Partnership recognises it cannot work in isolation. The Partnership will continue to strengthen relationships with colleagues within the Community Planning Partnership to ensure a joint approach to improving the lives of local people. Most importantly, the Partnership must work closer with local people and maximise the use of existing assets within communities to improve the overall health and wellbeing of people in North Ayrshire. 2025-2026 will see the progression of the implementation of the longer-term Strategic Plan and Transformation Plan. We will also continue the development of self-directed support, instilling an enablement ethos promoted by our professionals, collaborating with the third and independent sector to design and commission appropriate models of service. Conclusion 2024-2025 has been an extremely challenging year for the partnership financially, driven by the cost of delivering services to meet demand across the system. There has been a requirement to draw on the remaining unearmarked reserves and also seek additional funding from North Ayrshire Council and NHS Ayrshire & Arran. This is not a sustainable approach. The IJB has a strong track record in delivering approved savings. The IJB will continue to pursue transformational change in how it supports individuals, families and communities to live independently from statutory services for as long as they can safely do so. This is not just about changing the ways in which services are structured but will require a change in how they are planned and delivered, and will inevitably, unless further national investment is forthcoming, reduce the level of service provision available in North Ayrshire for our residents. Our health and social care services should reflect and respond to the needs of local people. To support this, we will help to build greater capacity in our communities and provide more ways for service users and local people to share their views with us to help shape services. We are fully committed to planning and designing services together with local people, our staff and our key partners including acute health services, housing, community planning and the third and independent sectors. The IJB, through the Strategic Plan, outlines the belief that together we can transform health and social care services to achieve the joint vision for the future “all people who live in North Ayrshire are able to have a safe, healthy and active life.” A new Transformation Plan 2024-2027 was agreed by the IJB in March to support the redesign of services and to assist with meeting the financial challenges ahead. Moving into 2025-2026, we are working proactively to address the financial challenges, while at the same time, providing high-quality and sustainable health and social care services for the communities in North Ayrshire. 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 North Ayrshire Health and Social Care Partnership website 124
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 33 Statement of responsibilities Responsibilities of the IJB The IJB is required to: • Make arrangements for the proper administration of its financial affairs and to secure that the proper officer of the board has responsibility for the administration of those affairs (Section 95 of the Local Government (Scotland) Act 1973). In this authority, that officer is the Chief Finance Officer • Manage its affairs to secure economic, efficient and effective use of resources and safeguard its assets • Ensure the annual financial statements are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014), and so far, as is compatible with that legislation, in accordance with proper accounting practices (section 12 of the Local Government in Scotland act 2003) • Approve the Annual Accounts for signature. Joyce White IJB Chair 125
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 34 Responsibilities of the Chief Finance Officer The Chief Finance Officer is responsible for the preparation of the IJB’s Annual Accounts in accordance with proper practices as required by legislation and as set out in the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom (the Accounting Code). In preparing the annual accounts, the Chief Finance Officer has: • Selected suitable accounting policies and then applied them consistently. • Made judgements and estimates that were reasonable and prudent. • Complied with legislation. • Complied with the local authority Code (in so far as it is compatible with legislation). The Chief Finance Officer is also required to: • Keep proper accounting records which are up to date. • Take reasonable steps to ensure the propriety and regularity of the finances of the Integration Joint Board. I certify that the financial statements give a true and fair view of the financial position of the North Ayrshire Integration Joint Board as at 31 March 2025, and its income and expenditure for the period then ended. Eleanor Currie CPFA Chief Finance Officer 126
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 35 Annual Governance Statement The Annual Governance Statement explains how North Ayrshire IJB complies with the Code of Corporate Governance and meets the requirements of the CIPFA / SOLACE Framework ‘Delivering Good Governance in Local Government 2016’ and the ‘Code of Practice for Local Authority Accounting in the UK: A Statement of Recommended Practice’, in relation to the Statement on the System of Internal Financial Control. Scope of responsibility North Ayrshire IJB is responsible for ensuring that its business is conducted in accordance with the law and proper standards, and that public money is safeguarded and properly accounted for and used economically, efficiently and effectively. The IJB is also responsible for putting in place proper arrangements for the governance of its affairs and facilitating the effective exercise of its functions, which includes arrangements for the management of risk. In discharging this responsibility, the Chief Officer has put in place arrangements for governance which includes the system of internal control. Reliance is placed on these controls which are designed to manage risk to a reasonable level but cannot eliminate the risk of failure to achieve policies, aims and objectives. It can therefore only provide reasonable but not absolute assurance of effectiveness. Purpose of the governance framework The governance framework comprises the systems and processes, and culture and values by which the IJB is directed and controlled and the activities through which it accounts to and engages with the community. It enables the IJB to monitor the achievement of its strategic priorities and to consider whether those priorities have led to the delivery of appropriate, cost- effective services. The system of internal control is a significant part of that framework and is designed to manage risk to a reasonable level. The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of North Ayrshire IJB’s policies, aims and objectives, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. 127
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 36 Governance framework The main features of the governance framework that was in place during 2024-2025 are summarised below: • The IJB, comprising all IJB Board members, was the key decision-making body. The Performance and Audit Committee considered all matters in relation to Internal and External Audit, Risk Management and Performance and fulfilled the requirements of the CIPFA document ‘Audit Committees: Practical Guidance for Local Authorities and Police.’ • Strategic decision-making is governed by the IJB’s key constitutional documents including the Integration Scheme, standing orders, scheme of administration, scheme of delegation to officers and financial regulations. • The Integration Scheme sets out the process to determine financial contributions by partners to Integration Joint Boards. This has been supplemented by directives from the Scottish Government in relation to the level of resources for delegation by the Council and NHS Board for Health and Social Care Integration. • The IJB’s purpose and vision are outlined in the IJB Strategic Commissioning Plan 2022- 2030 which links closely to the vision of the North Ayrshire Community Planning Partnership and the Local Outcome Improvement Plan (LOIP) 2022-30 and is underpinned by an annual action plan and performance indicators. Quarterly performance reports are provided to the Performance and Audit Committee on the delivery of the values and strategic priorities set out in the strategic plan, with a formal Annual Performance Report published each year. • The performance management framework focuses firmly on embedding a performance management culture throughout the IJB. Regular reporting to Board Members takes place. • A risk management strategy, strategic risk register and risk appetite statement is in place for the IJB. The second version of the risk appetite statement was approved by the IJB in November 2023. Future reviews of the risk appetite statement will routinely be conducted alongside the triennial review of the risk management strategy, with the next one due in June 2025. It may be reviewed in the interim in the event of an urgent need. The strategic risk register is updated annually, with the operational risk registers updated in line with the IJB’s risk strategy. • The Health and Care Governance Framework covers governance arrangements in relation to complaints and customer feedback, risk management, health and safety, Internal Audit, workforce planning and public protection. Regular updates are provided to the IJB by the Clinical and Care Governance Group. • The IJB has adopted a ‘Code of Conduct’ for all its Board Members and employees, a register of interests is in place for all Board members and senior officers. • The IJB has in place an informal development programme for all Board Members, the Partnership Senior Management Team and senior managers across the Partnership. • There have been several changes in membership of the IJB over the course of 2024-2025 so refresher training on Code of Conduct is planned as well as an updated induction pack for new IJB members. • In order to facilitate greater scrutiny of the financial position, the IJB agreed to establish a ‘Finance Working Group’, chaired by the IJB Vice Chair. This group will facilitate increased oversight and scrutiny of the financial position and transformation programme as well as 128
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 37 detailed budget planning for future financial years and will become part of our regular governance arrangements. • Performance and Personal Development schemes are in place for all staff, the aim of which is to focus all staff on their performance and development that contributes towards achieving service objectives. • The Strategic Planning Group has oversight of developing and monitoring the Strategic Plan, and the Locality Planning process, as well as enabling strategies to maintain a consistent strategic approach. SPG is chaired by the Vice Chair of the IJB and the IJB receives copies of the minute to keep Board members informed of its activity. • The IJB has established five locality planning review groups, reflecting the previously agreed local planning areas, and has an integrated approach with the Community Planning Partnership for Locality Planning in Arran. These provide Board Members, health and social care staff and local community representatives with the opportunity to be involved in considering and influencing priorities for each area. • A Transformation Board is in place, which recognises the significant change programme which is required to support delivery of the priorities within the new 2022-30 strategic plan. Terms of Reference are in place which detail the Board’s membership, duties, authority, reporting and governance. The Board meets monthly. The governance framework was in place during the period ended 31 March 2025. Review of effectiveness North Ayrshire IJB has responsibility for conducting, at least annually, a review of the effectiveness of its governance framework including the system of internal control. The review of the effectiveness of the framework is informed by the work of the Partnership Senior Management Team who have responsibility for development and maintenance of the governance environment, the annual report by the Chief Internal Auditor and reports from Audit Scotland and other review agencies. The Chief Internal Auditor reports directly to the IJB Performance and Audit Committee on all audit matters, with the right of access to the Chief Officer, Chief Finance Officer and Chair of the Performance and Audit Committee on any matter. In accordance with the principles of the code of corporate governance, regular reports were made to the IJB’s Performance and Audit Committee during 2024-2025. The Internal Audit function has independent responsibility for examining, evaluating and reporting on the adequacy of internal control. During 2024-2025, the Internal Audit team operated in accordance with the Public Sector Internal Audit Standards. The Chief Internal Auditor is responsible for forming an annual opinion on the adequacy and effectiveness of the systems of internal control. The approved IJB internal audit plan for 2024-2025 focussed on a review of the IJB’s arrangements in relation to Transformation, with the assignment concluding with reasonable assurance. It is the opinion of the Chief Internal Auditor that the systems of internal control relied upon by the IJB continue to provide reasonable assurance against loss. 129
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 38 System of internal financial control The governance framework described operates on the foundation of internal controls. The system of internal financial control is based on a framework of regular management information, financial regulations, administrative procedures (including segregation of duties), management supervision, and a system of delegation and accountability. Development and maintenance of these systems is supported by NHS Ayrshire and Arran and North Ayrshire Council in relation to the operational delivery of health and social care services. These systems include: • Financial regulations and codes of financial practice • Comprehensive budgeting systems • Regular reviews of periodic and annual financial reports that indicate financial performance against the forecasts • Setting targets to measure financial and other performance • Formal project management disciplines • A Transformation Board to provide further scrutiny of service re-design and financial delivery • An effective Internal Audit function The IJB’s financial management arrangements conform to the governance requirements of the CIPFA statement: ‘The Role of the Chief Finance Officer in Local Government (2016)’. The IJB complies with the CIPFA Financial Management Code. Through the counter fraud arrangements that are in place within NHS Ayrshire and Arran and North Ayrshire Council, the IJB conforms with the CIPFA ‘Code of Practice on Managing the Risks of Fraud and Corruption.’ During 2024-2025, the Head of Service (Finance and Transformation) led on improvement work to review and tighten controls across a number of areas in the HSCP. Developments during 2024-2025 The elements noted below incorporate progress with the further actions or developments identified in the 2024-2025 Annual Accounts. Medium-Term Financial Outlook (MTFO) A medium-term financial outlook was prepared covering the period 2025-2026 to 2026-2027 and presented to the IJB in March 2024. An MTFO update was provided to the IJB on 12 December 2024 and was included in the 2025-2026 budget paper which was approved by the Council on 26 February 2025. A full update report will therefore be presented to the IJB by September 2025, covering the period 2026-2027 to 2027-2028. Review of IJB key governance documents The IJB continues to review its key governance documents on a rolling basis. 130
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 39 Clinical and Care Governance Group (CCGG) Clinical and Care Governance is the system in which the HSCP is 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. The CCGG meets on a monthly to discuss and review a number of topics and an annual report was provided to the IJB in September 2024. Care Home and Care at Home Oversight Arrangements The HSCP stepped up oversight arrangements for Care Homes and Care at Home Services in North Ayrshire as part of the accountability and assurances sought by Scottish Government during the Covid pandemic; these forums have been invaluable to oversee the quality and sustainability of provision in North Ayrshire and as such both groups now remain part of the core governance structure. These multi-disciplinary groups are made up of key clinical and care professionals who have a lead role in the oversight of care and support services based in the North Ayrshire area. Carer’s Strategy 2023-2025 One of the responsibilities of the Carer’s (Scotland) Act 2016 is a duty for a local carer strategy and the establishment and maintenance of an information and advice service for carers resident or caring for someone in the local authority area. The Carer’s Strategy 2023-2025 “Building Caring Communities” was approved by the IJB in August 2023, with the priorities being taken forward with the new strategic partner, Unity Enterprise. Updates on the progress of the strategy were reported to the IJB in May and December 2024. Children’s Services Plan 2023-2026 The Children’s Services Plan 2023-2026 was approved by the IJB in June 2023, and builds on the progress made since the previous Children’s Services Plan 2020-2023. The Children’s Services Plan is aligned to the Children’s Poverty Strategy and Action Plan and Children’s Rights Report, together forming the suite of children’s services planning documents. The plan identifies five priorities in order to achieve the vision “For all our children and young people to have the best start in life and for North Ayrshire to be the best place in Scotland to grow up”. These priorities are: • The rights of children and young people are promoted and protected • Acting early to improve what happens next • Making Things Fairer • Promoting good mental health and wellbeing • Inspiring children and young people to be active. 131
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 40 A range of actions aligned to the Children’s Services Plan priorities are in place, with progress reporting against these actions provided in line with agreed timescales. The 2024-2025 performance report will be submitted to the IJB in June 2025. The Scottish Government recently undertook a review of the Plan against the statutory guidance and an individual feedback report received which provides assurance of the alignment of the plan with national statutory guidance, noting areas of strength and improvement. Equality Outcomes Plan 2022-2025 / Equality Mainstreaming and Outcomes Reporting Following the approval of the Equality Outcomes Plan 2022-25 by the IJB in March 2023, there is a specific duty within the Equality Act that the HSCP must publish a mainstreaming and outcomes report detailing how the HSCP has progressed against its Equality Outcomes. Reporting of Equality Mainstreaming and Outcomes commenced in May 2023 with the purpose of demonstrating how, as a public sector organisation, the HSCP will mainstream equality work into day-to-day practice. This reporting demonstrates positive progress towards the mainstreaming of the Public Sector Equality Duty (PSED) and the identified Equality Outcomes. A further Equality Mainstreaming and Outcomes report was presented to the IJB in May 2024. Transformation Plan 2024-2027 The HSCP Transformation Plan for 2024-2027 was approved by the IJB in March 2024. This is an ambitious programme of change which consists of a range of improvement and reform projects across all service areas, each aiming to improve the quality of service and contribute to the long- term sustainability of health and care in North Ayrshire. The Transformation Plan links closely to the high-level aspirations which are set out in the Strategic Plan and is mapped to one or more key drivers (savings/overspend reduction, investment, improving quality and safety, and national or local policy). The Transformation Plan will be overseen by the HSCP Transformation Board who will provide assurance on progress and effectiveness to the IJB. Updates on the Transformation Plan were reported to the IJB in September 2024 and February 2025. NAHSCP Learning & Development Strategy (Social Work & Social Care) 2023- 2028 “Be the Best You Can Be” The Learning & Development Strategy, which was approved by the IJB in October 2023, consolidates the HSCP Offer of development opportunities and the need to ensure the workforce feels valued and supported in meaningful ways. The strategy takes cognisance of current and ongoing workstreams and agendas in the HSCP. It also considers the professional and technical learning & development needs of the social work/care workforce operating within the HSCP. 132
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 41 The Key elements for consideration in implementing this strategy are: • Continuous Professional Learning (CPL) requirements of social work practitioners aligned to SSSC re -registration criteria • Known requirements related to care inspectorate inspections of services • Policy and procedural requirements/development and drivers relevant to social work practice both locally and nationally • Operational Service Plans • Service redesign, improvement, quality assurance and cultural activity. Membership of IJB There has been stability in the roles of Chair and Vice Chair throughout 2024-2025 and these positions will rotate in May 2025 per the IJB Standing Orders. The Chair and Vice Chair of the Performance and Audit Committee will also rotate in 2025. During 2024-2025, the following new members have been appointed to the IJB. • Councillor Tom Marshall replaced Councillor Timothy Billings following his resignation from the IJB. • Sharon Morrow has replaced Jean Ford as a new non-Executive NHS Ayrshire and Arran member of IJB and has also agreed to join the Performance and Audit Committee • Paul Smith has been appointed to the IJB as the Carer Representative and Barbara McNeice appointed as his deputy. Chief Officers Paul Doak left in January 2025 and Eleanor Currie was appointed Interim Chief Finance Officer pending the post being recruited to a permanent basis. Eleanor Currie was appointed to this post on a permanent basis on 23 June 2025. Annual Performance Report The IJB endorsed the Annual Performance Report for 2023-2024 at the meeting in August 2024. This report outlined the performance of the Health and Social Care Partnership and how it delivered against the strategic priorities and the national outcomes. Quarterly performance reports are published on the Partnership’s website once they have been reviewed by the Performance and Audit Committee. This supports a commitment to make more performance information accessible and available for public scrutiny. Workforce Planning and Engagement The HSCP published its current Workforce Plan (2022-25) in October 2022, in line with Scottish Government timescales. 133
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 42 The Workforce Plan focusses on the five pillars of workforce planning identified by the Scottish Government. From these, the HSCP identified our own local workforce priorities that map directly to the five pillars. They are: • Understanding our workforce (PLAN). • Promoting our organisation (ATTRACT). • Investing in our people (TRAIN). • Building our Workforce (EMPLOY). • Growing our people (NURTURE). The two-year progress report was presented to Performance and Audit Committee in January 2025, where positive progress against the 31 actions within the plan were noted. The annual iMatter Staff Experience survey took place in June 2024, providing all staff the opportunity to provide feedback on their experiences of working in the Health and Social Care Partnership. Overall iMatter seeks to measure how engaged staff are in the workplace. The response rate for the 2024 survey was 58% which is the lowest rate in the last 5 years, and a drop from the 65% response rate from the previous year. However, the HSCP reported an engagement index of 81, the same as the previous year when it was the highest ever score. Pan Ayrshire Integration Work The Head of Service (Finance and Transformation) of the North Ayrshire IJB chaired a working group which was re-established with a view to addressing some of the more significant work required by the proposals made in the Scottish Government Ministerial Steering Group (MSG) review of progress with integration. The working group includes representatives from NHS Ayrshire and Arran and the three Ayrshire IJBs: • Directions – directions have been implemented since the beginning of 2023-2024 for decisions made by the IJB which impact on the service delivery of the Health Board and/or the Council. • Joint commissioning plan and set aside budgets – work is being taken forward around the development of a joint commissioning plan by colleagues from NHS Ayrshire and Arran and the three Ayrshire HSCPs. Alongside this, Finance Leads have developed a set aside model to determine the cost of large hospital services which are being used by each of the HSCPs. In addition, work has commenced locally to review the Integration Scheme, in close liaison with the other Ayrshire HSCPs in order to remain consistent and support the Health Board in working with all IJBs. A number of workstreams have been established, overseen by a programme board which is co-chaired by the chief executives of NHS Ayrshire and Arran and East Ayrshire Council. 134
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 43 Further actions for 2025-2026 The IJB has identified the following actions for 2025-2026 that will assist with the further strengthening of corporate governance arrangements: • Develop commissioning plans and associated directions in relation to the acute set-aside resources. • Support the Local Authorities and NHS Board with the requirement for a Pan Ayrshire Review of the Integration Scheme(s). • Develop a Strategic Needs Assessment to inform the refresh of the Strategic Plan and ensure the HSCP has a renewed approach to addressing long-term challenges • Develop locality plans for each locality planning area to ensure a local community approach to identifying and addressing priorities. • Refresh the Partnership’s Participation and Engagement Strategy, identifying a programme of work that will ensure local people are able to participate in the planning and improvement of health and social care services. • Following the development of the MTFP for 2026-2027 onwards and the financial challenges anticipated, develop a robust approach to developing service plans and the transformation plan to ensure future financial and service sustainability. • Given the scale of the financial challenges and volatility of capacity and demand across services, further refine financial monitoring arrangements and ensure robust governance, reporting and development of financial recovery plans where required. • Embed health and care governance arrangements, ensuring robust arrangements in place across all areas of service with appropriate escalations through formal governance forums, ensuring these reflect the new Health and Care Staffing Act requirements. Assurance Subject to the above, and on the basis of the assurances provided, we consider the governance and internal control environment operating during 2024-2025 to provide reasonable and objective assurance that any significant risks impacting on the achievement of our actions will be identified and actions taken to avoid or mitigate their impact. Systems are in place to continually review and improve the governance and internal control environment and action plans are in place to address identified areas for improvement. The Annual Governance Statement explains how North Ayrshire IJB complies with the Code of Corporate Governance and meets the requirements of the CIPFA / SOLACE Framework ‘Delivering Good Governance in Local Government 2016’ and the ‘Code of Practice for Local Authority Accounting in the UK: A Statement of Recommended Practice’, in relation to the Statement on the System of Internal Financial Control. The Annual Governance Statement was approved by the IJB Performance and Audit Committee on 27 June 2025. Caroline Cameron, Chief Officer Joyce White, IJB Chair 135
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 44 Remuneration report This remuneration report is provided in accordance with the Local Authority Accounts (Scotland) Regulations 2014. It discloses information relating to the remuneration and pension benefits of specified IJB members and staff. The information in the tables below is subject to external audit. The explanatory text in the Remuneration Report is reviewed by the external auditor to ensure it is consistent with the financial statements. Remuneration: IJB Chair and Vice Chair The IJB comprises eight voting members appointed through nomination in equal numbers by NHS Ayrshire and Arran and North Ayrshire Council. A Chair and Vice Chair are appointed in accordance with the Integration Scheme and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. As required in Article 4 of the Order the nomination of the IJB Chair and Vice Chair post holders alternates between a Council and Health Board representative, with the Vice Chair appointment by the constituent authority which did not appoint the Chair. The IJB does not provide any additional remuneration to the Chair, Vice Chair or any other board members relating to their role on the IJB. The IJB does not reimburse the relevant partner organisations for any voting board member costs borne by the partner. There were no taxable expenses paid by the IJB. Therefore, no remuneration disclosures are provided for the Chair or Vice Chair. The IJB does not have responsibilities, either in the current year or in future years, for funding any pension entitlements of voting IJB members. Therefore, no pension rights disclosures are provided for the Chair or Vice Chair. Remuneration: Senior Officers of the IJB The IJB does not directly employ any staff in its own right, however specific post-holding officers are non-voting members of the Integration Joint Board. Chief Officer and Chief Finance Officer The appointment of an Integration Joint Board Chief Officer is required by section 10 of the Public Bodies (Joint Working) (Scotland) Act 2014 which includes the statement “an Integration Joint Board is to appoint, as a member of staff, a chief officer”. The Chief Officer for the IJB has to be appointed and the employing partner has to formally second the officer to the IJB. The employment contract for the Chief Officer adheres to the legislative and regulatory framework of the employing partner organisation. The remuneration terms of the Chief Officer’s employment are approved by the IJB. As the IJB is constituted as a Local Government body as set out by Section 106 of the Local Government (Scotland) Act 1973, it also requires to appoint an officer responsible for the proper administration of its financial affairs, the Chief Finance Officer (Section 95 Officer). 136
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 45 Other Officers No other staff are appointed by the IJB under a similar legal regime. Non-voting board members who meet the criteria for disclosure are included in the tables below. 2023-2024 Total Remuneration £ Name and Post Title 2024-2025 Salary, fees and allowances £ 2024-2025 Taxable Expenses £ 2024-2025 Total Remuneration £ 129,076 Caroline Cameron, Chief Officer 1 April 2024 to 31 March 2025 Employing organisation: North Ayrshire Council 133,720 0 133,720 99,067 Paul Doak Chief Finance Officer 1 April 2024 to 19 January 2025 Employing organisation: North Ayrshire Council 81,807 0 81,807 0 Eleanor Currie Interim Chief Finance Officer 6 January 2025 to 31 March 2025 Employing organisation: North Ayrshire Council 21,814 0 21,814 *The full year equivalent salaries are given in the table below. Name and post title 2024-2025 Full Year Salary £ Paul Doak, Chief Finance Officer, 1 April 2024 to 19 January 2025 102,630 Eleanor Currie, Interim Chief Finance Officer, 6 January to 31 March 2025 (salary and responsibility allowance) 80,827 In respect of officers’ pension benefits the statutory liability for any future contributions to be made rests with the relevant employing partner organisation. On this basis there is no pensions liability reflected on the IJB balance sheet for the Chief Officer or any other officers. The IJB however has responsibility for funding the employer contributions for the current period in respect of the officer time spent on fulfilling the responsibilities of their role on the IJB. The following table shows the IJB’s funding during the period to support officers’ pension benefits. The table also shows the total value of accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions. 137
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 46 In Period pension contributions Officer 2023-2024 (£) 2024-2025 (£) Caroline Cameron, Chief Officer 24,493 7,777 Paul Doak, Chief Finance Officer 19,120 5,317 Eleanor Currie, Interim Chief Finance Officer 0 1,314 Accrued pension benefits Officer Type of benefit 2023-2024 (£) 2024-2025 (£) Caroline Cameron, Chief Officer Pension 13,727 17,065 Caroline Cameron, Chief Officer Lump Sum 0 0 Paul Doak, Chief Finance Officer Pension 47,661 46,079 Paul Doak, Chief Finance Officer Lump Sum 69,717 71,734 Eleanor Currie, Interim Chief Finance Officer Pension 0 40,319 Eleanor Currie, Interim Chief Finance Officer Lump Sum 0 45,392 Disclosure by pay bands As required by the regulations, the following table shows the number of persons whose remuneration for the period was £50,000 or above, in bands of £5,000. Number of employees in band 2023-2024 Remuneration band Number of employees in band 2024-2025 0 £130,000 to £134,999 1 1 £125,000 to £129,999 0 1 £95,000 to £99,999 0 0 £90,000 to £94,999 0 0 £80,000 to £84,999 1 Exit packages There were no exit packages during 2023-2024 or 2024-2025. Caroline Cameron, Chief Officer Joyce White, IJB Chair 138
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 47 Financial statements The Comprehensive Income and Expenditure Statement shows the cost of providing services for the period according to accepted accounting practices. 2023-2024 Gross Exp £000 2023-2024 Gross Income £000 2023-2024 Net Exp £000 Area of Service 2024-2025 Gross Exp £000 2024- 2025 Gross Income £000 2024- 2025 Net Exp £000 97,275 0 97,275 Community Care and Health 98,181 0 98,181 35,764 0 35,764 Mental Health 38,208 0 38,208 44,318 0 44,318 Children’s Services and Criminal Justice 45,634 0 45,634 52,863 0 52,863 Primary Care 53,662 0 53,662 12,849 0 12,849 Management and Support Costs 13,365 0 13,365 1,236 0 1,236 Change Programme 0 10,098 0 10,098 Allied Health Professionals 10,749 0 10,749 108,607 0 108,607 Lead Partnership and Set Aside 120,555 0 120,555 1,317 0 1,317 Chief Social Work Officer 1,725 0 1,725 364,327 0 364,327 Cost of Services 382,079 0 382,079 0 (124,933) (124,933) North Ayrshire Council Funding 0 (135,243) (135,243) 0 (228,176) (228,176) NHS Ayrshire and Arran Funding 0 (244,487) (244,487) 0 (353,109) (353,109) Total Taxation And Non- Specific Grant Income (note 5) 0 (379,730) (379,730) 364,327 (353,109) 11,218 (Surplus) or Deficit on Provision of Services 382,079 (379,730) 2,349 There are no statutory or presentation adjustments which affect the IJB’s application of the funding received from partners. The movement in the General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently, an Expenditure and Funding Analysis is not provided in these annual financial statements. 139
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 48 The Movement in Reserves Statement shows the movement in the period on the reserves held by the IJB. The movements which arise due to statutory adjustments which affect the General Fund balance are separately identified from the movements due to accounting practices. In 2024- 2025 there were no statutory adjustments. Note 8 to the accounts provides more detail on the movement in reserves. Total Reserves 2023-2024 Movement in reserves General Fund – Debt to NAC 2024-2025 General Fund 2024- 2025 Earmarked Reserves 2024-2025 Total Reserves 2024-2025 16,728 Opening balance as at 1 April 0 357 5,153 5,510 (11,218) Total Comprehensive Income and Expenditure 0 (357) (1,992) (2,349) 0 Adjustments between accounting basis and funding basis under regulations 0 0 0 0 (11,218) Increase\ (Decrease) in period 0 (357) (1,992) (2,349) 5,510 Closing Balance as at 31 March 0 0 3,161 3,161 The Balance Sheet shows the value of the IJB’s assets and liabilities as at the balance sheet date. The net assets of the IJB (assets less liabilities) are matched by the reserves held by the IJB. 31 March 2024 £000 Balance Sheet Description Notes 31 March 2025 £000 5,510 Short Term Debtors 6 3,161 0 Long Term Creditors 7 0 5,510 Net Assets Not applicable 3,161 5,510 Usable Reserve: General Fund 8 3,161 5,510 Total Reserves Not applicable 3,161 The Statement of Accounts present a true and fair view of the financial position of the Integration Joint Board as at 31 March 2025 and its income and expenditure for the period then ended. The unaudited financial statements were authorised for issue on 27 June 2025. Eleanor Currie CPFA, Chief Finance Officer 140
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 49 Notes to the financial statements Note 1 – Significant Accounting Policies General principles The Financial Statements summarise the authority’s transactions for the 2024-2025 financial period and its position at the period-end as at 31 March 2025. The North Ayrshire IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. The Financial Statements are therefore prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2024-2025, supported by International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment. The accounts are prepared on the going concern basis, which provides that the entity will continue in operational existence for a minimum of 12 months from the date of these accounts. In accordance with the Code, the going concern concept will apply as there is the assumed continuation of service provision into the future. The historical cost convention has been adopted. Accruals of expenditure and income Activity is accounted for in the period that it takes place, not simply when cash payments are made or received. In particular: • Expenditure is recognised when goods or services are received, and their benefits are used by the IJB. • Income is recognised when the IJB has a right to the income, for instance by meeting any terms and conditions required to earn the income, and receipt of the income is probable. • Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the Balance Sheet. • Where debts may not be received, the balance of debtors is written down. For the Integration Joint Board financial statements, a debtor and/or creditor will be recorded where the partner contributions differ from the actual net expenditure in period, this allows any surplus or deficit on the provision of services to be transferred to the reserves held by the Integration Joint Board. Funding The IJB is primarily funded through contributions from the statutory funding partners, North Ayrshire Council and NHS Ayrshire and Arran. Expenditure is incurred as the IJB commissions specified health and social care services from the funding partners for the benefit of service recipients in North Ayrshire. 141
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 50 Cash and cash equivalents The IJB does not operate a bank account or hold cash. Transactions are settled on behalf of the IJB by the funding partners. Consequently, the IJB does not present a ‘Cash and Cash Equivalent’ figure on the balance sheet. The funding balance due to or from each funding partner as at 31 March is represented as a debtor or creditor on the IJB’s Balance Sheet. Employee benefits The IJB does not directly employ staff. Staff are employed by the funding partners who retain the liability for pension benefits payable in the future. The IJB therefore does not present a Pensions Liability on its Balance Sheet. The IJB has a legal responsibility to appoint a Chief Officer and a Chief Finance Officer. More details on the arrangements are provided in the Remuneration Report. The charges from the employing partner are treated as employee costs. Where material the Chief Officer’s and Chief Finance Officer’s absence entitlement at 31 March is accrued, for example in relation to annual leave earned but not yet taken. Provisions, Contingent Liabilities and Contingent Assets Provisions are liabilities of uncertain timing or amount. A provision is recognised as a liability on the balance sheet when there is an obligation as at 31 March due to a past event; settlement of the obligation is probable; and a reliable estimate of the amount can be made. Recognition of a provision will result in expenditure being charged to the Comprehensive Income and Expenditure Statement and will normally be a charge to the General Fund. A contingent liability is a possible liability arising from events on or before 31 March, whose existence will only be confirmed by later events. A provision that cannot be reasonably estimated, or where settlement is not probable, is treated as a contingent liability. A contingent liability is not recognised in the IJB’s Balance Sheet but is disclosed in a note where it is material. A contingent asset is a possible asset arising from events on or before 31 March, whose existence will only be confirmed by later events. A contingent asset is not recognised in the IJB’s Balance Sheet but is disclosed in a note only if it is probable to arise and can be reliably measured. Reserves The Integration Joint Board’s reserves are classified as either Usable or Unusable Reserves. The IJB’s only Usable Reserve is the General Fund. The balance of the General Fund as at 31 March shows the extent of resources which the IJB can use in later years to support service provision. Indemnity insurance The IJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding Board member and officer responsibilities. NHS Ayrshire and Arran and North Ayrshire Council have responsibility for claims in respect of the services that they are statutorily responsible for and that they provide. Unlike NHS Ayrshire and Arran, the IJB does not have any ‘shared risk’ exposure from participation in CNORIS (Clinical Negligence and Other Risks Indemnity Scheme). The IJB participation in the CNORIS scheme is therefore equivalent to normal insurance arrangements. 142
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 51 Known claims are assessed as to the value and probability of settlement. Where it is material the overall expected value of known claims taking probability of settlement into consideration, is provided for in the IJB’s Balance Sheet. The likelihood of receipt of an insurance settlement to cover any claims is separately assessed and, where material, presented as either a debtor or disclosed as a contingent asset. VAT Status The IJB is a non-taxable body and does not charge or recover VAT on its functions. Note 2 – Critical Judgements and Estimation Uncertainty The critical judgements include: • On behalf of all IJBs within the NHS Ayrshire and Arran area, the IJB acts as the lead partner for Mental Health Services. It commissions services on behalf of the three Ayrshire IJBs and reclaims the costs involved. This arrangement is treated as an agency arrangement. In the absence of an alternative agreement or approach being outlined in the Integration Scheme, the recharges across the partnerships for lead services are based on an NRAC share of costs, this may not reflect the actual cost of delivering services to the population in the three areas. • In applying the accounting policies, the IJB has had to make a critical judgement relating to the values included for Set Aside services. The Set Aside figure included in the IJB accounts is the baseline of 2023-2024 bed days at 2024-2025 prices as the 2024-2025 actual usage is not known until after the date of accounts signing. As such, the Set Aside sum included in the accounts will not reflect the true cost of actual hospital usage in 2024-2025. There are no material estimation uncertainties included within the Financial Statements. Note 3 – Events after the Reporting Period The audited annual financial statements will be authorised for issue by the Chief Finance Officer on 25 September 2025. Events taking place after this date are not reflected in the financial statements or notes. Events after the Balance Sheet date are those events, both favourable and unfavourable, that occur between the end of the reporting period and the date when the Annual Accounts are authorised for issue. Two types of events can be identified: • Those that provide evidence of conditions that existed at the end of the reporting period - the financial statements are adjusted to reflect such events. • Those that are indicative of conditions that arose after the reporting period – the financial statements are not adjusted to reflect for such events, but where a category of events would have a material impact disclosure is made in the notes of the nature of the events and their estimated financial effect. There are no such events to report for 2024-2025. 143
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 52 Note 4 – Expenditure and Income Analysis by Nature 2023-2024 £000s Description 2024-2025 £000s 158,982 Services commissioned from North Ayrshire Council 163,908 205,312 Services commissioned from NHS Ayrshire and Arran 218,137 33 Auditor Fee: External Audit Work 34 (353,109) Partners Funding Contributions and Non-Specific Grant Income (379,730) 11,218 (Surplus) / deficit on the Provision of Services 2,349 Note 5 - Taxation and Non-Specific Grant Income 2023-2024 £000’s Description 2024-2025 £000’s (124,933) Funding Contribution from North Ayrshire Council (135,243) (228,176) Funding Contribution from NHS Ayrshire and Arran (244,487) (353,109) Taxation and Non-specific Grant Income (379,730) The funding contributions from the partners shown above exclude any funding which is ring-fenced for the provision of specific services. Such ring-fenced funding is presented as income in the Cost of Services in the Comprehensive Income and Expenditure Statement. There was no ring-fenced funding in 2023-2024 or 2024-2025. The funding contribution from NHS Ayrshire and Arran shown above includes £39.966m (2023- 2024 £35.008m) in respect of ‘set aside’ resources relating to acute hospital and other resources. These are provided by the NHS which retains responsibility for managing the costs of providing the services. The IJB however has responsibility for the consumption of, and level of demand placed on, these resources. Note 6 – Debtors 31 March 2024 £000’s Description 31 March 2025 £000’s 5,363 North Ayrshire Council 3,161 147 NHS Ayrshire and Arran 0 5,510 Total Debtors 3,161 Amounts due from to the funding partners are stated on a net basis. Debtor and Creditor balances recognised by the funding partners but not yet settled in cash terms are offset against the funds they are holding on behalf of the Integration Joint Board. 144
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 53 Note 7 – Creditors 31 March 2024 £000’s Description 31 March 2025 £000’s 0 North Ayrshire Council 0 0 NHS Ayrshire and Arran 0 0 Total Creditors 0 Amounts owed to the funding partners are stated on a net basis. Debtor and Creditor balances recognised by the funding partners but not yet settled in cash terms are offset against the funds they are holding on behalf of the Integration Joint Board. This position is summarised below: Funding Partner (Surplus) or Deficit on provision of services £000’s Movement in Reserves £000’s Uncommitted Surplus (funds which are not earmarked for specific purposes) £000’s North Ayrshire Council 2,465 (2,465) 0 NHS Ayrshire and Arran (116) 116 0 Total 2,349 (2,349) 0 Note 8 – Usable Reserve: General Fund The IJB holds a balance on the General Fund which will normally comprise one of three elements: • As a working balance to help cushion the impact of uneven cash flows. • As a contingency to manage the impact of unexpected events or emergencies. • As a means of building up funds, often referred to as earmarked reserve, to meet known or predicted liabilities. The table below shows the movements on the General Fund balance, analysed between those elements earmarked for specific planned expenditure and the amount held in unallocated reserves. The ‘free’ general fund balance is £0.000m which is below the target level of a contingency reserve of between 2% and 4%. 145
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 54 It is acknowledged that uncommitted reserves require to be restored to the minimum recommended level. However, in the short-term, service pressures mean that this would not be achievable without implementing further reductions in service delivery that would impact on the levels of care provided and increase the levels of risk for service users. Transfers Out 2023- 2024 Transfers In 2023- 2024 Balance at 31 March 2024 Area of Reserves Transfers Out 2024- 2025 Transfers In 2024- 2025 Balance at 31 March 2025 0 0 0 Earmarked Funds 0 0 0 (715) 641 641 Alcohol & Drug Partnership (641) 353 353 (125) 57 57 Mental Health Action 15 (57) 135 135 157 0 0 Primary Care Improvement Fund 0 46 46 (445) 0 1,774 Service Redesign / Challenge Fund (994) 0 780 (136) 0 377 Community Living Change Fund (377) 0 0 (76) 0 0 Covid19 Funding 0 0 0 (71) 0 0 NAC Recovery and Renewal – Mental Health Element 0 0 0 (300) 0 0 West Road 0 0 0 (1,065) 0 0 Care at Home Capacity 0 0 0 (584) 0 0 Interim Care 0 0 0 (50) 0 0 Trauma Training 0 0 0 (804) 1,313 1,313 Family Wellbeing Fund (1,313) 934 934 (34) 0 0 Perinatal MH Nurse 0 0 0 0 50 50 Wellbeing Fund (50) 0 0 (644) 0 0 Multi-Disciplinary Teams 0 0 0 0 26 26 Breast Feeding Network (26) 36 36 (1,170) 546 546 MH Recovery and Renewal (546) 365 365 (168) 23 23 Buvidal (23) 0 0 0 0 0 LD – Coming Home 0 82 82 0 0 0 Early Intervention in Psychosis 0 92 92 0 5 5 Brooksby (5) 0 0 0 0 0 Donation – Police Scotland 0 1 1 (18) 4 4 Cossette Funding (4) 0 0 (55) 55 55 Expansion of Primary Care Estates (55) 0 0 (71) 63 63 GP Premises Improvements - tranches 1 and 2 (63) 3 3 (80) 81 81 Mental Health Wellbeing in Primary Care (81) 0 0 0 0 0 Primary Care Improvement Fund 0 303 303 (101) 29 29 Dental Practice Improvement (29) 29 29 (13) 0 0 Childsmile 0 0 0 0 2 2 Appropriate Adult Scheme (2) 2 2 146
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 55 Transfers Out 2023- 2024 Transfers In 2023- 2024 Balance at 31 March 2024 Area of Reserves Transfers Out 2024- 2025 Transfers In 2024- 2025 Balance at 31 March 2025 0 19 19 Adult Tier 3 Weight Management Service (19) 0 0 0 22 22 Phlebotomy (22) 0 0 (42) 0 0 Dental Winter Preparedness 0 0 0 (126) 46 66 LD Health Checks (66) 0 0 (2,000) 0 0 2023-2024 Budget Support 0 0 0 (8,736) 2,982 5,153 Total Earmarked (4,373) 2,381 3,161 0 0 0 Outstanding Debt 0 0 0 (5,464) - 357 Unallocated General Fund (357) 0 0 (14,200) 2,982 5,510 General Fund (4,730) 2,381 3,161 Note 9 – Agency Income and Expenditure On behalf of all IJBs within the NHS Ayrshire and Arran area, the IJB acts as the lead manager for Mental Health Services. It commissions services on behalf of the other IJBs and reclaims the costs involved. The payments that are made on behalf of the other IJBs, and the consequential reimbursement, are not included in the Comprehensive Income and Expenditure Statement (CIES) since the IJB is not acting as principal in these transactions. The amount of expenditure and income relating to the agency arrangement is shown below. 2023-2024 £000 Description 2024-2025 £000 39,490 Expenditure on Agency Service – Lead Partnership 43,932 0 Expenditure on PPE and Test Kits from National Services Scotland 0 39,490 Total agency expenditure 43,932 (39,490) Reimbursement for Agency Service – Lead Partnership 43,932 0 Reimbursement for PPE from National Services Scotland 0 (39,490) Total agency income 43,932 0 Net Agency Expenditure Excluded from the CIES 0 147
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 56 Note 10 – Related Party Transactions The IJB has related party relationships with NHS Ayrshire and Arran and North Ayrshire Council. In particular the nature of the partnership means that the IJB may influence, and be influenced by, its partners. The following transactions and balances included in the IJB’s financial statements are presented to provide additional information on the relationships. Transactions with NHS Ayrshire and Arran 2023-2024 £000 Transactions with NHS Ayrshire and Arran 2024-2025 £000 (228,176) Funding Contributions received from NHS Board (244,487) 0 Service Income received from NHS Board 0 205,264 Expenditure on Services Provided by NHS Board 218,087 65 Key Management Personnel: Non-Voting Board Members 67 0 Support Services 0 (22,847) Net Transactions with NHS Board (26,333) Balances with NHS Ayrshire and Arran 31 March 2024 £000 Balances with NHS Ayrshire and Arran 31 March 2025 £000 147 Debtor Balances: Amounts due from NHS Board 0 0 Creditor Balances: Amounts due to NHS Board 0 147 Net Balances with NHS Board 0 148
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 57 Transactions with North Ayrshire Council 2023-2024 £000 Transactions with North Ayrshire Council 2024-2025 £000 (124,933) Funding Contributions received from the Council (135,243) 0 Service Income received from the Council 0 158,934 Expenditure on Services Provided by the Council 163,858 64 Key Management Personnel: Non-Voting Board Members 67 0 Support Services 0 34,065 Net Transactions with the Council 28,682 Balances with North Ayrshire Council 31 March 2024 £000 Balances with North Ayrshire Council 31 March 2025 £000 5,363 Debtor Balances: Amounts due from the Council 3,161 0 Creditor Balances: Amounts due to the Council 0 5,363 Net Balances with the Council 3,161 There are key management personnel employed by NHS Ayrshire and Arran and North Ayrshire Council; these costs are included in the expenditure on services provided. The non-voting Board members employed by the Council and Health Board include the Chief Officer, Chief Finance Officer, Chief Social Work Officer, representatives of primary care, nursing and non-primary care services, and a staff representative. Details of the remuneration for some specific post-holders is provided in the Remuneration Report. Support services were not delegated to the Integration Joint Board through the Integration Scheme and are instead provided by NHS Ayrshire and Arran and North Ayrshire Council free of charge as ‘services in kind.’ These include services such as financial management, human resources, legal services, committee services, ICT, payroll, internal audit and accommodation. 149
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 58 Note 11 – VAT VAT payable is included as an expense only to the extent that it is not recoverable from Her Majesty’s Revenue and Customs. VAT receivable is excluded from income. The VAT treatment of expenditure in the IJB’s financial statements depends on which of the partner agencies is providing the service as these agencies are treated differently for VAT purposes. Where the Council is the provider, income and expenditure excludes any amounts related to VAT, as all VAT collected is payable to H.M. Revenue and Customs and all VAT paid is recoverable from it. The Council is not entitled to fully recover VAT paid on a very limited number of items of expenditure and for these items the cost of VAT paid is included within service expenditure to the extent that it is irrecoverable from H.M. Revenue and Customs. Where the NHS is the provider, expenditure incurred will include irrecoverable VAT as generally the NHS cannot recover VAT paid as input tax and will seek to recover its full cost as income from the Commissioning IJB. Note 12 – Accounting Standards Issued Not Yet Adopted The Code requires the disclosure of information about accounting changes that will be required by new accounting standards that have been issued, but not yet adopted. At the date of authorisation of these financial statements, the IJB has not applied the following new and revised IFRS Standards that have been issued, but are not yet effective: • IAS 21 The Effects of Changes in Foreign Exchange Rate (Lack of Exchangeability) issued in August 2023. The amendments clarify how an entity should assess whether a currency is exchangeable and how it should determine a spot exchange rate when exchangeability is lacking, as well as require the disclosure of information that enables users of financial statements to understand the impact of a currency not being exchangeable. • IFRS 17 Insurance Contracts issued in May 2017. This replaces IFRS4 and sets out principles for recognition, measurement, presentation and disclosure of insurance contracts. • The Changes to the Measurement of Non-Investment Assets include adaptations and interpretations of IAS 16 Property, Plant and Equipment and IAS 38 Intangible Assets. These include setting out three revaluation processes for operational property, plant and equipment, requiring indexation for tangible non-investment assets and a requirement to value intangible assets using the historical cost approach Adoption of the Standards listed above will not impact on the 2024-2025 Annual Accounts and it is not anticipated that the adoption of the applicable Standards will have a material impact on the financial statements in future periods. 150
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 59 Glossary of Terms While the terminology used in this report is intended to be self-explanatory, it may be useful to provide additional definition and interpretation of the terms used. Accounting Period The period of time covered by the Accounts normally a period of twelve months commencing on 1 April each year. The end of the accounting period is the Balance Sheet date. Accruals The concept that income and expenditure are recognised as they are earned or incurred not as money is received or paid. Balance Sheet A statement of the recorded assets, liabilities and other balances at the end of the accounting period. CIPFA The Chartered Institute of Public Finance and Accountancy. Consistency The concept that the accounting treatment of like terms within an accounting period and from one period to the next is the same. CNORIS The Clinical Negligence and Other Risks Indemnity Scheme COSLA Convention of Scottish Local Authorities Creditor Amounts owed by the IJB for work done, goods received or services rendered within the accounting period, but for which payment has not been made by the end of that accounting period. Debtor Amount owed to the IJB for works done, goods received, or services rendered within the accounting period, but for which payment has not been received by the end of that accounting period. 151
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 60 Entity A body corporate, partnership, trust, unincorporated association or statutory body that is delivering a service or carrying on a trade or business with or without a view to profit. It should have a separate legal personality and is legally required to prepare its own single entity accounts. IFRS International Financial Reporting Standards. ISA International Standard on Auditing ISD Information Services Division Scotland LASAAC Local Authority (Scotland) Accounts Advisory Committee Liability A liability is where the IJB owes payment to an individual or another organisation. A current liability is an amount which will become payable or could be called in within the next accounting period e.g. creditors or cash overdrawn. A non-current liability is an amount which by arrangement is payable beyond the next year at some point in the future or will be paid off by an annual sum over a period of time. NRAC NHS Scotland Resource Allocation Committee (Scottish NHS resource allocation formula) Post Balance Sheet Events Post Balance Sheet events are those events, favourable or unfavourable, that occur between the Balance Sheet date and the date when the Annual Accounts are authorised for issue. Provisions An amount put aside in the accounts for future liabilities or losses which are certain or very likely to occur but the amounts or dates of when they will arise are uncertain. Related Parties Bodies or individuals that have the potential to control or influence the IJB or to be controlled or influenced by the IJB. For the IJB’s purposes, related parties are deemed to include voting members, the Chief Officer and their close family and household members. 152
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 61 Remuneration All sums paid to or receivable by an employee and sums due by way of expenses allowances (as far as these sums are chargeable to UK income tax) and the monetary value of any other benefits received other than in cash. Reserves The accumulation of surpluses, deficits and appropriation over past years. Reserves of a revenue nature are available and can be spent or earmarked at the discretion of the IJB. Revenue Expenditure The day-to-day expenses of providing services. Significant Interest The reporting authority is actively involved and is influential in the direction of an entity through its participation in policy decisions. 153
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 62 Independent Auditor’s Report Independent auditor’s report to the members of North Ayrshire Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of North Ayrshire Integration Joint Board for the year ended 31 March 2025 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet, and notes to the financial statements, including material accounting policy information. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25 (the 2024/25 Code). In my opinion the accompanying financial statements: • give a true and fair view of the state of affairs of the body as at 31 March 2025 and of its income and expenditure for the year then ended; • have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2024/25 Code; and • have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I was appointed by the Accounts Commission on 3 April 2023. My period of appointment is five years, covering 2022/23 to 2026/27. I am independent of the body in accordance with the ethical requirements that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to the body. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion. Conclusions relating to going concern basis of accounting I have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work I have performed, I have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the body’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. 154
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 63 These conclusions are not intended to, nor do they, provide assurance on the body’s current or future financial sustainability. However, I report on the body’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement I report in my Annual Audit Report the most significant assessed risks of material misstatement that I identified and my judgements thereon. Responsibilities of the Chief Financial Officer and North Ayrshire Integration Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Financial Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Financial Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Financial Officer is responsible for assessing the body’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue the body’s operations. The North Ayrshire Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. I design procedures in line with my responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: • using my understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of the body; • inquiring of the Chief Financial Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of the body; • inquiring of the Chief Financial Officer concerning the body’s policies and procedures regarding compliance with the applicable legal and regulatory framework; • discussions among my audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and 155
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 64 • considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which my procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of the body’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report. Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report I have audited the parts of the Remuneration Report described as audited. In my opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Chief Financial Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. My responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In my opinion, based on the work undertaken in the course of the audit: • the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with 156
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 65 statutory guidance issued under the Local Government in Scotland Act 2003; and • the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion: • adequate accounting records have not been kept; or • the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or • I have not received all the information and explanations I require for my audit. I have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to my responsibilities for the annual accounts, my conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in my Annual Audit Report. Use of my report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. Fiona Mitchell-Knight FCA Audit Director Audit Scotland 4th Floor, The Athenaeum Building 8 Nelson Mandela Place Glasgow, G2 1BT 157
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North Ayrshire Integrated Joint Board Unaudited Annual Accounts to 31st March 2025 66 This document is available in other formats such as audio tape, CDF, braille and in large print. It can also be made available in other languages on request. All of our publications are available in different languages, larger print, braille (English only), audio tape or another format of your choice. Comments or questions about this document, including request for support information or documentation, should be made by email to annualaccountsNAHSCP@north-ayrshire.co.uk Follow us on Twitter @NAHSCP For more information, visit the North Ayrshire Health and Social Care Partnership website. 158
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8 Nelson Mandela Place Glasgow G2 1BT T: 0131 625 1500 E: info@audit-scotland.gov.uk www.audit-scotland.gov.uk 25 September 2025 North Ayrshire Integration Joint Board Audit of 2024/25 Annual Accounts Independent auditor's report 1. Our audit work on the 2024/25 Annual Accounts is now substantially complete. Subject to receipt of a revised set of Annual Accounts for final review, we anticipate being able to issue unqualified and unmodified audit opinions in the independent auditor's report following approval of the annual accounts by the IJB on xx September 2025 (the proposed report is attached at appendix A). Annual audit report 2. We also present for your consideration our proposed Annual Audit Report on the 2024/25 audit. International Standard on Auditing (ISA) 260 (Communication with those charged with governance) requires auditors to report specific matters arising from the audit of the Annual Accounts to those charged with governance, in sufficient time to enable appropriate action. 3. The Annual Audit Report will be issued in its final form after the Annual Accounts have been approved for issue and the independent auditor’s report has been signed. 4. The Annual Audit Report also sets out conclusions from our consideration of the four audit dimensions that frame the wider scope of public audit as set out in the Code of Audit Practice. Unadjusted misstatements 5. There are no unadjusted misstatements. Fraud, subsequent events and compliance with laws and regulations 6. In presenting this report to the IJB we seek confirmation from those charged with governance of any instances of any actual, suspected, or alleged fraud; any subsequent events that have occurred since the date of the financial statements; or material non-compliance with laws and regulations affecting the entity that should be brought to our attention. Representations from management 7. As part of the completion of our audit, we are seeking written representations from the Chief Financial Officer, as the “proper officer” appointed by virtue of section 95 of the Local Government Scotland Act 1973, on aspects of the Annual Accounts, including the judgements and estimates made. 8. A draft letter of representation is attached at appendix B. This should be reviewed for accuracy and any proposed amendments discussed with us. Once satisfied, the letter should be signed and returned by the Chief Financial Officer with the signed Annual Accounts. 159
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Concluding remarks 9. I take this opportunity to record my thanks for the patient and courteous assistance extended to the audit team. The Chief Financial Officer provided good support to the audit team which helped to ensure that the audit process ran smoothly. Fiona Mitchell-Knight FCA Audit Director Audit Scotland 4th Floor, The Athenaeum Building 8 Nelson Mandela Place Glasgow, G2 1BT 160
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Appendix A: Proposed Independent Auditor’s Report Independent auditor’s report to the members of North Ayrshire Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of North Ayrshire Integration Joint Board for the year ended 31 March 2025 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet, and notes to the financial statements, including material accounting policy information. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25 (the 2024/25 Code). In my opinion the accompanying financial statements: • give a true and fair view of the state of affairs of the body as at 31 March 2025 and of its income and expenditure for the year then ended; • have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2024/25 Code; and • have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I was appointed by the Accounts Commission on 3 April 2023. My period of appointment is five years, covering 2022/23 to 2026/27. I am independent of the body in accordance with the ethical requirements that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to the body. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion. Conclusions relating to going concern basis of accounting I have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work I have performed, I have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the body’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. 161
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These conclusions are not intended to, nor do they, provide assurance on the body’s current or future financial sustainability. However, I report on the body’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement I report in my Annual Audit Report the most significant assessed risks of material misstatement that I identified and my judgements thereon. Responsibilities of the Chief Financial Officer and North Ayrshire Integration Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Financial Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Financial Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Financial Officer is responsible for assessing the body’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue the body’s operations. The North Ayrshire Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. I design procedures in line with my responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: • using my understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of the body; • inquiring of the Chief Financial Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of the body; • inquiring of the Chief Financial Officer concerning the body’s policies and procedures regarding compliance with the applicable legal and regulatory framework; • discussions among my audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and 162
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• considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which my procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of the body’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report. Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report I have audited the parts of the Remuneration Report described as audited. In my opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Chief Financial Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. My responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In my opinion, based on the work undertaken in the course of the audit: • the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and 163
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• the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion: • adequate accounting records have not been kept; or • the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or • I have not received all the information and explanations I require for my audit. I have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to my responsibilities for the annual accounts, my conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in my Annual Audit Report. Use of my report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. Fiona Mitchell-Knight FCA Audit Director Audit Scotland 4th Floor, The Athenaeum Building 8 Nelson Mandela Place Glasgow, G2 1BT 164
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Appendix B: Letter of Representation (ISA 580) Fiona Mitchell-Knight Audit Director Audit Scotland 4th Floor, North Suite The Athenaeum Building 8 Nelson Mandela Place Glasgow G2 1BT Dear Fiona, North Ayrshire Integration Joint Board Annual Accounts 2024/25 1. This representation letter is provided in connection with your audit of the Annual Accounts of North Ayrshire Integration Joint Board for the year ended 31 March 2025 for the purpose of expressing an opinion as to whether the financial statements give a true and fair view in accordance with the financial reporting framework, and for expressing other opinions on the Remuneration Report, Management Commentary and Annual Governance Statement. 2. I confirm to the best of my knowledge and belief and having made appropriate enquiries of the North Ayrshire Integration Joint Board, North Ayrshire Council and NHS Ayrshire and Arran, the following representations given to you in connection with your audit of North Ayrshire Integration Joint Board’s Annual Accounts for the year ended 31 March 2025. 3. I acknowledge my responsibility and that of North Ayrshire Integration Joint Board for the Annual Accounts. All the accounting records, documentation and other matters which I am aware are relevant to the preparation of the annual accounts have been made available to you for the purposes of your audit, including minutes of all management and other meetings. All transactions undertaken by North Ayrshire Integration Joint Board have been recorded in the accounting records and are properly reflected in the financial statements. Financial reporting framework 4. The Annual Accounts have been prepared in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25 (2024/25 accounting code) the requirements of the Local Government (Scotland) Act 1973, the Local Government in Scotland Act 2003 and The Local Authority Accounts (Scotland) Regulations 2014. 5. Disclosure has been made in the financial statements of all matters necessary for them to show a true and fair view of the transactions and of the North Ayrshire Integration Joint Board for the year ended 31 March 2025. Legality of financial transactions 6. The financial transactions of North Ayrshire Integration Joint Board are in accordance with the relevant legislation and regulations governing its activities. I am unaware of any actual or non-compliance with laws and regulations. Accounting policies and estimates 7. All material accounting policies adopted are as shown in the Statement of Accounting Policies included in the financial statements. The appropriateness of these policies has been reviewed and takes account of the requirements set out in the 2024/25 accounting code. 165
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8. The significant assumptions used in making accounting estimates are reasonable and properly reflected in the financial statements. There are no changes in estimation techniques which should be disclosed due to their having a material impact on the accounting disclosures. Going concern 9. I have assessed North Ayrshire Integration Joint Board's ability to carry on as a going concern and concluded that it is appropriate to prepare the financial statements on a going concern basis. Carrying value of assets and liabilities 10. All liabilities and contingent liabilities at 31 March 2025 of which I am aware have been recognised in the annual accounts. The assets and liabilities have been recognised, measured, presented, and disclosed in accordance with the 2024/25 accounting code. There are no plans or intentions that are likely to affect the carrying value or classification of the assets in the financial statements. Litigation and Claims 11. We have made you aware that there are no known actual or possible legal claims Fraud 12. I have provided you with all information in relation to • my assessment of the risk that the financial statements may be materially misstated as a result of fraud • any allegations of fraud or suspected fraud affecting the financial statements • fraud or suspected fraud that I am aware of involving management, employees who have a significant role in internal control, or others that could have a material effect on the financial statements. Laws and Regulations 13. I have disclosed to you all known instances of non-compliance or suspected non- compliance with laws and regulations whose effects should be considered when preparing financial statements. Remuneration Report 14. The Remuneration Report has been prepared in accordance with the Local Authority Accounts (Scotland) Amendment Regulations 2014, and all required information of which I am aware has been provided to you. Management commentary 15. I confirm that the Management Commentary has been prepared in accordance with the statutory guidance and the information is consistent with the financial statements. Corporate Governance 16. I confirm that North Ayrshire Integration Joint Board has undertaken a review of the system of internal control during 2024/25 to establish the extent to which it complies with proper practices set out in the Delivering Good Governance in Local Government: Framework 2016. I have disclosed to you all deficiencies in internal control identified from this review or of which I am otherwise aware. 166
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17. I confirm that the Annual Governance Statement has been prepared in accordance with the Delivering Good Governance in Local Government: Framework 2016 and the information is consistent with the financial statements. There have been no changes in the corporate governance arrangements or issues identified, since 31 March 2025, which require to be reflected. Related Party Transactions 18. All material transactions with related parties have been appropriately accounted for and disclosed in the financial statements in accordance with the 2024/25 accounting code. I have made available to you the identity of all the North Ayrshire Integration Joint Board’s related parties and all the related party relationships and transactions of which I am aware. Events Subsequent to the Date of the Balance Sheet 19. I am not aware of there being any events subsequent to 31 March 2025 for which the 2024/25 accounting code requires adjustment or disclosure in the Annual Accounts. Yours sincerely Eleanor Currie Chief Finance Officer 167
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North Ayrshire Integration Joint Board 2024/25 Annual Audit Report Prepared for North Ayrshire Integration Joint Board and the Controller of Audit September 2025 Agenda Item 10 169
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0BNorth Ayrshire Integration Joint Board: 2024/25 Annual Audit Report | 2 Contents Key messages 3 Introduction 5 Audit scope and responsibilities 6 Audit of the annual accounts 8 Wider scope and Best Value audit 12 Appendix 1 28 Appendix 2 30 Appendix 3 33 Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility. 170
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Key messages | 3 Key messages Audit of the annual accounts 1 All audit opinions stated that the annual accounts were free from material misstatement. 2 There were no significant findings or key audit matters to report. All audit adjustments required to correct the financial statements were processed by North Ayrshire Integration Joint Board (NAIJB). Financial Sustainability 3 In 2024/25 a budget overspend of £3.593 million was reported, covered by additional funding contributions from partners. 4 The IJB used £4.730 million of reserves in the year. At 31 March 2025 the IJB has £3.161 million of earmarked reserves and no uncommitted reserves. The IJB Reserves Strategy recommends that the IJB will aspire to hold between 2 and 4% of its annual budgeted expenditure as an uncommitted reserve. The lack of any uncommitted reserves therefore represents a significant financial risk to both the IJB and its partners. 5 The 2025/26 budget included proposed savings of £4.019 million. The latest six-month progress update on the IJB’s transformation plan reports a £2.93 million savings and overspend reduction target for 2025/26. 6 The Medium-Term Financial Outlook has identified required savings of between £8.1 million and £21.4 million in 2026/27 (best case to worst case scenarios). The IJB’s cost base is not sustainable; current funding levels and savings from transformation will not cover the estimated costs. The IJB needs to support more radical reform and cost reductions if it is to demonstrate financial sustainability. Other Wider scope and Best Value audit 7 The IJB has a clear strategic vision that is supported by its partners but financial plans need to align to the vision to show how it can be delivered. 171
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Key messages | 4 8 Performance management arrangements are effective. Of the 18 national indicators, 16 (89%) either achieved or were above target for 2024/25. However delayed discharges have increased by more than 61% over the same period. 9 There is evidence of elements of Best Value being demonstrated by the IJB across a range of areas. However the mechanism for formally reviewing and reporting on the arrangements to secure Best Value needs to be formalised and reported to the board. 172
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Introduction | 5 Introduction Purpose of the Annual Audit Report 1. The purpose of this Annual Audit Report is to report the significant matters identified from the 2024/25 audit of North Ayrshire Integration Joint Board annual accounts and the wider scope areas specified in the Code of Audit Practice (2021). 2. The Annual Audit Report is addressed to North Ayrshire Integration Joint Board, hereafter referred to as ‘the IJB’ and the Controller of Audit, and will be published on Audit Scotland’s website in due course. Appointed auditor and independence 3. Fiona Mitchell Knight, of Audit Scotland, has been appointed as external auditor of the body for the period from 2022/23 until 2026/27. As reported in the Annual Audit Plan, Fiona Mitchell Knight as engagement lead and the audit team are independent of the IJB in accordance with relevant ethical requirements, including the Financial Reporting Council’s Ethical Standard. There have been no developments since the issue of the Annual Audit Plan that impact on the continued independence of the engagement lead or the rest of the audit team from the IJB, including no provision of non-audit services. Acknowledgements 4. We would like to thank the Audit and Performance Committee members, Joint Board members, senior management, and other staff, particularly those involved in the preparation of the annual accounts, for their cooperation and assistance during the audit. We look forward to working together constructively over the remainder of the five-year audit appointment. 173
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Audit scope and responsibilities | 6 Audit scope and responsibilities Scope of the audit 5. The audit is performed in accordance with the Code of Audit Practice, including supplementary guidance, International Standards on Auditing (ISA) (UK), and relevant legislation. These set out the requirements for the scope of the audit which includes: • An audit of the financial statements and an opinion on whether they give a true and fair view and are free from material misstatement. • An opinion on statutory other information published with the financial statements in the annual accounts, namely the Management Commentary and Annual Governance Statement. • An opinion on the audited part of the Remuneration Report. • Conclusions on the IJB’s arrangements in relation to the wider scope areas: Financial Management; Financial Sustainability; Vision, Leadership and Governance; and Use of Resources to Improve Outcomes. • Reporting on the IJB’s arrangements for securing Best Value. • Provision of this Annual Audit Report. Responsibilities and reporting 6. The Code of Audit Practice sets out the respective responsibilities of the body and the auditor. A summary of the key responsibilities is outlined below. Auditor’s responsibilities 7. The responsibilities of auditors in the public sector are established in the Local Government (Scotland) Act 1973. These include providing an independent opinion on the financial statements and other information reported within the annual accounts, and concluding on the IJB’s arrangements in place for the wider scope areas and Best Value. 8. The matters reported in the Annual Audit Report are only those that have been identified by the audit team during normal audit work and may not be all that exist. Communicating these does not absolve the IJB from its responsibilities outlined below. 174
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Audit scope and responsibilities | 7 9. The Annual Audit Report includes an agreed action plan at Appendix 1 setting out specific recommendations to address matters identified and includes details of the responsible officer and dates for implementation. The body’s responsibilities 10. The IJB has primary responsibility for ensuring proper financial stewardship of public funds, compliance with relevant legislation and establishing effective arrangements for governance, propriety, and regularity that enables it to successfully deliver its objectives. The features of proper financial stewardship include: • Establishing arrangements to ensure the proper conduct of its affairs. • Preparation of annual accounts, comprising financial statements for the body that gives a true and fair view and other specified information. • Establishing arrangements for the prevention and detection of fraud, error and irregularities, and bribery and corruption. • Implementing arrangements to ensure its financial position is soundly based. • Making arrangements to secure Best Value. • Establishing an internal audit function. Communication of fraud or suspected fraud 11. In line with ISA (UK) 240 (The Auditor’s Responsibilities Relating to Fraud in an Audit of Financial Statements), in presenting this report to the Performance and Audit Committee we seek confirmation from those charged with governance of any instances of actual, suspected or alleged fraud that should be brought to our attention. Should members have any such knowledge or concerns relating to the risk of fraud within the IJB, we invite them to communicate this to the appointed auditor for consideration prior to the Annual Accounts being certified. National performance audit reporting 12. The Auditor General for Scotland and the Accounts Commission regularly publish performance audit reports. These cover a range of matters, many of which may be of interest to the Integration Joint Board. Details of national and performance audit reports published over the last year can be seen in Appendix 3. 175
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Audit of the annual accounts | 8 Audit of the annual accounts Main judgements All audit opinions stated that the annual accounts were free from material misstatement. There were no significant findings or key audit matters to report. All audit adjustments required to correct the financial statements were processed by the body. Audit opinions on the annual accounts 13. The IJB’s annual accounts were approved at the meeting of the Integration Joint Board on 27th June 2025 and certified by the appointed auditor on 25th September 2025. The Independent Auditor’s Report is included in the body’s annual accounts, and this reports that, in the appointed auditor’s opinion, these were free from material misstatement. Audit timetable 14. The unaudited annual accounts and all working papers were received by 30 June 2025 in accordance with the agreed audit timetable. Audit Fee 15. The audit fee for the 2024/25 audit was reported in the Annual Audit Plan and was set at £34 thousand. There have been no developments that impact on planned audit work required, therefore the audit fee reported in the Annual Audit Plan remains unchanged. Materiality 16. The concept of materiality is applied by auditors in planning and performing an audit, and in evaluating the effect of any uncorrected misstatements on the financial statements or other information reported in the annual accounts. 17. Broadly, the concept of materiality is to determine whether misstatements identified during the audit could reasonably be expected to influence the decisions of users of the annual accounts. Auditors set a monetary threshold when determining materiality, although some issues may be considered material by their nature. Therefore, materiality is ultimately a matter of the auditor’s professional judgement. 176
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Audit of the annual accounts | 9 18. Materiality levels for the audit of the IJB were determined at the risk assessment phase of the audit and were reported in the Annual Audit Plan, which also reported the judgements made in determining materiality levels. These were reassessed on receipt of the unaudited annual accounts and updated as can be seen in Exhibit 1. Exhibit 1 2024/25 Materiality levels for the IJB Materiality IJB Materiality – set at 2% of gross expenditure £7.640 million Performance materiality – set at 70% of materiality. As outlined in the Annual Audit Plan, this acts as a trigger point. If the aggregate of misstatements identified during the audit exceeds performance materiality, this could indicate further audit procedures are required. £5.350 million Reporting threshold – set at 5% of materiality. £0.380 million Source: Audit Scotland Significant findings and key audit matters 19. ISA (UK) 260 requires auditors to communicate significant findings from the audit to those charged with governance, which for the body is the Integration Joint Board. 20. The Code of Audit Practice also requires public sector auditors to communicate key audit matters. These are the matters that, in the auditor’s professional judgement, are of most significance to the audit of the financial statements and require most attention when performing the audit. 21. In determining key audit matters, auditors consider: • Areas of higher or significant risk of material misstatement. • Areas where significant judgement is required, including accounting estimates that are subject to a high degree of estimation uncertainty. • Significant events or transactions that occurred during the year. 22. There are no significant findings or key audit matters to report. 177
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Audit of the annual accounts | 10 Qualitative aspects of accounting practices 23. ISA (UK) 260 also requires auditors to communicate their view about qualitative aspects of the body’s accounting practices, including accounting policies, accounting estimates, and disclosures in the financial statements. Accounting policies 24. The appropriateness of accounting policies adopted by the body was assessed as part of the audit. These were considered to be appropriate to the circumstances of the body, and there were no significant departures from the accounting policies set out in the Code of Practice on Local Authority Accounting in the United Kingdom (the Code). Accounting estimates 25. Accounting estimates are used in number of areas in the body’s financial statements. Audit work considered the process management of the body has in place around making accounting estimates, including the assumptions and data used in making the estimates, and the use of any management experts. Audit work concluded: • There were no issues with the selection or application of methods, assumptions, and data used to make the accounting estimates, and these were considered to be reasonable. • There was no evidence of management bias in making the accounting estimates. Disclosures in the financial statements 26. The adequacy of disclosures in the financial statements was assessed as part of the audit. The quality of disclosures was adequate, with additional levels of detail provided for disclosures around areas of greater sensitivity. Significant matters discussed with management 27. All significant matters identified during the audit and discussed with the body’s management have been reported in the Annual Audit Report. Audit adjustments 28. No audit adjustments were required to the financial statements greater than the reporting threshold of £0.380 million. Significant risks of material misstatement identified in the Annual Audit Plan 29. Audit work has been performed in response to the significant risks of material misstatement identified in the Annual Audit Plan. The outcome of audit work performed is summarised in Exhibit 2. 178
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Audit of the annual accounts | 11 Exhibit 2 Significant risks of material misstatement to the financial statements Risk of material misstatement Planned audit response Outcome of audit work Fraud caused by management override of controls Management is in a unique position to perpetrate fraud because of management’s ability to override controls that otherwise appear to be operating effectively. The audit team will: • Assurances will be obtained from the auditors of NHS Ayrshire and Arran and North Ayrshire Council over the completeness, accuracy and allocation of income and expenditure. • Evaluate any significant unusual transactions outside the normal course of business. Audit work performed found: • We obtained assurances from the auditors of NHS Ayrshire and Arran and North Ayrshire Council over the completeness, accuracy and allocation of income and expenditure. • No significant unusual transactions outside the normal course of business. Conclusion: no evidence of fraud caused by management override of controls. Source: Audit Scotland 179
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Wider scope and Best Value audit | 12 Wider scope and Best Value audit Conclusion The 2024/25 year end budget overspend of £3.593 million was met by additional funding contributions from partners. The IJB utilised £4.730 million of reserves in year. At 31 March 2025 the IJB has £3.161 million of earmarked reserves and no uncommitted reserves. This represents a significant financial risk to both the IJB and its partners. The 2025/26 budget included proposed savings of £4.019 million. The latest six-month progress update on the IJB’s transformation plan reports a £2.93 million savings and overspend reduction target for 2025/26. The Medium-Term Financial Outlook has identified required savings of between £8.1 million and £21.4 million in 2026/27 (best to worst case scenarios). The IJB’s cost base is not sustainable; current funding levels and savings from transformation will not cover the estimated costs. The IJB needs to support more radical reform and cost reductions if it is to demonstrate financial sustainability. The IJB has a clear strategic vision that is supported by its partners but financial plans need to be aligned to the vision to show how it can be delivered. Performance management arrangements are effective. Of the 18 national indicators, 16 (89%) either achieved or were above target for 2024/25. However delayed discharges have increased by more than 61% over the same period. Whilst there is evidence of elements of Best Value being demonstrated by the IJB across a range of areas, the mechanism for formally reviewing and reporting on the arrangements to secure Best Value needs to be formalised and reported to the board. 180
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Wider scope and Best Value audit | 13 Audit approach to wider scope and Best Value Wider scope 30. As reported in the Annual Audit Plan, the wider scope audit areas are: • Financial Management. • Financial Sustainability. • Vision, Leadership and Governance. • Use of Resources to Improve Outcomes. 31. Audit work is performed on these four areas and a conclusion on the effectiveness and appropriateness of arrangements the body has in place for each of these is reported in this chapter. Best Value 32. The duty on auditors to consider the arrangements in place to secure Best Value applies to the body as it falls within section 106 of the Local Government (Scotland) Act 1973. 33. Consideration of the arrangements the body has in place to secure Best Value has been carried out alongside the wider scope audit. Significant wider scope and Best Value risks 34. Audit work has been performed in response to the significant wider scope and Best Value risks identified in the Annual Audit Plan. The outcome of audit work performed is summarised in Exhibit 3. 181
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Wider scope and Best Value audit | 14 Exhibit 3 Significant wider scope and Best Value risks Significant risk Planned audit response Outcome of audit work Financial planning and sustainability At month 7 against the full- year budget of £324.231m there is a projected year-end overspend of £6.190m (1.9%), reduced to £3.613m through identified financial recovery actions. This overall position consists of a projected residual overspend of £2.548m in social care services and a projected overspend of £1.065m in health services. The IJB has approached NAC and NHSAA for additional funding. Current budget scenarios for 2025/26 are a £0.6m underspend (best-case), £3.7m overspend (medium- case) and a £11.8m overspend (worst- case). Additional budget savings will require to be identified to achieve a balanced budget position for approval by the IJB in March. The audit team will: • Monitor progress in achieving the 2024/25 revenue budget, 2024/25 financial recovery actions and cost avoidance plans. • Review of financial performance reports presented to the Board. • Review the medium- term financial plan and assessment of plans to address any forecasted budget deficits. • Evaluate the IJB’s progress with the development of its Transformation Plan and assess how this is contributing to the achievement of financial balance. Audit work identified that: • The 2024/25 budget was overspent by £3.593 million which was funded by contributions from partners. • Medium term financial forecasts show significant funding gaps in 2026/27 and 2027/28. • There are no approved plans to meet the budget gaps set out in the Medium Term Financial Outlook. This needs to be addressed as a matter of urgency. Conclusion: There is a risk that the IJB is unable to deliver the transformational change or cost reductions at the pace required. Source: Audit Scotland Prior year recommendations 35. The IJB has made some progress towards implementing the agreed prior year recommendations relating to the wider scope audit. Progress against these is outlined in Appendix 2 of this report. Two remain ongoing and will be followed up again as part of the 2025/26 audit. 182
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Wider scope and Best Value audit | 15 Conclusions on wider scope audit Financial Management A balanced budget was set for 2024/25 this included £10.290 million of savings proposals with no draw on reserves 36. The IJB set a balanced budget for 2024/25 on 14 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. Required savings were split £9.255 million social care and £1.035 million health services. 37. £7.238 million of the social care savings arose from the non- recurring reduction in employer superannuation contribution rates from 1 April 2024. A further £0.375 million was a reduction in the number of funded care home places by 15, leaving budgetary provision for 765 places at average cost. The largest element of health savings was £0.5 million from a reduction in Hospital Based Complex Continuing Care provision. The 2024/25 year end budget overspend of £3.593 million was met by additional funding contributions from partners 38. The year end budget was overspent by £1.212 million, prior to transfer of unspent funding allocations of £2.381 million to earmarked reserves. This resulted in an overall overspend of £3.593 million. The Integration Scheme provides for funds to be made available (by the partners) for overspends against the operational budget. However the partners also agreed to make funds available for the carry forward of unspent Scottish Government funding allocations including Whole Family Wellbeing (£0.9 million), Alcohol and Drug Partnership (£0.4 million), Mental Health Recovery and Renewal (£0.4 million) and Primary Care Improvement Fund (£0.3 million). 39. North Ayrshire Council considered this at their Cabinet meeting of 3 June 2025 and agreed to a non-recurring funding increase of £2.036 million and no requirement to repay the funds in future years. Similarly, NHSAA funded the health services overspend of £1.557 million. 40. The Chief Officer reported to the IJB meeting of 19 June 2025 that the required savings of £10.290 million had been achieved in full. 41. Significant variations from budget included Care at Home which was £2.712 million overspent reflecting the cost of meeting the increased demand and level of provision for care at home support. In addition, Care 183
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Wider scope and Best Value audit | 16 Experienced Children and Young People was overspent by £1.903 million, mainly due to increased demand for children’s residential placements. The IJB utilised £4.730 million of reserves in year. At 31 March 2025 the IJB has £3.161 million of earmarked reserves and no uncommitted reserves. This represents a significant financial risk to both the IJB and its partners 42. One of the key measures of the financial health of a body is the level of reserves held. The IJB general fund reserve can be earmarked balances for future commitments or uncommitted balances. The IJB’s reserve strategy was approved by the Board in March 2024. The strategy outlines a target contingency level of 2 - 4% of annual budgeted expenditure. 43. At 31 March 2025, the IJB had no uncommitted reserve balances against the target level for the year of £6.715 - £13.430 million. The absence of any uncommitted general fund reserves seriously limits the IJB’s ability to manage and mitigate future financial pressures and represents a significant financial risk to both the IJB and its partners. 44. In 2023/24 we recommended that the IJB must urgently map a clear route to bring uncommitted reserves back up to the minimum level. The IJB accepts and acknowledges that uncommitted reserves require to be restored to the minimum recommended level. However the Annual Accounts also report that in the short-term, service pressures mean that this will not be achievable. 45. Total earmarked reserves of £3.161 million include the unspent funding allocations of £2.381 million noted at paragraph 38 above together with the balance of £0.780 million on the Service Redesign/Challenge Fund. 46. Whilst concerns are highlighted in relation to the uncommitted reserves and a requirement to reinstate these as a tool for effective financial management and sustainability, it is acknowledged that the balance of reserves will be considered as part of the IJB annual budget setting process. Whilst the ambition would be to plan to replenish the contingency reserves for the IJB in future years, in setting the budget for 2025/26 the IJB were advised that the reality is in the current financial operating environment there is not the ability or scope to plan for this in the short term. This is acknowledged as a challenge for all IJBs, with reports that at the end of 2024/25 over half of IJBs across Scotland hold no contingency reserve and only one area is expected to have reserves over 2% moving into 2025/26. 184
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Wider scope and Best Value audit | 17 Financial systems of internal control operated effectively 47. The IJB is reliant on the systems of its partner bodies. NHS Ayrshire and Arran and North Ayrshire Council, for its key financial systems, including ledger and payroll. All IJB transactions are processed through respective partners’ systems and all controls over those systems are within the partner bodies rather than the IJB. 48. As part of our audit approach, we sought assurances from the external auditors of NHS Ayrshire and Arran and North Ayrshire Council (in accordance with ISA 402) and confirmed there were no weaknesses in the systems of internal control for either the health board or council. High absence rates were reported in areas which require cover arrangements, principally care at home. In 2024/25 this resulted in additional costs of £1.05 million 49. Overtime costs of £1.05 million were incurred by the HSCP to provide absence cover requirements. For Care at Home (£0.85 million) the HSCP budgets for a full establishment but overtime is funded through vacant posts or ‘20 hour’ posts. Cover requires to be provided as service users cannot be left without a life and limb service. The remaining £0.2 million relates to the children’s houses which also require that any absences are covered, and financial inclusion which relates to overtime worked as part of the financial reassessment process. 50. A performance report for Quarter 1 2025/26 submitted to the Performance and Audit Committee in September 2025 outlined that wellbeing action plans around sickness absence levels within the Care at Home workforce were being robustly managed and supporting staff to maintain attendance/return to work. Despite these efforts the service saw an increase in front line staff absences by a further 1% from Quarter 4 2024 to 2025 to Quarter 1 2025 to 2026, with sickness absence now over 14%. The service has also experienced significant challenges in sickness absence and vacancies within non-frontline service delivery roles. Standards of conduct and arrangements for the prevention and detection of fraud and error were appropriate 51. The IJB does not maintain its own policies relating to the prevention and detection of fraud and error but instead depends on those in place at its partner bodies. We reviewed the arrangements in place at NHS Ayrshire and Arran and North Ayrshire Council through consideration of the work by partner body auditors and found them to be adequate. 185
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Wider scope and Best Value audit | 18 52. Appropriate arrangements are in place for the prevention and detection of fraud and error. We are not aware of any specific issues we require to bring to your attention. Financial Sustainability The IJB cannot demonstrate the financial sustainability of its services 53. Financial sustainability looks forward to the medium and longer term to consider whether the body is planning effectively to continue to deliver its services or the way in which they should be delivered. 54. As outlined at Exhibit 3, a significant wider scope risk was identified around financial sustainability. We have noted below significant challenges going forward in the IJB’s ability to achieve financial balance. 55. The IJB approved its medium term financial plan 2025-2028 in December 2024. An update to the original projected funding gap was presented to the IJB in March 2025 as part of the annual budget for 2025/26. The 2025/26 budget includes proposed savings of £4.019 million 56. As set out in Exhibit 4, the 2025/26 budget has a funding gap of £3.069 million and the IJB approved savings of £4.019 million. This level of savings was proposed to create a surplus of £0.950m as a contingency towards any 2024/25 overspends which would continue into 2025/26. The IJB was updated on the projected implications of overspends in 2024/25 moving into the new financial year and additional savings were approved to support the management of these overspends during 2025/26 rather than any surplus being planned to for example reinstate reserves. 186
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Wider scope and Best Value audit | 19 Exhibit 4 North Ayrshire IJB 2025/26 Budget Gap and Savings Source: North Ayrshire IJB 57. The £4.019 million savings are rated £2.984 million Amber and £1.035m Green. Amber rated savings include: Improve outcomes for care experienced young people (£1.0 million); Continued review of Care at Home service (£0.5 million); and review of Financial Inclusion Service (£0.36 million). 58. There is considerable uncertainty around a significant proportion of these savings. For example, improving outcomes for care experienced young people will require significant understanding of both the costs associated with the current system and to identify what needs to change, and further reduction in the care at home service has the potential to create cost pressures in other parts of the system. Care Experienced Children and Young People is projected at Month 3 to overspend by £2.857 million in 2025/26. Care at Home is projected at Month 3 to be £1.641 million overspent in 2025/26. In addition and as noted at para 41 above, both of these areas were significantly overspent in 2024/25. The Chief Officer has confirmed that issues are being addressed by various initiatives, monitoring and review. The Medium-Term Financial Outlook has identified required savings of between £13.6 million and £21.4 million in 2026/27 59. A Medium-Term Financial Outlook (MTFO) has been prepared to identify what the financial position may look like moving into 2026/27 and 2027/28. The MTFO notes that for 2025/26, the outturn was between the projected medium and the worst case scenarios for that year and it would be prudent to assume a similar position for2026/27 and 2027/28. As set 187
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Wider scope and Best Value audit | 20 out at Exhibit 5, the modelling which has been carried out has identified required savings of between £13.6 million and £21.4 million for 2026/27 and between £5.7 million and £14.7 million for 2027/28. 60. The significant shortfall in 2026/27 is linked to the expected increase in local government employer pension contributions from 6.5% in 2025/26 to 17.5% in 2026/27. Exhibit 5 North Ayrshire MTFO 2026/27 – 2027/28 Source: North Ayrshire IJB The MTFO indicates the IJB’s cost base is not sustainable; current funding levels and savings from transformation will not cover the estimated costs. The IJB needs to support more radical reform and reduce the cost base if it is to demonstrate financial sustainability 61. The Accounts Commission’s July 2024 report on Integration Joint Boards: Finance and Performance 2024 emphasised the need for a more significant transformation of services to achieve financial sustainability. This is becoming increasingly important as recurring savings get more difficult to identify and achieve. 62. The overall picture, set out by the Accounts Commission is concerning. It shows a continued picture of overspending, depletion of reserves and reliance on one-off rather than recurring savings. There is a need for transformational changes in the way services are being delivered and for the identification and delivery of significant recurring savings. IJBs in Scotland also need to be working collaboratively with each other and with their NHS and council partners to find ways to transform services on a longer-term basis so that they are affordable. 63. In 2023/24 we reported that the IJB has recognised that the challenging financial environment it is operating in will likely continue for some years to come and agreed an updated Transformation Plan 2024-27 in March 2024. We also reported that the Service Redesign and Change 188
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Wider scope and Best Value audit | 21 Fund aims to support the Transformation Plan through the redesign of services and investments in new technologies. The balance on the Fund at 31 March 2025 was £0.780 million. These funds are allocated on a non- recurring basis. 64. An Internal Audit review of IJB transformation submitted to the September 2025 Performance and Audit Committee gave an opinion of substantial assurance in relation to the governance of the Transformation Plan. 65. Not all projects in the Transformation Plan have a direct financial impact although a number will deliver financial savings. Of the 75 projects approved in March 2024, 40 were reported as having a financial impact. Some financial targets were identified as part of the budget development for 2025/26. Identified savings and overspend reductions are tracked in the online trackers. 66. The latest six-month progress update was provided to the IJB in August 2025. The report provided updates on specific projects across all service areas and notes a £2.93 million savings and overspend reduction target for 2025/26. 67. The Transformation Plan is critical to the ongoing sustainability of service delivery. In 2023/24 we reported that that the refreshed Transformation Plan includes timescales and is being overseen by the IJB’s Transformation Board. However based on current projections, savings from transformation fall significantly short of the potential budget gaps in 2026/27 and 2027/28. Financial recovery from this position will require radical reform of services. Whilst the transformation programme needs to be sufficiently ambitious to respond to the scale of the financial challenges, the Chief Officer is clear that future recurring savings also need to be made through workforce changes, service review and charging reviews. In the absence of any contingency reserve of its own, the increased demand for health and social care services alongside rising costs presents a significant financial risk to both the IJB and its partners. 68. Recurring pressures are currently being met with a combination of recurring and non-recurring solutions with an underlying recurring over- commitment. This needs to be addressed as a matter of urgency. An effective medium term financial recovery plan needs to be introduced, and decisions made about the way services are delivered in the short, medium and longer-term based on information about the cost, impact and quality of all available options. Detailed scenario planning should also be undertaken to provide an understanding for the IJB of the effects of various reform options. 69. In 2023/24 we reported that in order to facilitate greater scrutiny of the financial position and the delivery of the financial recovery plan during 2024/25. The IJB agreed at its June 2024 meeting to establish a ‘Finance Working Group’, chaired by the IJB Vice Chair. The Director and Heads of 189
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Wider scope and Best Value audit | 22 Service are members of the group. This Group will continue to meet monthly during 2025/26 to facilitate increased oversight and scrutiny of the financial position and transformation programme as well as detailed budget planning for future financial years. 70. Change and cost base reduction now needs to happen quickly if the IJB is to address its transformational challenges. More focused and effective leadership is needed to drive the change and to promote a culture of challenge. Joint Board members should challenge the progress being made. Recommendation 1: The Chief Officer, Joint Board members and the Finance Working Group need to produce a financial plan that demonstrates how efficiencies from service reform, cost base reduction and transformation will meet the budget gaps outlined in the MTFO. Progress should be reviewed and challenged by the board. 71. There are an additional number of risks and challenges faced by the IJB from the anticipated budget pressures. 72. We have previously reported that IJBs, with the support of council and NHS board partner bodies, should be clear about how and when they intend to achieve their priorities and outcomes, in line with their available resources; and ultimately how they intend to progress to sustainable, preventative and community-based services. 73. The IJB needs to operate within its delegated budgets however there are a number of risks and challenges faced by the IJB from the anticipated budget pressures. For example: • The IJB is stopping or reducing services to deliver from within reduced financial allocations. Whilst the IJB is not in a positive financial position, further reductions of service in the community has the potential to create cost pressures in other parts of the system • NHS Ayrshire and Arran continue to meet the increased costs of energy, e-health and all drugs (including primary care prescribing) in line with the approved integration scheme (see paragraph 74 below). The IJB holds the budget for mental health services and addictions prescribing • In relation to the set aside budget, the monitoring of large hospital activity is complex and requires significant work to be undertaken to monitor budgets and changes in activity levels (see paragraph 75 below) • The Integration Scheme for North Ayrshire IJB was last updated in 2018. There is a legal duty on councils and health boards to review the Integration Schemes at least every 5 years to consider whether 190
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Wider scope and Best Value audit | 23 any changes are necessary or desirable. The Integration Scheme is being reviewed on a Pan Ayrshire basis and will be taken to respective governance boards in 2026. Work to rebalance the financial risk between the Integration Joint Boards and the Health Board in some areas remains ongoing 74. NHS Ayrshire and Arran currently meet the increased costs of energy, e-health and all drugs (including primary care prescribing). The IJB holds the budget for mental health services and addictions prescribing. The integration scheme sets out the position in relation to primary care prescribing, however the scheme also requires that in relation to the set aside budget, the IJBs should contribute financially if they are responsible for increased use and risk sharing in these areas. 75. In 2023/24 we reported that Ayrshire Finance Leads have now developed and agreed on a new model for costing the set aside arrangements, based on actual bed usage and average costs which was expected to be enacted operationally during 2024/25. However NHS Ayrshire and Arran has also requested the development of a joint strategic commissioning plan to enable the setting of directions for Unscheduled Care, aligned with the Set Aside resources, which has not yet been approved by the three IJBs. 76. We previously reported that during 2023/24, a Task Group relating to Primary Care Prescribing and led by the Health Board’s Director of Finance, agreed in principle that whilst IJBs should hold full responsibility for Primary Care Prescribing, a prudent approach would be to undertake a period of learning to enable chief officers and funding partners to fully understand the implications of such a decision. We are now advised that the transfer of responsibility of primary care prescribing would require all parties to the integration schemes to agree to this change (council and health board) and for due diligence to establish if the service is appropriately funded. Vision, Leadership and Governance Governance arrangements are appropriate and operate effectively 77. The audit work performed on the arrangements the IJB has in place around its Vision, Leadership and Governance found that these were effective and appropriate. 78. There continues to be an increasing focus on demonstrating the best use of public money. Openness and transparency in how a body 191
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Wider scope and Best Value audit | 24 operates and makes decisions is key to supporting understanding and scrutiny. Transparency means that the public has access to understandable, relevant, and timely information about how the body is taking decisions and using resources. 79. For 2024/25 the IJB held its meetings in person. The meeting papers and minutes are available on the IJB’s website. All Performance and Audit Committee meetings continued to be held remotely. 80. We consider that governance arrangements are appropriate and generally support effective scrutiny, challenge and decision-making. The IJB has a clear strategic vision that is supported by its partners 81. The Public Bodies (Joint Working) (Scotland) Act 2014 requires the IJB to prepare a strategic plan that sets out the arrangements in place to carry out the integration functions over the period of the plan. The Act also requires that the plan set out how those arrangements are intended to achieve, or contribute to achieving, the national health and wellbeing outcomes. 82. To support the IJB in achieving these responsibilities, it has established a clear strategic vision as set out in its “Caring Together “Strategic Plan 2022-2030. The plan contains five strategic objectives/priorities: • Enable communities • Develop and support workforce • Provide early and effective support • Improve mental and physical health and wellbeing • Tackle inequalities 83. The IJB provides services as set out in its Integration Scheme. The Strategic Plan objectives aim to give direction to the services provided and commissioned by the IJB and are based on its engagement with its partners and other key stakeholders together with consideration of national outcomes. The current Strategic Plan has no links to financial plans. 84. In 2022/23 we reported that the IJB was to refresh the Strategic Plan in 2024 to ensure it is relevant and up to date. That review is now underway and includes the development of a new action plan together with a refresh of the main document to bring this in line with the current landscape. It is proposed to present the updated document to the IJB in December 2025. 192
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Wider scope and Best Value audit | 25 A review of the Integration Scheme is ongoing and is due to conclude in 2026 85. The Public Bodies (Joint Working) (Scotland) 2014, places a legal duty on Councils and Health Boards to review the Integration Schemes at least once every five years to consider whether any changes are necessary or desirable. 86. As set out at para 71 above, the Integration Scheme for the IJB was last reviewed in 2018. The current review of the Integration Scheme has been undertaken on a pan-Ayrshire basis by the three Councils and the Health Board to ensure a consistent and co-ordinated approach. A project Board was established to oversee the work and various work groups were established. The review of the Integration Scheme through the various workgroups concluded in March 2024. Further work has since been undertaken to consider specific issues and the overall legal competence of the Scheme. 87. It is anticipated that the Integration Scheme review will conclude in 2026. Following this, it will require approval by North Ayrshire Council and NHS Ayrshire and Arran, prior to submission to the Scottish Ministers. Use of Resources to Improve Outcomes Performance management arrangements are effective. Of the 18 national indicators, 16 (89%) either achieved or were above target for 2024/25. However delayed discharges have increased by more than 61% over the same period 88. The Performance and Audit Committee has a role in providing oversight of performance reporting against the strategic plan. Twelve month rolling performance reports are presented to most meetings of the committee. This provides assurance to the Performance and Audit Committee of overall performance. 89. There are local indicators used for performance reporting by the IJB, however for comparability when assessing the performance of the IJB, we have considered several key Ministerial Strategic Group for Health and Community Care (MSGHCC) measures that are used to track performance in Integration Authorities. 90. Of the 16 local indicators used, 14 out of 16 (87.5%) either achieved or were above target. Exhibit 6 sets out the IJB’s results against a number of the MSG measures for 2024/25 . Of the 18 indicators, 16 (89%) either achieved or were above target. However delayed discharges 193
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Wider scope and Best Value audit | 26 bed days increased from 1,785 during March 2024 to 2,876 during March 2025, an increase of 61.1%. 91. Delays in accessing Care at Home supports are largely due to overall capacity to deliver services. As part of the IJB’s financial recovery plan for 2024/25, which has continued into 2025/26, a recruitment freeze was implemented to reduce the overspend. This has resulted in a reduction in the overall workforce and an overall reduction in service capacity. The service has developed a Winter Preparedness and Delayed Discharge Improvement Plan with a key focus on supporting Care at Home Capacity. However with a reduction in service capacity, an increased focus on early discharge from hospital and a sickness absence rate of over 14% in the Care at Home workforce, improvement in this area is unlikely without radical reform. Current initiatives include implementation of a call monitoring system, a review of roles, prioritisation of access including reviews of eligibility criteria. Exhibit 6 National performance measures (age 18+) Measures 24/25 performance Improving from 23/24 Emergency admissions to acute hospitals 9.1% decrease Yes Unscheduled “hospital bed days” in acute hospital 40.8% decrease Yes Unscheduled “hospital bed days” in geriatric long stay 68.3% decrease Yes Emergency department attendances 0.5% increase No Delayed transfers of care bed days (all) 61.1% increase No Source: North Ayrshire IJB - Annual Performance Report 2024-25 92. Whilst there is a need for caution when drawing conclusion from national comparisons, the Accounts Commission’s Integration Joint Boards: Finance and Performance 2024 report makes it clear that IJB’s need to make best use of available data. This needs to include effective data sharing between partners and key stakeholders. To that end, it is important that members and management of North Ayrshire IJB satisfy themselves that the performance results of it are fully assessed on a continual basis and that these results are used to effectively inform how to improve outcomes for people who use its services. 93. We conclude that the IJB has established appropriate arrangements for reporting performance against national outcomes through the Annual Performance report. 194
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Wider scope and Best Value audit | 27 A formal review should be undertaken to demonstrate how the IJB is achieving Best Value 94. The Code of Audit Practice requires us to consider the adequacy of the arrangements in place to demonstrate how the IJB meets its Best Value duty to secure continuous improvement in the performance of its functions. We expect bodies to demonstrate that they meet the expectations in the Scottish Government, Local Government in Scotland Act 2003 Best Value: Revised Statutory Guidance 2020. 95. Our work on the four wider scope audit areas financial management, financial sustainability, vision, leadership and governance and the use of resources to improve outcomes provides evidence of how the IJB performs in some important areas of Best Value. Whilst there is evidence of elements of Best Value being demonstrated by the IJB across a range of areas, the mechanism for formally reviewing and reporting on the arrangements to secure Best Value is not formalised and reported to the Board. Recommendation 2: A Best Value assurance framework should be formalised, to set out how annual assurances from the IJB’s partners can be used to provide assurance on Best Value arrangements to the Board. 195
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Appendix 1 | 28 Appendix 1 Action plan 2024/25 2024/25 recommendations Matter giving rise to recommendation Recommendation Agreed action, officer and timing 1. Financial sustainability There are no approved plans to meet the budget gaps set out in the MTFO. This needs to be addressed as a matter of urgency. An effective long term financial recovery plan needs to be introduced, and decisions about the way services are delivered in the short, medium and longer-term based on information about the cost, impact and quality of all available options. Detailed scenario planning should also be undertaken to provide an understanding for the IJB of the effects of various reform options. Risk: There is a risk that the IJB is unable to deliver the transformational change at the pace that is required. The Chief Officer, Joint Board members and the Finance Working Group need to produce a financial plan that demonstrates how efficiencies from service reform , cost base reductions and transformation will meet the budget gaps outlined in the MTFO. Progress should be reviewed and challenged by the board. (paragraph 70) Accepted Preparation for the 2026/27 budget has commenced. The Transformation Plan is being further developed with a focus on aligning financial impact to areas of service change. A series of meetings is being held with every senior manager to review their services and look at ways of reducing spend through either redesign or cessation of services. Once completed the actions identified will be discussed at the Finance Working Group prior to proposals being presented to the IJB for approval. Proposals will be submitted throughout 2025/26 e.g Brighter Pathways will be presented in November 2025. Final proposals to bridge any remaining gap will be presented in March 2026 as part of the 2026/27 budget paper. This work will also include savings beyond 2026/27. Chief Officer and Chief Finance Officer March 2026 196
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Appendix 1 | 29 Matter giving rise to recommendation Recommendation Agreed action, officer and timing 2. Arrangements to secure Best Value Whilst there is evidence of elements of Best Value being demonstrated by the IJB across a range of areas, the mechanism for formally reviewing and reporting on the arrangements to secure Best Value is not formalised and reported to the Board. Risk: The is a risk that the IJB is not meeting its Best Value duty to secure continuous improvement in the performance of its functions. A formal review of the Best Value assurance framework and an assessment of the partnership’s Best Value arrangements should be completed and reported to the Joint Board. (paragraph 95) Accepted A Best Value framework will be developed and presented to the IJB, thereafter this will be incorporated into the Annual Performance Report as the mechanism for regular reporting to the IJB. Chief Officer February 2026 197
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Appendix 2 | 30 Appendix 2 Follow-up of prior year recommendations in the 2023/24 Annual Audit Report Issue/Risk Recommendation Agreed management action/timing PY1. Financial management Financial monitoring report projections during the year varied significantly from actual outturn. Financial projections should be based on clear evidence and realistic assumptions. Complete The projection for Care at Home costs in 2023/24 was understated due to an error in the forecasting template. This was explained to the IJB at the June meeting and was rectified for 2024/25. PY2. Unidentified savings At the end of Month 4 (July 2024), the IJB reported a projected year-end overspend of £6.697m. Identified financial improvement actions amount to £3.702m, A further £2.995m of financial recovery improvement actions still require to be identified. The IJB should ensure that savings plans are developed as a matter of urgency, identifying how the required £2.995 million of financial recovery improvement actions in 2024/25 will be achieved. Ongoing The IJB set a balanced budget for 2024/25 on 14 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 2005/26 budget has a funding gap of £3.069 million and proposed savings of £4.019 million. 198
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Appendix 2 | 31 Issue/Risk Recommendation Agreed management action/timing PY 3. Uncommitted reserves The IJB Reserves Strategy recommends that the IJB will aspire to hold between 2 and 4% of its annual budgeted expenditure as an uncommitted reserve. The uncommitted reserve balance at 31 March 2024 was £0.357 million (representing only 0.1% of the IJB’S 2024/25 budget) and therefore does not meet the lower target. In addition, uncommitted reserves are forecast to be depleted by 31 March 2025. The IJB must urgently map a clear route to bring uncommitted reserves back up to the minimum level. Ongoing. At 31 March 2025, the IJB had zero uncommitted reserves balance against the target level for the year of £6.715 - £13.430 million. The absence of any uncommitted general fund reserves seriously limits the IJB’s ability to manage and mitigate future financial pressures and represents a significant financial risk to both the IJB and its partners. The IJB accepts and acknowledge that uncommitted reserves require to be restored to the minimum recommended level. However it also reports in the Annual Accounts that in the short-term, service pressures mean that this will not be achievable. This will require to be considered as part of the annual budget setting process alongside the funding allocations from both partner bodies. 199
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Appendix 2 | 32 Issue/Risk Recommendation Agreed management action/timing PY B/F 1. Transformation Plan (2022/23 recommendation) The IJB needs to be clearer about how the ongoing improvement activity makes a difference to the outcomes the IJB and its partners want to achieve. The IJB and its partners need to clearly set out what achieving its intended outcomes looks like in the short, medium and longer term. Superseded Based on current projections, projected savings from transformation are not enough to close the potential budget gaps in 2026/27 and 2027/28. Financial recovery from this position will require radical reform of services and service/cost reductions. In the absence of any contingency reserve of its own, this presents a significant financial risk to both the IJB and its partners. An effective long term financial recovery plan needs to be introduced, and decisions about the way services are delivered in the short, medium and longer- term based on information about the cost, impact and quality of all available options. Detailed scenario planning should also be undertaken to provide an understanding for the IJB of the effects of various reform options. See Recommendation 1 of our 2024/25 action plan. 200
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Appendix 3 | 33 Appendix 3 Supporting national and performance audit reports Report name Date published Local government budgets 2024/25 15 May 2024 Scotland’s colleges 2024 19 September 2024 Integration Joint Boards: Finance and performance 2024 25 July 2024 The National Fraud Initiative in Scotland 2024 15 August 2024 Transformation in councils 1 October 2024 Alcohol and drug services 31 October 2024 Fiscal sustainability and reform in Scotland 21 November 2024 Public service reform in Scotland: how do we turn rhetoric into reality? 26 November 2024 NHS in Scotland 2024: Finance and performance 3 December 2024 Auditing climate change 7 January 2025 Local government in Scotland: Financial bulletin 2023/24 28 January 2025 Transparency, transformation and the sustainability of council services 28 January 2025 Sustainable transport 30 January 2025 A review of Housing Benefit overpayments 2018/19 to 2021/22: A thematic study 20 February 2025 Additional support for learning 27 February 2025 Integration Joint Boards: Finance bulletin 2023/24 6 March 2025 Integration Joint Boards finances continue to be precarious 6 March 2025 General practise: Progress since the 2018 General Medical Services contract 27 March 2025 Council Tax rises in Scotland 28 March 2025 201
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North Ayrshire Integration Joint Board 2024/25 Annual Audit Report Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 Email: info@audit.scot www.audit.scot AS.5.0 202
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Integration Joint Board 25th September 2025 Subject: 2025-26 – Month 4 Financial Performance Purpose: To provide an overview of the IJB’s financial performance as at Month 4 (July). 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 £5.259m reducing to £1.733m 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; (d) note the projected overspend position of £0.134m for services managed under Lead Partnership arrangements by South Ayrshire HSCP and request that a financial recovery plan is proposed to bring the budget back online for 2025/26; (e) note that services managed in East Ayrshire under Lead Partnership arrangements are projected to overspend by £0.430m and that a financial recovery plan will be presented to the IJB on 29 October 2025 for formal approval; and (f) 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 11 203
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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 July 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 £5.259m (1.5%) reduced to £1.733m 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 @ mth4 5.259 2.051 3.208 Financial Recovery Plan Projections (3.526) (1.275) (2.251) Residual Risk 1.733 0.776 0.957 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 within allocated budget, on that basis further information will be brought forward with further detail on Lead Partnership services. 204
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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. This request will be informed by information collated from services on the actual impact and cost. • Pay settlements for both NHS and Local Government staff have been agreed for 2025/26. The NHS element has been funded, and the current assumption is that the shortfall between budget planning assumptions and actual settlements will be fully funded for Local Government staff. 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 4 At month 4 against the full-year budget of £341.975m there is a projected year-end overspend of £5.259m (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 £3.208m in social care services and a projected overspend of £2.051m 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 the capacity of providers to take on work. Appendix F provides information on the costs of bank and agency staff. 205
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2.3 Health and Community Care Services Against the full-year budget of £98.615m there is a projected overspend of £4.330m (4.4%) which is an adverse movement of £0.206m and the main variances are: a) Care home placements – net projected overspend of £0.575m. This includes an overspend on placements of £1.275m which 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 adverse movement is mainly due to £0.508m of PD care home placements transferring to this budget which was approved as part of the recovery plan. The budgeted number of permanent placements was 765 and at month 4 there were 792 placements for older people and 14 PD placements resulting in a projected overspend of £1.275m. The plan to manage down the number of permanent placements to reach the target is challenging due to the need to respond to referrals from hospital and to continue to support those in critical and substantial need in the community. The overspend is partially offset by income recovered from charging orders which is projected to be £0.700m 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 £1.672m overspent (£0.031m adverse). 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 £0.429m (£0.494m favourable) split as follows: £0.845m over in residential placements, £0.240m under in direct payments and £0.176m under in community care packages. The favourable movement is due to the transfer of £0.508m of PD cases to the older people care home placement budget. d) Integrated Island Services is projected to overspend by £0.311m (£0.045m adverse). The most significant variance is a projected overspend at Montrose House of £0.133m (£0.056m favourable) 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. The Arran Patient Transfer contract is projected to overspend by £0.040m. e) Specialist Rehab wards – projected overspend of £0.190m (£0.024m favourable) (Redburn ward £0.234m overspend and Douglas Grant £0.044m underspend). The overspend is due to cover costs for vacancies as well as supplementary staffing for patients who require one to one support. 206
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f) Wards 1 and 2 – Projected overspend of £0.783m (£0.044m favourable). 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 plan which will reduce this overspend and the reduction is reflected in the recovery plan. g) District Nursing – projected to overspend by £0.093m (£0.007m favourable) mainly due to an overspend on continence supplies. 2.4 Mental Health Services Against the full-year budget of £120.719m there is a projected overspend of £0.605m (0.5%) which is a favourable movement of £0.335m prior to the re-allocation of the Lead Partnership variance to East and South HSCP. The main variances are: • Learning Disabilities are projected to overspend by £0.620m (£1.044m adverse). It should be noted that most of the adverse movement is due to the all-age disability budgets being transferred from children’s services to Learning Disabilities and this resulted in an adverse movement of £1.094m. This £1.094m is across residential placements (£1.481m over), direct payments (£0.317m under) and community packages (£0.178m under). The main historic LD budget is projected to underspend by £0.385m across community care packages (£0.699m under), direct payments (£0.231m over) and residential placements (£0.034m over). This improvement from 2024-25 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 £0.154m (£0.059m favourable movement) across community care packages (£0.538m under), direct payments (£0.167m over), residential placements (£0.347m 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 holding the funding was agreed as part of the recovery plan at month 3. 207
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• The Lead Partnership for Mental Health is projected to be £0.486m overspent (£1.321m favourable) and the main variances are as follows: • Adult Inpatients – projected overspend by £0.639m (£0.267m adverse) due to very high levels of continuous intervention which require additional supplementary staff and enhanced observations (1:1 and 2:1) and use of bank staff. There is an overspend of £0.288m at month 4 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. • The UNPACS (Unplanned Activities) budget – projected overspend of £1.353m (£0.016m favourable) based on current placements. UnPACS placements are for individuals with very specific needs that require a higher level of security and/or care from a staff group with a particular skill set/competence. There are no local NHS secure facilities for women, people with a learning disability or people with neurodevelopmental disorder. This can necessitate an UNPACs placement with a specialist provider which can be out-of-area. The nature of mental health UNPACs spend is that it is almost exclusively on medium- or long-term complex secure residential placements which are very expensive so a small change in placements can have a high budgetary impact. Due to the complexity and risk involved, transitions between units or levels of security can take many months. Applications to approve a placement are made to the Associate Medical Director for Mental Health who needs to be satisfied that the placement is appropriate and unavoidable prior to this being agreed. Part of the additional control measures agreed in month 3 was to expand the high- cost care package review group to include all UNPACS placement requests. • Learning Disability Services – projected to overspend by £0.056m (£0.045m favourable). 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 in July 2025. It is assumed that Ward 7A budget will be online as the use of bank staff will reduce. • Elderly Inpatients – projected overspend of £0.133m (£0.131m favourable) 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. 208
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• Eating Disorders – projected to overspend by £0.127m (£0.002m favourable movement) due to the staffing level being higher than the funding allocation. This is being considered alongside the overall resource allocation. • Enhanced Mental Health Outcome Framework (EMHOF) – projected underspend of £0.624m. There was £0.624m of reserves held for EMHOF and the recovery plan approved the draw down of these reserves which is the reason for the favourable movement. • Psychiatry – is projected to overspend by £0.292m (£0.023m adverse) 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 £0.036m (£0.360m favourable), This favourable movement is mainly due to a prior year rebate. Prior to this rebate there was an overspend due to increased demand and cost of medicines, and particularly the cost of Buvidal. This position is after investing £0.510m on a Pan Ayrshire basis (£0.170m per HSCP). • Action 15 – is projected to underspend of £0.229m (£0.497m favourable). There was £0.487m of reserves held for Action 15 and the recovery plan approved the draw down of these reserves which is the reason for the favourable movement. The projected underspend is after considering the legacy costs from the 2024/25 review of funding. Innovation Fund – projected underspend of £0.025m (no movement) 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 (adverse movement of £0.173m) in 2025-26. Further information is included in the table below: Vacancy Savings Target (£1.160m) Projected to March 2026 £1.688m Over/(Under) Achievement £0.528m 2.5 Children and Justice Services Against the full-year budget of £41.619m there is a projected overspend of £1.606m (3.9%) which is a favourable movement of £0.924m and the main variances are: 209
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a) Care Experienced Children and Young People is projected to overspend by £1.915m (£0.942m favourable). This favourable movement is primarily due to the children with disabilities budget moving to Learning Disabilities. 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 £2.691m (£0.037m favourable) based 34 placements in month 4. This demonstrates an increase of 5 places since the start of the financial year. There are several factors leading to this challenging position: o We have 32 places available in our internal children’s houses, due to demand these have been operating at 100% occupancy or over for some time, leading to increased use of external placements where residential care is required. o There remains an acute shortage of foster carers leading to residential care being necessary in emergency placement situations. o The requirement to support Unaccompanied Asylum-Seeking Children (UASC) under the National Transfer Scheme and to support trafficked young people who have been identified in North Ayrshire. o A number of young people in residential care have requested Continuing Care, whereby a young person can remain in their placement until age 21. o Where appropriate young people are placed to meet their educational needs, the cost of Residential School Placements in the most cases is shared 50/50 with Education services. o Contractual inflation has still to be agreed for most 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 £0.905m (£0.014m adverse) underspent. • Residential respite – placements are overspent by £0.073m (no movement). 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 £0.071m (£0.079m favourable movement), largely due to staffing levels in the children’s houses and regrading of posts. 210
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• Care Leavers – projected underspend of £0.071m (no movement) in rent costs. • Section 29 Payments (Throughcare Team) are projected to overspend by £0.064m (no movement). b) Head of Service – is projected to underspend by £0.568m (£0.020m favourable). This consists of a projected overspend of £0.166m (£0.030m favourable) 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 £0.764m (£0.028m adverse) and which contributes to costs incurred across a number of C&F service areas. c) C&F Health Team – is projected to overspend by £0.144m (£0.023m adverse) 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 was 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. 2.7 CHIEF SOCIAL WORK OFFICER This is projected to underspend by £0.204m (£0.001m favourable). One contract has ceased at the end of June and there are savings against other areas. There is also 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 £1.026m (£0.089m adverse) and the main areas of variance are: • There is projected slippage on the LD and MH transition funding of £0.263m (£0.017m favourable) due to delays in children transitioning into adult services. This involves complex planning by services with service users and families and can change over time based on assessed need when moving into adult services. • 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. 211
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• There is also a balance of overachieved savings of £0.061m (no movement) 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 £1.100m (£0.100m adverse) for social care services and an over-recovery of £0.302m (£0.101m adverse) 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 £4.500m £1.869m Over/(Under) Achievement £1.100m £0.302m 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. 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 4 £m Red - 1.000 Amber 2.984 1.041 Green 1.035 0.686 Blue - 1.292 TOTAL 4.019 4.019 212
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b) The main area to note is that the red savings have increased since month 3 as the saving in relation to the Brighter Pathways is not as certain. 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 Virement to Medical Directorate from Mental Health Admin (0.028) 2 Primary Care Prescribing Tariff Reduction (0.556) 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 4 the MH lead partnership is projected to overspend by £0.485m (£0.159m NRAC share for East and £0.139m for South). South HSCP (month 3 info) – projected overspend of £0.134m of which £0.050m (no change) 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 4 info) - projected overspend of £0.430m (of which £0.159m will be allocated to North - £0.119m adverse movement). The main variances are: 213
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• The Primary Care and Out of Hours Services budget £134.522m budget is projected to overspend by £0.622m. There are projected additional costs within Primary Care Contracting and Support £0.493m, due to a number of variances, including new Office 365 licence costs, additional spend related to the GP’s Sub-Committee and staffing costs. Primary Medical Services are projected to overspend by £0.688m, due to additional staffing costs, including increased pension and sickness cover costs. These projected additional costs are being partially offset by a projected underspend £0.170m against Ayrshire Urgent Care Services based on Summer/Winter module. Funding has been allocated to fully offset Urgent Care Pathway costs £0.823m, as well as Covid-19 Therapeutics of £0.274m, with costs projected at £0.233m. There is a £0.304m underspend in Dental services that reflects that staffing numbers are running at less than establishment. • Prison and Police Healthcare (Lead Partnership) The £0.106m projected overspend at month 4 is largely due to increase prescribing costs and is partially offset by reduced staffing costs. Prison prescribing was highlighted as a budget pressure as part of the 2025/26 budget. Both East and South Ayrshire IJBs have approved additional funding to offset this pressure however North Ayrshire IJB did not provide for this in their approved budget. The additional funding has not been allocated against the prescribing budget at this stage, with further pan-Ayrshire discussions to be undertaken to determine how to account for this in the current financial year and going forward. It is anticipated that the Prison and Police Healthcare projected overspend highlighted in this report will reduce as a consequence of this work. • Allied Health Professions (Lead Partnership) There is a projected underspend of £0.445m on AHPs services hosted by East Ayrshire for the current year, which mainly relates to staffing savings. • Other Services (Lead Partnership) The £0.146m projected overspend is due to increased Area Wide Evening Services costs, mainly due to additional staffing costs including high use of bank staff, which will require to be addressed going forward. • An initial financial recovery plan for East Hosted Services will be developed and progressed and will be brought to the IJB on 29 October 2025 for formal approval. This financial recovery plan will also require to be approved by North and South Ayrshire IJBs. Set Aside: - Work has been undertaken with partnerships to progress and develop set aside arrangements to fully implement the legislative requirement. This includes 214
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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 £488.0million. The directorate is overspent by £10.5 million after 4 months including legacy CRES. 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 £2.2m after 4 months. Within the overall £10.5m overspend Medicine are over by £4.5m, Emergency Care by £3.6m, Surgery by £1.0m, Labs and Diagnostics by £1.2m and Women and Children by £0.9m. Legacy CRES and underspends on other budgets make up the difference. 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. 215
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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. • Pay settlements for both NHS and Local Government staff have been agreed for 2025/26. The NHS element has been funded, and the current assumption is that the shortfall between budget planning assumptions and actual settlements will be fully funded for Local Government staff. • 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. • 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. 216
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• 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 services have been 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. 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: MANAGEMENT ACTIONS/CONTROLS AGREED IN 2024/25 217
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• 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. GOVERNANCE MEASURES AGREED IN 2024/25 • 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. MANAGEMENT ACTIONS/CONTROLS AGREED IN 2025/26 (AUGUST 2025) • 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. NEW ACTIONS: • The senior managers for the main areas of overspend have been tasked with preparing an SBAR reports to be considered at the PSMT. This will cover current action being taken to reduce the overspend and future planned action. This will inform the update to the month 6 recovery plan. These actions will 218
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be tracked each reporting period and if progress is not being made an update will be made to the finance working group and IJB. • The Director and Chief Finance Officer have started a rolling programme of one-to-one meetings with individual budget holders across the HSCP to consider opportunities for cost reduction, service change and any spend to save propositions – to support the development of the 2026/27 budget but also to identify further cost reductions for the current financial year. RECOVERY ACTIONS – MONTH 4 UPDATE • The updated recovery action is outlined in Appendix E. This includes the proposals agreed at month 3 and updated progress at month 4 and any changes to target reductions. The actions are a mix of cost reduction targets across various services and a drawdown of reserves. At month 3 the position was: 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 • At month 4 this has deteriorated to: TOTAL Health/ NHS AA Social Care/NAC Projected Overspend @ mth4 5.259 2.051 3.208 Financial Recovery Plan Projections (3.526) (1.275) (2.251) Residual Risk 1.733 0.776 0.957 • 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. 219
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3.3 Measuring Impact Ongoing updates to the financial position will be reported to the IJB throughout 2025- 26. 4. IMPLICATIONS 4.1 Financial The outturn is an overall year-end overspend of £5.259m (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. 220
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5.2 The IJB financial monitoring report is shared with the NHS Ayrshire and Arran Director of Finance and North Ayrshire Council’s Head of Finance after the report has been finalised for the IJB. Caroline Cameron, Director Author – Eleanor Currie, Chief Finance Officer [eleanorcurrie@north-ayrshire.gov.uk] 221
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PUBLIC INFORMATION 2025-26 Budget Monitoring Report–Objective Summary as at 31st July 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 £'000 £'000 COMMUNITY CARE AND HEALTH 77,507 80,514 3,007 21,108 22,431 1,323 98,615 102,945 4,330 4,124 206 : Locality Services 32,828 33,942 1,114 5,914 6,006 92 38,742 39,948 1,206 1,137 69 : Community Care Service Delivery 40,500 42,245 1,745 0 40,500 42,245 1,745 1,624 121 : Rehabilitation and Reablement 2,108 2,118 10 0 2,108 2,118 10 (21) 31 : Long Term Conditions 868 915 47 10,661 11,677 1,016 11,529 12,592 1,063 1,123 (60) : Community Link Workers 384 379 (5) 0 0 0 384 379 (5) (5) 0 : Integrated Island Services 819 915 96 4,533 4,748 215 5,352 5,663 311 266 45 MENTAL HEALTH SERVICES 40,722 41,195 473 79,392 79,524 132 120,114 120,719 605 940 (335) : Learning Disabilities 31,712 32,332 620 747 747 0 32,459 33,079 620 (424) 1,044 : Community Mental Health 7,015 6,861 (154) 1,831 1,831 0 8,846 8,692 (154) (95) (59) : Addictions 1,995 2,002 7 1,899 1,899 0 3,894 3,901 7 6 1 : HBCCC 0 0 0 353 0 (353) 353 0 (353) (353) 0 : Lead Partnership Mental Health NHS Area Wide 0 0 0 74,562 75,047 485 74,562 75,047 485 1,806 (1,321) CHILDREN & JUSTICE SERVICES 35,862 37,307 1,445 5,757 5,918 161 41,619 43,225 1,606 2,530 (924) : Irvine, Kilwinning and Three Towns 3,122 3,184 62 0 0 0 3,122 3,184 62 50 12 : Garnock Valley, North Coast and Arran 3,538 3,595 57 0 0 0 3,538 3,595 57 54 3 :Intervention Services 1,788 1,793 5 0 0 0 1,788 1,793 5 9 (4) : Care Experienced Children & Young people 22,550 24,465 1,915 0 0 0 22,550 24,465 1,915 2,857 (942) : Head of Service - Children & Families 1,336 769 (567) 0 0 0 1,336 769 (567) (548) (19) : Justice Services 3,099 3,099 0 0 0 0 3,099 3,099 0 0 0 : C&F Health Team 429 402 (27) 4,995 5,140 145 5,424 5,542 118 95 23 : Lead Partnership NHS Children's Services 0 0 0 762 778 16 762 778 16 13 3 CHIEF SOCIAL WORK OFFICER 1,954 1,750 (204) 0 0 0 1,954 1,750 (204) (205) 1 PRIMARY CARE 0 0 0 54,591 54,627 36 54,591 54,627 36 (69) 105 ALLIED HEALTH PROFESSIONALS 0 11,349 11,350 1 11,349 11,350 1 0 1 MANAGEMENT AND SUPPORT COSTS 10,510 8,997 (1,513) 3,223 3,710 487 13,733 12,707 (1,026) (1,115) 89 OUTTURN ON A MANAGED BASIS 166,555 169,763 3,208 175,420 177,560 2,140 341,975 347,323 5,348 6,205 (857) Return Hosted Over/Underspends to East 0 0 0 0 (159) (159) 0 (159) (159) (591) 432 Return Hosted Over/Underspends to South 0 0 0 0 (139) (139) 0 (139) (139) (517) 378 Receive Hosted Over/Underspends South 0 0 0 0 50 50 0 50 50 50 0 Receive Hosted Over/Underspends East 0 0 0 0 159 159 0 159 159 40 119 OUTTURN ON AN IJB BASIS 166,555 169,763 3,208 175,420 177,471 2,051 341,975 347,234 5,259 5,187 72 Over/ (Under) Spend Variance at Period 3 Movement in variance from Period 3 TOTAL Partnership Budget - Objective Summary Council Health 2025/26 Budget 222
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2025-26 Savings Tracker Appendix B Social Care: Ref Description Deliverability Status at budget setting Deliverability Month 4 2025/26 Saving Previously Agreed Savings (Full year impact) 1 Review of Day Care provision Green Blue 0.100 2 Service redesign (CAAST Team and Corporate Parenting team) Green Blue 0.034 Adjustments 3 Payroll Turnover Green Blue 0.099 Mental Health 4 LD Responder Service Amber Amber 0.150 Children, Families & Criminal Justice 5 Brighter Pathways Amber Red 1.000 Community Care & Health 6 Review of Day Care provision Amber Blue 0.107 7 Care at Home Amber 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 2.903 223
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Health: Ref Description Deliverability Status at budget setting Deliverability Month 4 2025/26 Saving Adjustments 13 Increase recharge to East Ayrshire for beds at Woodland View Green Blue 0.010 14 Payroll Turnover Green Blue 0.079 Other Savings 15 Admin Savings Amber Blue 0.186 16 Trindlemoss House - move to social care model Amber Amber 0.250 17 EICT/Rehab Amber Blue 0.150 18 Community MH/Wellbeing Review Amber Amber 0.100 19 Ward 7A - Woodland View Amber Amber 0.341 TOTAL HEALTH SAVINGS 1.116 TOTAL NORTH HSCP SAVINGS 4.019 224
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2025-26 Budget Reconciliation Appendix C COUNCIL Period Permanent or Temporary £'m Initial Approved Budget 137.739 Adjustments to baseline 0.014 Revised Budget 137.753 Resource Transfer 25/26 1-3 25.447 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 (0.002) Social Care Budget Reported at Month 4 166.555 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 (25.447) 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 0.174 225
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HEALTH Period Permanent or Temporary £'m Training Grade Adj - May 2 (0.013) Bwp 25-26 East Chest Heart Stroke 2 0.001 Bwp 25-26 East Nest Expansion 2 0.023 Bwp 25-26 East - Sds Advice Service 2 0.013 Bwp 25-26 East Sub Prescribing 2 0.170 25-26 South Budget Paper - North Substitute Prescribing 2 0.170 25-26 South Budget Paper - Pan Ayrshire Chest Heart And Stroke 2 0.001 25-26 North Budget Paper - Pan Ayrshire (vision Support Service 2 (0.005) 25-26 North Budget Paper - Pan Ayrshire (community store) 2 (0.155) HD52: EARLY INTERVENTION PSYCHOSIS 3 0.100 25-26 Pay Award Increase North 3 1.179 Training Grade Adjustment (Dean Funding) 4 0.011 Medical Pay Award - Senior Medical - Additional 1% 4 0.086 Medical Pay Award - Specialty Doctors - Additional 1% 4 0.006 Virement to Medical Directorate from Mental Health Admin 4 (0.028) Transfer MAT Standards Psychiatrist 0.2 WTE 4 0.029 Primary Care Prescribing Tariff Reduction 4 (0.556) BBV transfer from Public Health 4 0.269 ANTICIPATED BUDGETS INCL HERE (NOT IN LEDGER) 4 0.419 Roundings 0.001 Health Budget Reported at Month 4 175.420 TOTAL COMBINED BUDGET 341.975 226
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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 3,161 227
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Financial Recovery Action Plan Appendix E FINANCIAL RECOVERY PLAN £m £m Projected Overspend at Month 4 5,259 5,259 SERVICE AREA Orginal Cost reduction target Revised Target at Month 4 Achieved at Month 4 Still to be achieved Target set (IJB Date) Comment a) Care home placements (60) (568) 0 (568) August 2025 - month 3 report This will bring the overall budget for placements and charging order income online. b) Physical Disability Services (res, community and DPs) (575) 0 0 0 August 2025 - month 3 report Some PD residential packages £508K (prev £575K) have moved to the older people Care Home placements budget. The older people placements will need to manage this transfer within the existing budget. c) Specialist Rehab wards (75) (75) (24) (51) August 2025 - month 3 report Based on planned action developed by the senior manager. d) Wards 1 and 2 (275) (275) (44) (231) August 2025 - month 3 report Based on planned action developed by the senior manager. e) Care at Home (300) (300) 0 (300) August 2025 - month 3 report Reflects the potential reduction to costs as an impact of the SG investment in unscheduled care TOTAL (1,285) (1,218) (68) (1,150) a) Learning Disabilities 0 0 0 0 August 2025 - month 3 report b) Community Mental Health services 0 0 0 0 August 2025 - month 3 report c) Lead Partnership for Mental Health : - Adult Inpatients (150) (150) 0 (150) August 2025 - month 3 report Inpatient Review being undertaken - Elderly Inpatients (50) (150) (50) (100) August 2025 - month 3 report Inpatient Review being undertaken - Psychiatry (150) (150) (150) August 2025 - month 3 report Junior doctor rota still to be revised. - Action 15 Reserves (486) (486) (486) 0 August 2025 - month 3 report Draw down of the full pan Ayrshire reserve - agreed with the CFOs at East and South - Enhanced MH Outcome Framework Reserves (624) (624) (624) 0 August 2025 - month 3 report Draw down of the full pan Ayrshire reserve - agreed with the CFOs at East and South NORTH AYRSHIRE ELEMENT 38.65% (564) (603) (448) (155) August 2025 - month 3 report TOTAL (564) (603) (448) (155) 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. 228
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FINANCIAL RECOVERY PLAN SERVICE AREA Orginal Cost reduction target Revised Target at Month 4 Achieved at Month 4 Still to be achieved Target set (IJB Date) Comment Children and Justice Services a) Residential Placements (1,000) (1,000) 0 (1,000) August 2025 - month 3 report Based on some placements moving to tenancies and other placements moving from external to in-house provision. TOTAL (1,000) (1,000) 0 (1,000) ALLIED HEALTH PROFESSIONALS 0 0 0 0 August 2025 - month 3 report No cost reduction proposed but the service need to maintain the current position. CHIEF SOCIAL WORK OFFICER 0 0 0 0 August 2025 - month 3 report No cost reduction proposed but the service need to maintain the current position. MANAGEMENT AND SUPPORT a) Payroll turnover (200) (200) 0 (200) August 2025 - month 3 report Increase to the current projection based on dragging vacancies for 4 weeks after vacancy scrutiny approval. b) Transition slippage (100) (100) (17) (83) August 2025 - month 3 report Based on historic slippage. c) Contractual inflation (25) (100) 0 (100) August 2025 - month 3 report TOTAL (325) (400) (17) (383) OTHER AREAS b) Agenda for Change - assume fully funded (838) (838) 0 (838) August 2025 - month 3 report Based on 100% cost of the half hour reduction in working week being funded. (838) (838) 0 (838) TOTAL RECOVERY ACTION (4,012) (4,059) (533) (3,526) Remaining projected overspend 1,733 229
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Bank and Agency Costs to Month 4 Appendix F Bank and Agency Costs M1-4 2025-26 1) NHS 4863 (Registered) 4864 (Unregistered) 4853 (Registered) 4854 (Unregistered) TOTAL Average per month NORTH CORE SLT ADULT 2,243 2,243 561 WARD 1 WOODLANDS VIEW 13,014 105,966 118,980 29,745 WARD 2 WOODLANDS VIEW 10,433 163,458 173,891 43,473 ACH REDBURN REHAB WARD NRS 13,388 67,121 80,509 20,127 ACH DOUGLAS GRANT REHAB WD NRS 10,033 15,926 25,959 6,490 WARD 3 WOODLANDS VIEW NURSING 4,009 163,350 167,359 41,840 WARD 4 WOODLANDS VIEW NURSING 682 14,566 15,248 3,812 NEW CLONBEITH NURSING(JURA) 42,815 35,539 78,354 19,589 WVIEW THE GLEN ECT 1,854 1,095 2,949 737 WVIEW WARD 10 ACUTE MH NRS 1,342 65,584 66,926 16,732 WVIEW WARD 8 ACUTE MH NRS 7,224 348,128 355,352 88,838 WARD 5 WOODLANDS VIEW 358 7,738 8,096 2,024 WVIEW WARD 7B REHAB MH NRS 2,302 2,302 576 NEW DUNURE NURSING(CLONBEITH) 15,397 57,881 73,278 18,320 MH BED MANAGEMENT 5,180 5,180 1,295 TRINDLEMOSS 25,494 80,544 106,038 26,510 ARRAN HOSPITAL NURSING 24,985 16,973 41,958 10,490 CAMHS UNSCHEDULED CARE 589 589 147 EARLY YRS-C/F TEAM 1 599 599 150 PACKAGE OF CARE (P) - AMG 47,860 47,860 11,965 PACKAGE OF CARE (P) - LMO 312 312 78 ARRAN DN 12,413 12,413 3,103 NC POC TEAM 2 990 990 248 NC POC TEAM 3 2,701 2,701 675 THREE TOWNS DN 101- 101- 25- IRVINE DN 11,776 11,776 2,944 NORTH WEST COAST DN 15,024 15,024 3,756 GARNOCK VALLEY DN 30,150 30,150 7,538 NORTH AHP MANAGEMENT TEAM 3,515 3,515 879 LADY MARGARET NURSING 5,274 2,873 8,147 2,037 PREVENTION + SERVICES SPT TEAM 2,397 2,397 599 LD HEALTH CHECKS 12,238 12,238 3,060 NORTH CLDT 5,777 164 5,941 1,485 LDS MANAGEMENT 2,286 2,286 572 MHANPS MH UNSCHEDULED CARE 1,720 1,720 430 MHS INPATIENT MGT 15,722 210 15,932 3,983 CMHT NURSING-NORTH AYRSHIRE 1,697 1,697 424 WVIEW WARD 7C FORENSIC REHAB N 2,207 39,395 41,602 10,401 INTENSIVE COMMUNITY NURSING TEAM 13,430 335 13,765 3,441 ADULT MENTAL HEALTH LIASION TEAM 13,881 13,881 3,470 PCMHT NORTH 1,798 1,798 450 WVIEW WARD 6 LOW SECURE NRS 14,683 54,904 69,587 17,397 WARRIX AVE 30,178 29,983 60,161 15,040 ICFN - COMMUNITY PHLEBOTOMY 4,709 4,709 1,177 WVIEW WARD 7A LD A+T NRS 25,422 25,422 6,356 WVIEW WARD 9 ACUTE MH NRS 11,528 11,528 2,882 WVIEW WARD 11 ACUTE MH NRS 11,631 11,631 2,908 WVIEW WARD 7A LD A+T NRS 402,876 1,804 14,532 419,212 104,803 WVIEW WARD 9 ACUTE MH NRS 107,700 107,700 26,925 WVIEW WARD 11 ACUTE MH NRS 48,625 48,625 12,156 419,132 1,894,961 1,804 14,532 2,330,429 2) SOCIAL CARE Month 4 Agency Cost Montrose House 128,839 Mh Acm 13,606 Ld Acm 13,864 TOTAL 156,309 Bank Agency 230
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Integration Joint Board 25th September 2025 Subject : IJB - Reserves Policy Purpose : To consider the IJB Reserves Policy following review. Recommendation : The IJB is asked to approve the Reserves policy. 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 1. EXECUTIVE SUMMARY 1.1 The IJB’s Reserves Policy outlines the statutory and regulatory framework for reserves and the operation of reserves. 2. BACKGROUND 2.1 The current reserves policy was approved in 2022 and is due for review. 2.2 The purpose of a reserves policy is to: • outline the legislative and regulatory framework underpinning the creation, use or assessment of the adequacy of reserves; • identify the principles to be employed by the IJB in assessing the adequacy of the IJB’s reserves; • indicate how frequently the adequacy of the IJB’s balances and reserves will be reviewed; and • set out arrangements relating to the creation, amendment and use of reserves and balances. • 3. PROPOSALS 3.1 The IJB Reserves Policy has been reviewed and there are no planned changes to the policy. Agenda Item 12 231
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The role, function and purpose for holding reserves has not changed, with CIPFA guidance outlining the framework for reserves, the purpose of reserves and some key issues to be considered when determining the appropriate level of reserves. There is no guidance on the minimum level of reserves that should be held. In determining the prudential target, the Chief Finance Officer/Section 95 Officer must take account of the strategic, operational and financial risks facing the IJB over the medium term and the IJB’s overall approach to risk management. Whilst it is generally accepted that it is prudent to hold between 2-4% of contingency or free general fund reserves there is no inclusion of this within the Reserves Policy on the basis of consideration of this as part of the budget setting process. 3.2 Anticipated Outcomes Improved governance and clarity around the operation of reserves. 3.3 Measuring Impact The level of reserves will be considered as part of the budget setting process each year and be formally approved by the IJB. 4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic None 4.5 Risk The report falls in line with the agreed risk appetite statement which is a low-risk appetite in respect to adherence to standing financial instructions, financial controls and financial statutory duties. 4.6 Community Wealth Building None 4.7 Key Priorities None 5. CONSULTATION There was no consultation required or undertaken. Eleanor Currie, Chief Finance Officer – Finance at eleanorcurrie@north-ayrshire.gov.uk Appendices • Appendix 1, Reserves Policy 232
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North Ayrshire Integration Joint Board Reserves Policy Date Effective: September 2025 Review Date: September 2028 233
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1. Background 1.1 To assist local authorities (and similar bodies) in developing a framework for reserves, CIPFA have issued guidance in the form of the Local Authority Accounting Panel (LAAP) Bulletin 55 – Guidance Note on Local Authority Reserves and Balances. This guidance outlines the framework for reserves, the purpose of reserves and some key issues to be considered when determining the appropriate level of reserves. As the North Ayrshire IJB has the same legal status as a local authority, i.e. a section 106 body under the Local Government (Scotland) Act 1973 Act, and is classified as a local government body for accounts purposes by the Office of National Statistics (ONS), it is able to hold reserves which should be accounted for in the financial accounts and records of the IJB. 1.2 The purpose of a reserve policy is to: • outline the legislative and regulatory framework underpinning the creation, use or assessment of the adequacy of reserves; • identify the principles to be employed by the IJB in assessing the adequacy of the IJB’s reserves; • indicate how frequently the adequacy of the IJB’s balances and reserves will be reviewed; and • set out arrangements relating to the creation, amendment and use of reserves and balances. 1.3 In common with local authorities, the IJB can have reserves within a usable category. 2. Statutory/Regulatory Framework for Reserves Usable Reserves 2.1 Local Government bodies - which includes the IJB for these purposes - may only hold usable reserves for which there is a statutory or regulatory power to do so. In Scotland, the legislative framework includes: Usable Reserve Powers General Fund Local Government Scotland Act 1973 2.2 For each reserve there should be a clear protocol setting out: • the reason / purpose of the reserve; • how and when the reserve can be used; • procedures for the reserves management and control; and • the review timescale to ensure continuing relevance and adequacy. 234
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3. Operation of Reserves 3.1 Reserves are generally held to do three things: • create a working balance to help cushion the impact of uneven cash flows – this forms part of general reserves; • create a contingency to cushion the impact of unexpected events or emergencies – this also forms part of general reserves; and • as a means of building up funds, often referred to as earmarked reserves, to meet known or predicted liabilities. 3.2 The balance of the reserves normally comprises of three elements: • funds that are earmarked or set aside for specific purposes. In Scotland, under Local Government rules, the IJB cannot have a separate Earmarked Reserve within the Balance Sheet, but can highlight elements of the General Reserve balance required for specific purposes. The identification of such funds can be highlighted from a number of sources: o future use of funds for a specific purpose, as agreed by the IJB; or o commitments made under delegated authority by Chief Officer, which cannot be accrued at specific times (e.g. year end) due to not being in receipt of the service or goods; • funds which are not earmarked for specific purposes, but are set aside to deal with unexpected events or emergencies; and • funds held in excess of the target level of reserves and the identified earmarked sums. Reserves of this nature can be spent or earmarked at the discretion of the IJB. 3.3 The Integration Scheme outlines that where there is an underspend in the operational budget that this can either fund additional capacity in-year or be carried forward to fund capacity in future years. Any final underspend in the operational budget in-year will be credited to IJB General Fund reserve. 4. Role of the Chief Finance Officer 4.1 The Chief Finance Officer is responsible for advising on the targeted optimum levels of reserves the IJB would aim to hold (the prudential target). The IJB, based on this advice, should then approve the appropriate reserves strategy as part of the budget process. 5. Adequacy of Reserves 5.1 There is no guidance on the minimum level of reserves that should be held. In determining the prudential target, the Chief Finance Officer must take account of the strategic, operational and financial risks facing the IJB over the medium term and the IJB’s overall approach to risk management. 235
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5.2 In determining the prudential target, the Chief Finance Officer should consider the IJB’s Strategic Plan, the medium term financial outlook and the overall financial environment. Guidance also recommends that the Chief Finance Officer reviews any earmarked reserves as part of the annual budget process and development of the Strategic Plan. 5.3 In light of the size and scale of the IJB’s responsibilities, over the medium term it is proposed to hold a prudent level of general reserves. This value of reserves must be reviewed annually as part of the IJB Budget and Strategic Plan; and in light of the financial environment at that time. Where it is assessed that the financial environment at the time of setting the budget does not support a prudent level of reserves to be held this should be reported to the IJB together with an aspirational reserves position. The level of other earmarked funds will be established as part of the annual financial accounting process. 5.4 The Integration Scheme states that where there is an overspend in the operational budget the Parties will consider making interim funds available to the IJB. Where funds are not provided and the IJB has insufficient General Fund reserves the IJB may report a negative reserves position on the Balance Sheet. This position must be addressed with a plan agreed between the IJB and the Parties in relation to future plans to address the negative reserves position. 6. Reporting Framework 6.1 The Chief Finance Officer has a fiduciary duty to ensure proper stewardship of public funds. 6.2 The level and utilisation of reserves will be formally approved by the IJB based on the advice of the Chief Finance Officer. To enable the IJB to reach a decision, the Chief Finance Officer should clearly state the factors that influenced this advice. 6.3 As part of the budget report the Chief Finance Officer should state: • the current value of general reserves, the movement proposed during the year and the estimated year-end balance and the extent that balances are being used to fund recurrent expenditure; • the adequacy of general reserves in light of the IJB’s Strategic Plan, the medium term financial outlook and the overall financial environment; • an assessment of earmarked reserves and advice on appropriate levels and movements during the year and over the medium term; and • if the reserves held are under the prudential target, that the IJB should be considering actions to meet the target through their budget process. 236
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7. Accounting and Disclosure 7.1 Expenditure should not be charged directly to any reserve. Any movement within Revenue Reserves is accounted for as an appropriation and is transparent. Entries within a reserve are specifically restricted to ‘contributions to and from the revenue account’ with expenditure charged to the service revenue account. 237
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Integration Joint Board 25th September 2025 Subject : Financial Inclusion Strategy 2025-30 Purpose : To provide an update on progress relating to the Financial Inclusion Strategy 2023-28 and present an updated Strategy for 2025-30. Recommendation : That the IJB notes the positive progress and approves the Financial Inclusion Strategy for 2025-30 Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required 2. North Ayrshire Council X 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership FIO Financial Inclusion Officer 1. EXECUTIVE SUMMARY 1.1 Following a review of Financial Inclusion services in 2022, Money Matters and the Welfare Reform Advice team came together to form a new Financial Inclusion service within the HSCP. A new temporary Senior Manager (Financial Inclusion) post was created to develop a Financial Inclusion Strategy for 2023-28 (approved by Cabinet in March 23) and to lead on integrating the teams. The Senior Manager worked with the Transformation Team and Project Board on systems development, review of practice and processes and improving delivery models and established a Financial Inclusion Partnership. A non-recurring budget to cover the costs of the temporary Senior Manager post, contracting out debt advice services for two years and other costs associated service developments was agreed by Cabinet in March 2023. 1.2 Over the last two years our ambitions have been achieved. In December 2024, a report was submitted to the Integration Joint Board detailing recommendations for implementation by 1 May 2025 which were approved and have now been implemented. These include the rebranding of the Financial Inclusion service as Money Smart, the move of Money Matters from a universal service to one targeting priority groups, a restructure of the team and the creation of an in-house debt advice service for non-council tenants. Agenda Item 13 239
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AdvicePro, is now in use across the Money Smart team and a new Performance Management and Quality Assurance Framework has been integrated with AdvicePro. The Advice Line delivery model has been reviewed and a new, more client-centred model introduced in May 25. The Financial Inclusion Partnership was established in May 2023 and is much valued by the 21 member agencies for information sharing, learning and networking. 1.4 A Financial Inclusion Strategy for 2025-30 has now been produced and is attached with this report for the approval of the IJB. 1.5 The Money Smart team continue to achieve significant financial gains for residents in North Ayrshire with a total of £27.2m of financial gains reported for 2024-25. 2. BACKGROUND 2.1 As part of the Council’s Transformation Programme and in response to the Cost-of- Living crisis, a review of Financial Inclusion services across the Council was progressed during 2022. The outcomes included recommendations that a temporary Senior Manager post be created and that Money Matters and the Welfare Reform Advice Team (formerly in Housing Services) should form a new Financial Inclusion team within the Health and Social Care Partnership. 2.2 In January 2023, the new Senior Manager took up post. An interim Financial Inclusion Strategy for 2023-28 was approved by Cabinet in March 2023, detailing key intentions for 2023-24, and the new Financial Inclusion team was formed on 1 April 2023. The Project had Chief Officer Sponsorship within the HSCP, recognising the importance of ensuring the development of financial inclusion services, this was progressed at pace 2.3 The Senior Manager led on integrating the teams and worked with the Transformation Team and Project Board to review and implement a new case management system (CMS), whilst reviewing and implementing new, more efficient, processes and delivery models and developing a Performance Management and Quality Assurance Framework to be integrated in the new CMS. The Financial Inclusion strategy was reviewed and updated following a public and stakeholder consultation process. 3. PROGRESS OF THE IMPLEMENTATION OF THE FINANCIAL INCLUSION STRATEGY 2023-28 3.1 The new North Ayrshire Financial Inclusion Partnership was established in May 2023 and now has representation from 21 different services or agencies. A working group was established to develop and deliver a community and stakeholder consultation to inform a review and refresh of the Strategy. This was carried out in October/November 2023 and the findings incorporated into the Strategy for 2025-30. 240
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A Fuel Poverty sub-group was established in 2024 followed by a Communications sub-group at the start of 2025 to take a joint approach to promotion of services and the key issues impacting on our residents. The Partnership brought new opportunities to improve partnership working and referral pathways and a review conducted at the end of 2024 found that it is valued by members for information sharing, learning and networking. A Partnership Action Plan has been developed and is incorporated into the Strategic Ambitions for 2025-30. 3.3 In 2024, as part of the ‘Accessing our Council’ initiative, Welfare Rights and Money Advice was incorporated into the online Corporate Referral Pathway developed and implemented by the Transformation Team, with pathways effectively established. From 1st May 2025 Money Smart calls were routed through the main council number with both the Money Matters adviceline and Welfare Reform Team numbers being phased out. A single point of contact has been developed for Money Smart calls, emails and referral form. 3.4 Following a technical appraisal carried out by the Transformation Team, AdvicePro, a system designed by and for the advice sector and already in use by the Welfare Reform Advice Team, was expanded to include Money Matters and went live on 30 September 2024. 3.5 AdvicePro incorporates the new Performance Management and Quality Assurance framework which supports a standardised approach to data capture and reporting, a systematic approach to service development and to encourage a culture of continuous improvement. 3.6 A total of £753,000 was approved by Cabinet in March 2023 aligned to progressing the strategy and the commissioning of debt advice services. The detail of the funding sources is detailed below: Funding agreed Source £258,000 Cost of Living budget £380,000 Employability earmarked reserves (originally the Better Off demonstrator budget) £15,000 NAC ‘Islands Budget’ £100,000 Funding allocated as part of NAC budget 2023-24 (up to £100k) £753,000 TOTAL 241
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Actual expenditure to 30 June 2025 is £633k with any remaining cost commitments being within the £753k allocated by North Ayrshire Council with the remaining balance being held in Council earmarked reserves. 3.7 In December 2024, a report was submitted to the Integration Joint Board detailing recommendations for implementation by 1 May 2025 which were approved and have now been implemented. This includes: A re-branding and re-launch of the Financial Inclusion team under the new name of Money Smart The CHAP two-year contract to provide debt advice to non-council tenants came to an end on 30 June 2025 Debt Advice for non-council tenants has been added to the debt advice service available to council tenants. This allows us to make debt advice available to non- council housing tenants who approach the service for Welfare Rights advice but also need help with debts The Money Matters delivery model has moved from a universal service to one targeting priority groups. This includes referrals from HSCP/NHS/NAC and third sector, and self-referrals from people who have disabilities or dependent children, are pregnant or carers, or are from minority ethnic groups. These groups represented around 82% of clients in 2024-25. A restructure of the Financial Inclusion team, including management. The restructure incorporated the removal of a number of posts through a VER process and staff movement. 3.8 Despite the move from a universal to a targeted service, referrals numbers have not reduced, indicating that some non-priority groups are open to services. Referrals to date to the service are detailed below: Money Smart Referrals 25/26 Total HSCP HRA Apr 520 365 155 May 530 361 169 June 498 359 139 July 528 342 186 Money Smart have received only 11 ineligible self-referrals since May 2025, of these, individuals have either been referred on to other alternative providers and supports or have been provided with advice only. Referrals continue to be managed by the recently integrated teams with the introduction of AdvicePro, implementation of our new delivery model, and adjustments to the way that work is distributed having been designed to ensure continuity and efficiency. While the workforce has been reduced, the new structure has been 242
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designed to streamline processes, eliminate duplication, and use digital technology to assist with routine tasks. 4. The Financial Inclusion Strategy and Ambitions for 2025-30 4.1 The development of the strategy was informed by community and stakeholder consultation as well as engagement with staff and key service leads including Child Poverty, Community Wealth Building and Housing services. 4.2 Economic Context – Recent data for 2023-24 confirms that child poverty in Scotland has fallen from 26% to 22%, this is largely attributed to Scottish Government policy interventions and contrasts with a wider upward trend across the rest of the UK. However, ongoing welfare reforms continue to pose a significant risk of income loss and the households most likely to experience high poverty rates often are those reliant on benefits. North Ayrshire recorded the second highest rate of child poverty in Scotland with 29.2% of children living in poverty (after housing costs). Across Scotland, data for 2021-24 indicates that around 75% of children living in poverty were in families where at least one parent was working. There is evidence of a decline in workers earning below the living wage in North Ayrshire between 2018-22, demonstrating that employment does not necessarily guarantee a pathway out of poverty for many families. Poverty continues to be a significant challenge across Scotland and particularly in North Ayrshire. 4.3 Tackling Poverty – the role of Financial Inclusion services Unclaimed benefits across Britain were estimated to be around £23 billion in 2024, this excludes unclaimed disability benefits and discretionary support which have not yet been assessed (Poverty in Practice 2024). Benefits go unclaimed for many reasons including a lack of awareness, an assumption of ineligibility, the complexity of the welfare rights system, digital exclusion and stigma. Welfare Rights advice services break down those barriers. Debt repayments are not deducted from income for the purposes of determining whether a household is in income poverty. They do however reduce the level of household disposable income and increase the risk of material deprivation. Debt Advice services offer options for managing debt more effectively and in some cases, debt can be reduced or written off. 4.4 Demand for services 1. The Money Smart welfare rights and debt advice service dedicated to council tenants (formerly known as the Welfare Reform Advice Team) is funded through the Housing Revenue Account through a Service Level Agreement for 2025-30 with Housing Services. This service saw a significant increase in demand between 2023-24 and 2024-25, continuing the pattern of year on year increases for the last five years. Demand included: • A 28% increase in referrals to the Welfare Rights and Debt Advice service. 1889 referrals were received (self-referrals from tenants doubled) and 72% of 243
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these resulted in cases being allocated. Complex (multiple) debt cases also increased. • Referrals to the Financial Inclusion Officers (FIOs) through the DWP Landlord’s Portal (managed by the service) for support with Universal Credit (UC) claims increased from 2,140 to 2,334. FIOs also receive referrals from Housing Services for ‘pre-tenancy checks’ for new tenants. Officers can explain changes to benefits arising from taking on a tenancy, provide support with Universal Credit claims, provide advice on managing household budgets and help tenants access grants/furnishings for their new home. Those referrals halved in number during 2024-25 due largely to the increase in vacated council properties being allocated to those who are homeless and who receive this support from the Housing support team. However, this was a temporary measure and referrals to the FIOs are anticipated to increase again during 2025-26. Financial Gains of £5.7m were secured in 2024-25 for council tenants, an increase of 50% on 2023-24. 2. The Money Smart welfare rights service (formerly known as Money Matters and which was open to all North Ayrshire residents in 2024-25) has maintained a high level of referrals for the last five years with a total of 5,433 referrals across the year. 44% were from HSCP/NHS and 45% were self-referrals (or from a family member/friend). Around 70% engaged with the service and received advice and support. 811 of the referrals from HSCP were for financial assessments – 653 for non- residential charging and 158 for kinship carers. Full breakdown of HSCP referrals opposite. £21.5m in Financial Gains were achieved for 2024-25. 244
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4.5 Funded projects • GP practices – Through this Scottish Government initiative launched in 2022, funding has been granted to support the development and embedding of welfare rights advisers in nine priority mainland GP practices, which was extended in 2023 to include the island practices on Arran and Cumbrae. The delivery model has proven effective and efficient with high levels of engagement. Over £3m in financial gains was achieved last year (this is included in the £21.5m above) for the 536 patients referred by Practice staff (additional to the 5,433 referrals from other sources). • Schools – Through funding from Education services which started in October 2021, a named Adviser with a direct referral pathway was dedicated to engaging parents through secondary schools and through increased funding, last year three named advisers now incorporate primary schools and early years centres. Last year a total of 259 parents with school age children benefitted from this investment, through direct referrals from parents or schools or from HSCP social work teams who referred direct to the project. £560,509 in financial gains was achieved for those parents, an increase of 46% on 2023- 24. (included in the £21.5m above) • Foodbanks and Larders - Since April 2021, the Trussell Trust has been funding advisers to support those who access foodbanks and larders. Initially this was one adviser, but funding was expanded to add a second, and they now provide services in 14 foodbanks and larders across North Ayrshire. 128 foodbank/larder users received welfare rights advice through this project in 2024-25 and an additional 76 referrals were received direct from the foodbanks. 4.6 Feedback from a recent Money Smart beneficiary: “Thank you to everyone who supported me. They went over and above to be extremely helpful, compassionate and understanding. I feel like [my case worker] has literally saved my life and given me hope. She explained everything in such a calm and reassuring way and has calmed me down so much. The process of dealing with DWP has been very stressful and frightening as I have worked most of my 245
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life. She has given me a reason to live and that I am not hopeless by treating me so kindly like a normal person. The huge problems that seemed impossible to face as I kept asking for help and getting nowhere until [the team] changed my life for the better are now being looked at. [My case worker] kept in contact and consistently been available and kindly given her time and advice and also a lot of other helpful information. Thanks to her I have been focussing on health, eating and sleeping properly and hopefully will be able to get a job in the future. Thank you. I cannot thank you and your staff enough”. 4.7 Priorities and Ambitions to 2030 • Early and Effective Support: o Advisers within GP practices will be mainstreamed in the lead up to the external funding ending. o We will build on established referral pathways through named workers within primary and secondary schools and early learning centres. o We will take referrals from Housing for tenants in, or at risk of being in rent arrears o We will continue co-location within key HSCP services o We will continue the Advice Line delivery model established in May 25, through which ‘duty’ advisers answer calls at the point of contact. o We will continue to challenge stigma and fear as barriers to engagement and raise awareness of all available advice and wider financial inclusion services across North Ayrshire through the continuation of our Financial Inclusion Partnership • Wellbeing – Enabling Communities: o We will empower service users by pro-actively measuring customer satisfaction and seeking customer feedback. This will help us to identify potential service improvements and inform the content of campaigns and decision making o We will build financial resilience through the provision of welfare rights and debt advice services o We will support new tenants to maximise their income and sustain their tenancies o We will continue to build on the holistic approach to identifying and actioning wider and underlying issues to improve health and wellbeing • Tackling Inequalities through Community Wealth Building o We will reach out to marginalised individuals within our communities to improve accessibility and support engagement, in particular those in our 246
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island communities, minority ethnic groups and gypsy/traveller communities. o We will gather evidence of the number of clients who, as a result of the advice and support received, are more confident managing their household budget and feel better prepared for unplanned and planned expenditures. • Develop and Support our Workforce o Through the Performance Management and Quality Assurance framework we will encourage and support a culture of continuous improvement and enable the production of public performance reports which evidence the totality of our work and outcomes achieved for our customers. o We will Achieve accreditation to the Scottish National Standards for Information and Advice Providers to evidence to funders and to the public, of the high-quality services delivered by our team o We will seek opportunities to use technology where appropriate, to deliver more efficient and effective services and to maximise the use of resources Through the Financial Inclusion Partnership, we will continue to share information, knowledge and learning to enhance all services. 4.8 Anticipated Outcomes Through our strategic ambitions, Money Smart will contribute to the North Ayrshire council ‘No Wrong Door’ approach to improving access to services and ultimately to the aim of a sustained decrease in the number of people, and children in our communities living in poverty. 4.9 Measuring Impact Through our Performance Management and Quality Assurance Framework we will produce public performance reports which evidence the totality of our work and the outcomes achieved for people in our communities Through pro-actively measuring customer satisfaction we will evidence the value of our work from the customer perspective. Through our new ‘exit forms’ sent through AdvicePro when cases are closed, we will gather evidence of the extent to which the advice and support received by our teams has resulted in clients being more confident in managing their household budgets and feel better prepared for unplanned and planned expenditures. This will provide an indication of sustainable positive outcomes and impacts on child poverty. 5. IMPLICATIONS 5.1 Financial No direct financial impact for services, the report updates that the savings and changes to the Money Smart team previously approved by the IJB have been delivered in full. The report also highlights that in 2024-25 financial gains of £27.2m have been achieved for North Ayrshire residents by the Money Smart team. 247
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5.2 Human Resources “None”. 5.3 Legal “None”. 5.4 Equality/Socio-Economic ‘Financial inclusion’ refers to the ability of individuals to access appropriate financial services or products to manage their money effectively, sustain their homes, build savings for unplanned expenditures, be financially resilient, and more confident in making informed life choices. Financial exclusion is closely linked with poverty and social exclusion and is a significant contributor to child poverty. Poor financial wellbeing impacts on all aspects of life and can leave lasting damage on future life chances. Financial inclusion services enable and empower people to access the information, advice and support they need to maximise and effectively manage their disposable income, to be less likely to fall behind with bills, more able to deal with unexpected expenses, have improved mental and physical health and to become more active in their communities. Ultimately, they enable people to have the knowledge, skills and confidence to feel more secure and in control of their personal finances, both day to day and when future planning. Our Financial Inclusion strategy sets out how in North Ayrshire we continue to seek to improve our approach in partnership with wider partners through the Financial Inclusion Partnership to better support and meet these needs for our residents. 5.5 Risk No risk factors 5.6 Community Wealth Building The Financial Inclusion team supports the wellbeing economy by taking a people centred approach to service delivery and developments to ensure that the service is inclusive and people-centred. This includes the addition of the internal debt advice resource to provide a seamless pathway to debt advice for people who seek welfare rights but also require help with debts. The new delivery model and single point of access for Money Smart will ensure that the service is inclusive, particularly for the most vulnerable people in North Ayrshire communities. 5.7 Key Priorities Aligns with our IJB Strategic Plan priorities including providing early and effective support and addressing inequalities for our residents. 6. CONSULTATION The Financial Inclusion Partnership developed and delivered a Community Consultation late in 2023 to hear from our residents what they want from advice and wider financial inclusion services and to help inform the development of this strategy. A total of 177 responses were received from North Ayrshire residents, 57 of whom 248
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had accessed at least one advice service (44 had been to Money Matters, 7 to WRAT and 7 to CHAP) Services were highly rated for accessibility, response times and communications. 80% said they got more help than expected. 15 stakeholder agencies/services were also consulted, and the responses reinforced the positive views of advice services expressed by most of those who responded to the community consultation. There were high levels of trust in the quality of services and effective and efficient referral pathways and response times were valued. “You Said: We will”: Where both debt and welfare rights advice was needed, accessing both through one service is preferred A Welfare Rights and Debt Adviser for non-council tenants has been added to the service to ensure that all those who access our services can receive both welfare rights and debt advice without the need to refer to an external provider. Engaging with the same person is preferred when receiving advice and support The ‘named worker’ model has been expanded over the last two years. Some respondents said they did not know where to go for the help they needed or did not think there are services for homeowners.Stakeholders said that more effective promotion is needed as people they refer often do not know such services exist. A Communications sub-group of the Financial Inclusion Partnership has now been formed to take a cross-sector approach to promoting services more effectively. The launch of Money Smart, with single points of contact for all services will improve both accessibility and awareness. Poor physical or mental health is a barrier to accessing services We will more effectively promote the range of options for accessing services We need welfare rights advice on Arran. We have developed more services for island communities and will continue to seek options to improve accessibility You want more help with form-filling for claiming benefits This has been reviewed and more support with form-filling is now provided internally. Links with gypsy/traveller communities need to be improved We are now promoting our services through the Tenancy Chat for Gypsy Travellers and seeking options to improve engagement with those living in encampments. Stigma and fear of your situation getting worse are barriers to engagement This will be addressed through a Communications Plan for 2025-26 Caroline Cameron, Director Author: Annie Johson, Principal Manager Business Support Services Appendices Financial Inclusion Strategy 2025-30 249
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1 OFFICIAL INFORMATION OFFICIAL INFORMATION North Ayrshire Financial Inclusion Strategy 2025-30 250
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2 OFFICIAL INFORMATION OFFICIAL INFORMATION Contents 1. Introduction............................................................................................... 3 2. Alignment with HSCP Strategic Ambitions ............................................... 4 2.1 Enable Communities..................................................................... 4 2.2 Develop and support our Workforce ............................................. 4 2.3 Provide Early and Effective support .............................................. 4 2.4 Improve Health and Wellbeing ...................................................... 4 2.5 Tackle inequalities ........................................................................ 4 3. Our Interim Plan 2023-25 ......................................................................... 5 4. Economic context ..................................................................................... 7 5. Tackling Poverty – The Role of Financial Inclusion.................................. 8 5.1 Income from Social Security - the ‘take-up’ of social security entitlements ........................................................................................ 9 5.2 Costs of living – Fuel Poverty ..................................................... 10 5.3 Costs of Living - Unmanageable debt ......................................... 11 5.4 Costs of Living - Access to affordable credit and savings .......... 11 5.5 The Poverty Premium in North Ayrshire ..................................... 11 6. Advice Services in North Ayrshire .......................................................... 12 6.1 HSCP Financial Inclusion ........................................................... 12 6.1.1 The Welfare Reform Advice Team ................................. 12 6.1.3 Money Smart .................................................................. 16 6.2 CHAP ........................................................................................ 17 6.3 1st Alliance Community Bank – Progressive Finance ................ 17 6.4 Lemon Aid .................................................................................. 18 7. Developing the Plan for 2025-30 ............................................... 19 8. Vision, Mission and Core Values ............................................... 20 9. Money Smart Priorities and Ambitions to 2030 .......................... 22 Contact Information for Advice and Financial Inclusion Services ..... 25 Links ................................................................................................. 26 References ....................................................................................... 26 251
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3 OFFICIAL INFORMATION OFFICIAL INFORMATION 1. Introduction ‘Financial inclusion’ refers to the ability of individuals to access appropriate financial services or products to manage their money effectively, sustain their homes, build savings for unplanned expenditures, be financially resilient, and more confident in making informed life choices. Financial exclusion is closely linked with poverty and social exclusion and is a significant contributor to child poverty. Poor financial wellbeing impacts on all aspects of life and can leave lasting damage on future life chances. Low-income households are most at risk from the cost-of-living crisis, and people with disabilities, lone-parent households, carers and people from minority ethnic backgrounds are the most financially vulnerable. They are less likely to have savings that would cover their outgoings for more than a month should they lose their job and are most likely to have unmanageable debt. There is also a gendered dimension to the cost-of-living crisis. Women are more likely to live in lone-parent households (92%), as well as in households with an unpaid carer and larger households and can be more exposed to cost of living pressures. Financial inclusion services enable and empower people to access the information, advice and support they need to maximise and effectively manage their disposable income, to be less likely to fall behind with bills, more able to deal with unexpected expenses, have improved mental and physical health and to become more active in their communities. Ultimately, they enable people to have the knowledge, skills and confidence to feel more secure and in control of their personal finances, both day to day and when future planning. A financially healthy North Ayrshire is not only beneficial for individuals, but also for their families, communities, businesses and the economy. North Ayrshire Council and the Health and Social Care Partnership take pride in a co-production approach to strategic planning, through having meaningful conversations with people in our communities. Engagement with the public, service users, staff and key stakeholders was progressed in the second half of 2023, responses from which have informed the development of this Plan. The Financial Inclusion Strategy is closely aligned with North Ayrshire Council’s strategic aim to “Transition to a wellbeing economy, delivering prosperity, wellbeing and resilience for local people” A wellbeing economy is one that delivers fair distribution of wealth and opportunities within a healthy environment. The vision of North Ayrshire Council is for a North Ayrshire that is ‘Fair for All’ with a Mission of “Working Together to improve the lives of our people in North Ayrshire” 252
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4 OFFICIAL INFORMATION OFFICIAL INFORMATION 2. Alignment with HSCP Strategic Ambitions The NAHSCP Vision is “People who live in North Ayrshire are able to have a safe, healthy and active life” Overview of Financial Inclusion alignment to HSCP strategic ambitions: 2.1 Enable Communities Financial Inclusion services build knowledge and confidence to enable people in our communities to navigate the welfare rights system and manage household budgets effectively forming the foundations for sustainable outcomes that will reduce the likelihood of clients facing financial crises in the future. 2.2 Develop and support our Workforce Financial Inclusion services continue to face significant challenges in responding to ever- increasing demand, the changing demographic of people seeking advice and support, particularly for debt advice, and the increasing complexity of the welfare rights system with ongoing welfare reforms. We recognise the strain that this puts on our staff but ensure that time is set aside for regular training and learning activities that are essential to maintain a high level of expertise, that effective and regular support and supervision is routinely carried out and that wellbeing supports are widely promoted and taken up when appropriate. We recognise that many North Ayrshire residents are members of our own workforce and that they can also require advice and support from our services. 2.3 Provide Early and Effective support Financial inclusion services will continue to work with the most vulnerable people in our communities, providing early interventions to reduce likelihood of a financial crisis situation developing. We aim to ensure that those most at risk of financial crisis, or living in poverty have ease - and equity - of access to advice and related services so they can receive the right support at the right time, in the best way for them. 2.4 Improve Health and Wellbeing We recognise that in this ongoing cost-of- living crisis, many people are experiencing worry, anxiety, or depression relating to their financial situation. The main focus of financial Inclusion services is to maximise income and help with managing debt, but it is also well- evidenced that by removing money worries, physical health and mental wellbeing improve The free advice sector has an important role to play in ensuring vulnerable people have access to advisers with the expertise and skills to effectively support and advise on welfare rights and debt, whilst having established referral pathways to health and wellbeing services 2.5 Tackle inequalities The ongoing cost-of-living crisis has further highlighted the negative impact of deprivation and poverty on our communities, and we will continue to work collaboratively with other service providers to deliver shared solutions. We recognise those most vulnerable to the 253
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5 OFFICIAL INFORMATION OFFICIAL INFORMATION increasing costs-of-living are people living on low incomes, in particular lone-parent households, people with disabilities and those from minority ethic groups. We will build on our holistic approach to providing advice including co-location with other services to proactively support those who are hardest to reach in our communities. 3. Our Interim Plan 2023-25 Out interim Strategy was published in April 2023 and a summary of achievements against our priorities is set out below. Review, develop and improve North Ayrshire Advice Services to ensure they are responsive to the needs of all local residents, and particularly those most vulnerable: • In April 2023, Money Matters and the Welfare Reform Advice Team, previously part of Housing Services, came together to form the new Financial Inclusion Service within the North Ayrshire Health and Social Care Partnership • Processes, procedures and systems have been standardised and streamlined to improve efficiency and to ensure the most effective use of resources. • A new Performance Management and Quality Assurance Framework has been integrated with our case management system to ensure a systematic approach to service development and improvement, service user participation and to encourage a culture of continuous improvement • From 1 May 2025, Money Matters services moved from a universal service to a service targeting those most vulnerable, and most likely to be living in, or at risk of poverty. People referred by HSCP, NHS or other services, along with people who have disabilities or dependent children, are carers, pregnant or from black or minority ethnic groups, will continue to have access to our services (circa 82% of clients in 2024-25). Provision of universal debt advice services A new universal debt advice services was contracted through CHAP and commenced on 1 July 2023. This contract will end on 30 June 2025. However, a debt advice service will be added to the team, to ensure debt advice is available in-house for non-council tenants who seek welfare rights advice but also need help with debts. Improved referral pathways The review of Financial Inclusion services was a key workstream within the North Ayrshire Council Transformation Programme to improve access to services. Referral pathways to welfare rights and debt advice services have been incorporated into the new online corporate referral pathway, and calls are now routed through the main Council contact centre telephone line. On 1 May 2025, the financial inclusion service was rebranded and relaunched as Money Smart, with a single Money Smart email address for referrals to both Money Matters and the Welfare Reform Advice team. 254
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6 OFFICIAL INFORMATION OFFICIAL INFORMATION Establish a North Ayrshire Financial Inclusion Partnership The Partnership was established in May 2023 and currently has representation from 21 different services or agencies. Fuel Poverty and Communications sub-groups have now been established to support a joint approach to promotion of services across North Ayrshire. The Partnership has brought new opportunities to improve partnership working, referral pathways and joint working as detailed later in this strategy. A review conducted in 2024 found that members valued the Partnership for information sharing, learning and networking. A Partnership action plan has been developed and has been incorporated into the Strategic Ambitions for 2025-30 in Section 10 255
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7 OFFICIAL INFORMATION OFFICIAL INFORMATION 4. Economic context Poverty continues to be a significant challenge across Scotland, with over a million people experiencing its effects. Households most likely to experience high poverty rates are often those reliant on benefits, which constitute a larger proportion of their income. Scottish Government data from 2021-24 also shows that child poverty is highest in families with three or more children, in minority ethnic households, lone parent families, households with a child under one year or where there is a disabled family member. In the wider population, the Joseph Rowntree Foundation reported in 2024 that 26% of informal carers and 34% of people in families where someone is in receipt of carers’ allowance are also living in poverty in Scotland. Across the UK, in 2022-23, 30% of people with disabilities were living in poverty. However recent data for 2023-24 has confirmed that child poverty in Scotland is falling, with the relative child poverty rate (before housing costs) decreasing from 26% to 22%. This positive trend is largely attributed to Scottish Government policy interventions, particularly the Scottish Child Payment, and contrasts with a wider upward trend in child poverty across the rest of the UK. However, wider UK government welfare reforms, as highlighted by organisations like the Resolution Foundation and CPAG, and the cost of living, continue to pose a significant risk of income loss for households. North Ayrshire faces distinct economic challenges and has a higher proportion of its population experiencing deprivation compared to the Scottish average. The Scottish Index of Multiple Deprivation (SIMD) 2020 identified North Ayrshire as having the third highest proportion of data zones within the 20% most deprived areas in Scotland, with 40.9% of its data zones falling into this category (up from 33 in 2004). Of the 186 SIMD data-zones in North Ayrshire, 52 (28%) are in the 15% most deprived areas in Scotland. A notable shift within the area is that the Irvine locality now has the highest proportion of data zones in the 15% most deprived in Scotland, having overtaken the Three Towns locality (Ardrossan, Stevenston, and Saltcoats), which previously held this position until 2012. As a result of the Covid-19 epidemic, the 2024 SIMD update has been delayed until 2026. The strategy will be updated to reflect any significant changes in the data thereafter. Child Poverty in North Ayrshire In 2022/23, North Ayrshire recorded the second highest rate of child poverty in Scotland, with 29.2% of children living in poverty (after housing costs). This means that over 7,000 children and young people in our area may be struggling to access everyday essentials such as food, clothing, and transport. This figure compared at the time to a national average of 23% in Scotland, highlighting the persistent local challenge and its direct implications for child health and wellbeing. Note: most recent after housing costs data is expected from Loughborough University in June, 2025 Across Scotland, the latest data for 2021-24 indicates that approximately three-quarters (75%) of children living in poverty were in families where at least one adult was working. Nationally in 2024, 11.4% of employee jobs in Scotland were paid below the Living Wage. Whilst data specifically for North Ayrshire post-2022 is less readily available, we have been able to evidence a decline in workers earning below living wage in the region between 2018-2022. This information demonstrates to us that employment does not necessarily guarantee a pathway out of poverty for many families. 256
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8 OFFICIAL INFORMATION OFFICIAL INFORMATION Our People’s Panel Survey indicated a concerning trend in 2018: that the percentage of adults in North Ayrshire managing well financially was reducing, and the number of adults with no savings was increasing, in slight contrast to Scotland as a whole. More recent local survey insights from 2022/23 highlighted that 26% of North Ayrshire respondents rarely or never have money left to save, and 18% have unsecured debt exceeding one month's income. Furthermore, 6% reported not managing very well or experiencing financial difficulties. 5. Tackling Poverty – The Role of Financial Inclusion The need for specialist financial inclusion support services has never been greater. Universal Credit is complex, and UC claims can impact on other benefits. The ongoing migration to UC from DWP legacy benefits and the additional, or devolved benefits now provided by Social Security Scotland make it challenging for many people to navigate the welfare rights system without the support of a specialist welfare rights adviser. The requirement to apply and maintain UC claims online is an additional barrier for many. DWP research suggests that 45% of benefit claimants lack the digital skills to make and maintain their claims. Money Advice Scotland reported in March 2024 that there has been a ‘surge’ in unsecured personal debt, with an increase in energy debt and council tax debt. Bankruptcies are up by 3%. Stepchange reported in April 2023, that levels of debt on household bills increased in Scotland by 68% between 2021 and 2022 and sat at an average of £2,929. The Money and Pensions Service reported that 700,000 people in Scotland are at risk of, or in problem debt, only 54% save regularly and 15% borrow to pay for food or bills. Money and Pensions Service research reported in November 2023 that there has been a deepening vulnerability and complexity, more intensive cases, and ‘never been in debt before’ middle income homeowners accessing debt advice services. 257
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9 OFFICIAL INFORMATION OFFICIAL INFORMATION Direct drivers of poverty (Scottish Government) The direct drivers of poverty fall into three main categories – income from employment, costs of living and income from social security. Financial Inclusion services have a role in addressing costs of living and income from social security. 5.1 Income from Social Security - the ‘take-up’ of social security entitlements Unclaimed benefits across Britain were estimated to be around £23 billion in 2024, excluding unclaimed disability benefits and discretionary support which have not yet been assessed. It is estimated that the total unclaimed support is likely to be over £30bn when those elements are included (Poverty in Practice 2024). 258
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10 OFFICIAL INFORMATION OFFICIAL INFORMATION The reasons for benefits going unclaimed include lack of awareness of the existence of some benefits, or assumptions that they would not be eligible, the complexity of the system, digital exclusion and stigma. Welfare rights advice services break down those barriers. They enable people to better understand and claim their entitlements to maximise their income. Increasing benefits take-up and ensuring citizens are in receipt of their legal entitlements has a positive impact for North Ayrshire residents and also for the local economy. 5.2 Costs of living – Fuel Poverty The Scottish Government reported in 2023 that that an estimated 31% of Scottish households were living in fuel poverty (spending more than 10% of their income, after housing costs, on energy) and around 19% were in extreme fuel poverty (more than 20%). People are more likely to be in, or to fall into fuel poverty if they have an ongoing heath condition which requires higher than average fuel consumption, have a low income, live in the social rental sector, in a home off the gas grid, in a rural area, or where electricity is their primary heating fuel. There are significant differences across the six North Ayrshire localities with the North Coast/Cumbrae and Arran generally having less people living in poverty, claiming benefits and lower health inequalities. The one exception is fuel poverty where the average for mainland localities is 27% but 41% on the island of Arran, where import costs and lack of access to the grid mean fuel is more expensive for Arran residents. Lemon Aid are a specialist social enterprise and member of the North Ayrshire Financial Inclusion Partnership with established referral pathways from advice services for help with energy costs, problems with meters, arrears on energy bills and 259
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11 OFFICIAL INFORMATION OFFICIAL INFORMATION disputes with suppliers. 5.3 Costs of Living - Unmanageable debt Debt repayments are not deducted from income for the purposes of determining whether a household is in income poverty. They do, however, reduce the amount of disposable income that households have to spend on goods and services, and therefore increase their risk of material deprivation, ie unable to afford goods and activities that are the norm in today’s society. Debt advice services offered by Money Smart and CHAP options for managing debt more effectively and support to put in place debt solutions. In some cases, depending on the circumstances, debt can be reduced or written off. 5.4 Costs of Living - Access to affordable credit and savings As a result of low income, income only from benefits, or poor credit rating many people are unable to borrow money from the same sources as other members of the population. Many, as a result, turn to high-cost alternatives such as doorstep or payday lenders. Credit can therefore be the most expensive for those who can least afford it. Access to affordable credit and savings can protect against problem debt and material deprivation as they safeguard against unplanned costs and changes in income. Credit Unions/Community Banks are key providers of financial inclusion services. The 1st Alliance Community Bank, based in Kilwinning, is another key member of the North Ayrshire Financial Inclusion Partnership. 5.5 The Poverty Premium in North Ayrshire The poverty premium is the extra cost people on low incomes and in poverty pay for essential products and services: • Payments – Some payment methods create a poverty If they do not have a bank account they have no access to direct debts, often a cheaper way to pay bills. Paying things like insurance monthly rather than all in one go annually can cost more. • Energy – Paying bills as they arise costs an extra £106 (Jan-Mar 2024) compared to using direct debit. • Credit – people in poverty pay more to borrow money because they are more likely to have a low credit score and be ore of a risk to lend to. • Insurances provide protection from financial loss and give peace of mind. Low- income households often cannot afford insurance but when they do, often face additional costs. Car insurance for those in less affluent areas can cost £314 pa more than in more affluent areas. 260
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12 OFFICIAL INFORMATION OFFICIAL INFORMATION The total cost of the poverty premium in North Ayrshire is £4,888,380 with 23.3% of households experiencing any premium. The average cost to N Ayrshire households is £468. (Fair by Design 2024) 6. Advice Services in North Ayrshire In comparison with many other local authorities, North Ayrshire has relatively few local providers of advice and wider financial inclusion services, but they are well-established and much valued in our communities. The North Ayrshire Financial Inclusion Partnership, established in May 2023, with representation from both advice services and key stakeholders, work together to share best practice and learning and to improve awareness of services and understanding of the needs of vulnerable people in our communities. 6.1 HSCP Financial Inclusion In April 2023, Money Matters and the Welfare Reform Advice team (formerly in Housing services) came together to form a new Financial Inclusion service within the North Ayrshire Health and Social Care Partnership. 6.1.1 The Welfare Reform Advice Team, Funded through the Housing Revenue account, provides services for council tenants through a close working partnership with North Ayrshire Council Housing services. They are based within Saltcoats Housing Office. The team includes Welfare Rights and Debt Advisers and Financial Inclusion Officers. In 2024-25 the team received a total of 4740 referrals.1899 referrals were for Welfare Rights and Debt Advice (WRDA), an increase of 28% on 2023-24 with self-referrals being double the previous year. 72% of those referrals resulted in welfare rights and/or debt cases being allocated. Of the remaining 28%, most received initial advice and/or information. £422,522 £755,811 £1,658,213 £974,153 £455,956 £561,598 Prepayment meter premium Non-standard billing premium Non-switching premium Area-based insurance premium Single item insurance premiums 261
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13 OFFICIAL INFORMATION OFFICIAL INFORMATION ‘Internal’ referrals to the Welfare Rights and Debt Advisers were from Money Matters (mostly for debt advice) or from the Financial Inclusion Officers for the more complex welfare rights cases. 2334 referrals were to the Financial Inclusion Officers (FIOs), through the DWP’s Landlords portal, for support with UC claims or from Housing services for pre- tenancy checks, through which FIOs explain changes to benefits arising from taking on a tenancy, provide support with UC claims, managing household budgets and to access grants/ furnishings for their new home. The number of pre-tenancy checks has halved in number from 2023-24, due largely to the increase in vacated council properties being allocated to those who are homeless, who receive this support from Housing’s tenancy support team. The Welfare Reform Advice Team secured a total of £5.7m in financial gains for tenants through income maximisation (£5.6m) and debt reduction (£96k). An increase of 50% on 23-24. 98.5% rated services as ‘very satisfied’ in 2024-25. Feedback from one Welfare Reform Advice team client below: “I found [my case worker[ was very helpful. She explained things in a way could understand and she helped by relieving my anxiety and worries over my problems. She was very empathetic and understanding, an absolute asset to your Team” 6.1.2 Money Matters core funding is from the Health and Social Care Partnership and until 30 April 2025, they provided a universal welfare rights advice for all North Ayrshire residents. They have been embedded within the Health and Social Care Partnership services for a number of years, including named workers who co-locate within Community Justice, Children & Families, and Addictions services. 815 524 448 112 697 247 380 165 0 200 400 600 800 1000 Housing services Self referrals Internal Other Referrals for Welfare Rights and Debt Advice 24-25 23-24 2334 507 2140 1090 0 500 1000 1500 2000 2500 DWP Portal - UC support Housing Services - Pre-tenancy checks Referrals to Financial Inclusion 2024-25 2023-24 262
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14 OFFICIAL INFORMATION OFFICIAL INFORMATION In 2024-25, Money Matters received 5433 referrals, maintaining a similar level over the last five years. 44% were from HSCP/NHS and 45% were self-referrals or from a family member/friend. Around 70% engaged with the service and received advice and support Of the HSCP/NHS referrals, 811 were for financial assessments, 653 for non- residential social care charging services and 158 for kinship carers. A total of £21.5m in Financial Gains was achieved for their clients, through maximising income. Note: Due to changing to a new case management system in October 2024, these figures may be lower than actual totals. Money Matters Funded Projects GP practices – through the Welfare Advice and Health Partnerships Scottish Government initiative launched in 2022, Money Matters has received funding to support the development and embedding of welfare rights advice in nine priority mainland GP practices, extended at the end of 2023 to include the islands of Arran and Cumbrae. Three Welfare Rights Officers work from the GP practices, where welfare rights appointments are input to the GP patient information system by practice staff and where advisers can access medical information to inform and HSCP/NHS, 44%, 44%Self or family/friend, 45%, 45% Other, 11%, Referral sources 0 100 200 300 400 500 600 700 Macmillan Service access Addictions Children & Families Justice Services Mental Health NHS Non-residential Charging Kinship Care HSCP/NHS referrals 263
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15 OFFICIAL INFORMATION OFFICIAL INFORMATION support casework. The delivery model is very efficient, engagement is high and over £3m in financial gains (included in the total financial gains of £21.5m above) was secured for the 536 patients referred in 2024-25. “I honestly can thank you enough for all your help and support with sorting [all my my claims] out for my family, it’s put me in a far better financial position now, all thanks to you. I really appreciate everything you have done, thanks again” (GP practice client feedback) North Ayrshire Schools – through funding from Education services which started in October 2021, Welfare Rights Officers have been attached to North Ayrshire secondary schools, initially one adviser covering secondary schools and since 2024-25, three advisers to incorporate primary schools and early years centres. Referral pathways direct to those named workers are promoted through school activities/communication channels and the number of referrals from parents with school-age children has increased through this initiative. In 2024-25, a total of 259 parents with school age children benefitted from this initiative – through direct referrals from parents, referrals from schools or HSCP social work teams who referred direct to the project. This represents a 144% increase on the number of referrals in 2023-24. A total of £560,509 in financial gains was achieved for those parents in 2024-25 (an increase of 46%) – included in the £21.5m total above. “Thanks so much for all your help, time and patience, I really appreciate it. You have improved mine and my kids lives so much, I will be forever grateful” (Parent feedback, Schools project) North Ayrshire Foodbanks and Larders – since April 2021, the Trussell Trust has been funding advisers to support those who access foodbanks and larders. Initially this was one adviser but funding was expanded to add a second, and they now provide services in 14 foodbanks and larders across North Ayrshire. In 2025 they aim to expand this to include Largs, Millport and Springside. 128 foodbank/larder users received welfare rights advice through this project in 2024-25 and an additional 76 referrals were received direct from the foodbanks. Summary of referrals to Money Matters and the Welfare Reform Advice Team 2024-25 (excluding the projects above). 0 1000 2000 3000 4000 5000 6000 7000 Money Matters - WR WRAT - WR & Debt WRAT - FIOs Pre-Tenancy Checks WRAT - FIOs UC Claims 2024-25 2023-24 264
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16 OFFICIAL INFORMATION OFFICIAL INFORMATION Child Poverty Outcomes The Financial Gains for North Ayrshire residents who engage with our services are substantial and have been increasing year on year for some time. Our beneficiaries have had their income maximised and many have had their debt reduced and affordable repayment plans put in place. North Ayrshire Council tenants are also supported to manage their household budget and furnish their homes. Most clients will have improved financial circumstances, and being unburdened of money worries, their mental health and wellbeing improved. In 2025, we will start pro-actively seeking client feedback on wider outcomes, through asking them to complete a brief survey when their case is closed which includes the following two questions which provide an indication of impact of our services on child poverty: Do you, as a result of advice and support received, feel more confident managing your household budget and in your ability to pay your bills? Do you, as a result of advice and support received, feel financially more prepared for an unplanned expenditure or unexpected event? The first report from this activity will be for 2025-26 and responses will further evidence the impact of advice services in relation to the related child poverty indicators. 6.1.3 Money Smart On 1 May 2025, the integration of the two internal teams into one cohesive Financial Inclusion Service was reinforced through the rebranding and relaunch of the service as Money Smart. Going forward the Money Matters and Welfare Reform Advice Team names will be dropped and the service referred to as Money Smart. This change alongside the now fully integrated service will maximise the use of all resources with staff across the service working with one case management system which will support more effective joint working to meet the needs of people in our communities. It will also improve accessibility with: • A Single point of contact for all services – one email address, one telephone number and one online ‘contact us’ form. • Phone lines staffed by advisers from across the Money Smart service, taking calls at point of need • Welfare Rights and Debt Advice both available for all council tenants, and for other vulnerable residents who are referred by services, are disabled, parents, pregnant, carers of from minority ethnic groups. 265
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17 OFFICIAL INFORMATION OFFICIAL INFORMATION 6.2 CHAP Based in Ardrossan, CHAP is a well-established charitable organisation that provides welfare rights, money/debt and independent housing advice for people across North Ayrshire. CHAP has been contracted by North Ayrshire Health and Social Care Partnership since July 2023 to provide debt advice services for North Ayrshire residents. This contract was for two years to meet a gap in debt advice when the Better Off programme ended. In the first year of this contract, CHAP received 440 referrals for debt advice. 225 engaged with the service and by the end of year one, 121 had debt strategies in place, exceeding the agreed performance targets. Customer satisfaction ratings were excellent and feedback from one client is below. "Everything was spot on, the help you gave me was phenomenal. They were so nice. Can’t thank you enough. I got awarded my ADP which I didn't even know if I would get it, I didn't know I was entitled to it, grateful for them doing that for me. My repairs and all that are being done now and I set up a payment plan". Following a review, it was decided in November 2024 that as a significant number of referrals to CHAP were from Money Matters (28%), the contract with CHAP would not be extended beyond June 2025, but a debt advice service for non-council tenants would be added to the Money Smart team to provide in-house debt advice for those who access welfare rights advice but also need help with debts and thus eliminate the need to refer to an external agency for this service. It is recognised that many people make a conscious choice to seek advice from CHAP and they are actively seeking alternative sources of funding to enable them to continue to provide this service. CHAP also provide advice and support for homeowners facing threat of repossession through a partnership with Govan Law Centre, and through funding from Housing services, provide advocacy and representation services for council tenants facing eviction. 6.3 1st Alliance Community Bank – Progressive Finance In November 2021, North Ayrshire Council Cabinet approved a £150k investment in 1st Alliance Community Bank to enable lending of small loans to those who are of higher credit risk and who would not normally quality through typical lending rules, but who can afford repayments. A priority was to assist people to move away from high-cost lenders e.g. doorstep lenders, buy now pay later’ and high-cost catalogues and improve access to affordable, and ethical lending. As per the Credit Union saving/borrowing model, residents who access small loans through this investment would also become savers (a minimum of £3/week) – a requirement to access loans. As each loan is paid off, the borrower could then move onto a members’-based loan which has a lower interest rate. In November 2022, a £25 one-off incentive for new savers was incorporated into the SLA (from the original £150k investment) to encourage residents to become more financially resilient through developing a ‘saving habit’ and build a new savings pot which provides 266
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18 OFFICIAL INFORMATION OFFICIAL INFORMATION some security for both unplanned and planned expenditures such as Christmas. By becoming regular savers, they would also then become eligible to access affordable credit through 1st Alliance members-based loans when required. In September 2024 it was further agreed that the £150k investment could be used to fund staff time to support the ‘unbanked’ to open mainstream bank accounts. The longer-term intention was that as loans were repaid, the £150k investment would be recycled to create a legacy fund for other high-risk borrowers. By March 2025, when the SLA ended, the £150k investment had enabled 338 residents who were higher-risk borrowers to access loans totaling £286,429 (including first and subsequent ‘members’-based loans). £231,033 had been repaid, thus creating the anticipated legacy fund which will enable continued access to credit for higher-risk borrowers. This initiative has evidenced that higher-risk borrowers can also be ‘responsible’ borrowers through a) an arrears rate of 5% which was lower than anticipated and b) that 56% applied and were approved for ‘member’s based’ loans after paying off their initial loan. Residents who accessed loans through this investment have built a total of £84,615 in new savings, illustrating that people on low incomes can develop a savings habit (32% were unemployed or on disability benefits and 11% were part-time workers) In addition, the £25 one-off incentive to open a savings account has generated 252 new savers and 78 have been supported to open mainstream bank accounts. 6.4 Lemon Aid Lemon Aid is a social enterprise helping domestic energy consumers to save on their energy costs. They are currently funded to provide support to North Ayrshire Health and Social Care services through Energy Action Scotland. In 2024-25 they provided advice and support to 4528 North Ayrshire residents including 763 people who were ‘reconnected’ to their power supply after having ‘self-disconnected’ – more than double the number in the previous year. Self- disconnection arising from: “Debt amassed due to in-ability to pay is moved to the ‘back screen’ of the meter by the supplier which results in a debt recovery rate being applied. This rate can be high and forces consumers to go without power or heating as they can’t afford to top up the meter, meantime their standing charge keeps increasing the debt level.” (Lemon Aid) Lemon Aid services include advice and support with debts to utility providers including support to access discretionary grants to write off energy debts, or to set up repayment plans. They also provide advice and support in resolving disputes with suppliers and with the replacement of prepayment meters with credit meters. In 2024-25 they achieved over £257,245 in financial gains through energy debt reduction. Referral pathways are in place from advice services to Citrus Energy for this specialist service and last year 141 clients were referred from our Money Smart 267
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19 OFFICIAL INFORMATION OFFICIAL INFORMATION teams to Citrus for help with energy costs and debt to energy suppliers. 7. Developing the Plan for 2025-30 The Financial Inclusion Partnership developed and delivered a Community Consultation late in 2023 to hear from our residents what they want from advice and wider financial inclusion services and to help inform the development of this strategy. A total of 177 responses were received from North Ayrshire residents, 57 of whom had accessed at least one advice service (44 had been to Money Matters, 7 to WRAT and 7 to CHAP) Services were highly rated for accessibility, response times and communications. 80% said they got more help than expected. “Money Matters came to my house, was able to complete my benefits applications in privacy and at my pace, I can become overwhelmed when presented with a list of questions. She explained everything and also advised of other financial help and support available to me while waiting. Nothing was too much trouble”. 15 stakeholder agencies/services were also consulted and the responses reinforced the positive views of advice services expressed by most of those who responded to the community consultation. There were high levels of trust in the quality of services and effective and efficient referral pathways and response times were valued. “Very knowledgeable and extremely helpful – great partnership working. Gold standard” You Said: We will: Where both debt and welfare rights advice was needed, accessing both through one service is preferred A Welfare Rights and Debt Adviser for non-council tenants has been added to the service to ensure that all those who access our services can receive both welfare rights and debt advice without the need to refer to an external provider. Engaging with the same person is preferred when receiving advice and support The ‘named worker’ model has been expanded over the last two years. Some respondents said they did not know where to go for the help they needed or did not think there are services for homeowners. Stakeholders said that more effective promotion is needed as people they refer often do not know such services exist. A Communications sub-group of the Financial Inclusion Partnership has now been formed to take a cross-sector approach to promoting services more effectively. The launch of HSCP services as Money Smart, with single points of contact for both Money Matters and the Welfare Reform Advice Team will improve both accessibility and awareness. Poor physical or mental health is a We will more effectively promote the 268
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20 OFFICIAL INFORMATION OFFICIAL INFORMATION barrier to accessing services range of options for accessing services We need welfare rights advice on Arran. We have developed more services for island communities and will continue to seek options to improve accessibility You want more help with form- filling for claiming benefits This has been reviewed and more support with form-filling is now provided internally. Links with gypsy/traveller communities need to be improved We are now promoting our services through the Tenancy Chat for Gypsy Travellers and seeking options to improve engagement with those living in encampments. You also told us that stigma, and fear of your situation getting worse are barriers to engagement. This will be addressed through a Communications Plan for 2025-26. 8. Vision, Mission and Core Values Our shared vision is for A financially healthy North Ayrshire where people have the knowledge, skills, resources and confidence to manage their money effectively and live fulfilling and healthy lives. Our shared mission is to: “Provide accessible, professional advice services that work together and in partnership with related services, to ensure that all the needs of our customers are met” 269
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21 OFFICIAL INFORMATION OFFICIAL INFORMATION Our Core Values: As part of our engagement in developing this plan, we asked local people, and our staff teams, to tell us what values they would expect from, and what they value in our services. They told us they expect us to embody: CARE – EMPATHY – RESPECT Care People are at the heart of everything we do, and we are passionate about making a real difference in their lives. We provide a quality service from advisers who are knowledgeable and highly skilled in their field. Empathy By actively listening and establishing trusting relationships, we gain an understanding of individual needs and respond to our clients at their own pace and as appropriate to their circumstances. Respect We see people who access our service as unique individuals and active participants improving their financial circumstances and quality of life. We respond quickly to enquiries and keep you informed throughout your journey with us. You will always be treated with dignity and respect from a service which is inclusive and designed around the needs of our clients. Feedback from a beneficiary of Money Smart services “Thank you to everyone who supported me. They went over and above to be extremely helpful, compassionate and understanding. I feel like [my case worker] has literally saved my life and given me hope. She explained everything in such a calm and reassuring way and has calmed me down so much. The process of dealing with DWP has been very stressful and frightening as I have worked most of my life. She has given me a reason to live and that I am not hopeless by treating me so kindly like a normal person. The huge problems that seemed impossible to face as I kept asking for help and getting nowhere until [the team] changed my life for the better are now being looked at. [My case worker] kept in contact and consistently been available and kindly given her time and advice and also a lot of other helpful information. Thanks to her I have been focussing on health, eating and sleeping properly and hopefully will be able to get a job in the future. Thank you. I cannot thank you and your staff enough”. A Case Study A tenant was referred by a local housing office due to her rent arrears. On visiting her, it became apparent that she had multiple debts, including priority debts, and she was not managing to meet her payments. Her income was increased, including through support to claim disability benefits, but she was reluctant to engage in debt 270
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22 OFFICIAL INFORMATION OFFICIAL INFORMATION advice as she felt she could then deal with her debts herself. A couple of months later she was again referred for her rent arrears. At this point her case was being taken to court and the housing office were requesting eviction from the property. She had withdrawn from speaking with her housing officer and all other agencies involved with her. She continued to be reluctant to engage in debt advice, but when an eviction date was given, she did, and potential debt solutions were discussed. Her options were limited, and she chose to apply for bankruptcy but then, after being advised on what was required to make the application she again withdrew. Meantime, the eviction had been postponed on the grounds that she would engage and work the adviser. After several attempts to re-engage with her to discuss the severity of the situation, we were able to apply and she was granted bankruptcy, including her rent arrears and all other debts. Both her mental and physical health had deteriorated due to the situation she was in, but when concluded she said that this was: “Like a weight lifted off my shoulders….I have not been sleeping or eating due to worry and anxiety and feel as if I can now look forward and start afresh…..I do not know what I would’ve have done without the service or where I would have ended up”. The outcome of the referral – income maximised to include disability benefits, £17k debt written off and the tenant and her child were able to remain in their home. 9. Money Smart Priorities and Ambitions to 2030 The following strategic priorities will build on the strategic ambitions for 2023-25, including service developments and the work of the Financial Inclusion Partnership over the last two years. Provision of Early and Effective Support – to meet this ambition we will ensure services are accessible at point of need through: 1. Co-location of welfare rights advisers within GP surgeries mainstreamed as Scottish Government Funding ends. 2. Engagement with parents through established referral pathways with schools, from early learning to secondary level. 3. Early engagement with council tenants in, or at risk of being in rent arrears, to provide support with managing payments, to put debt strategies in place and sustain tenancies, through established partnership with Housing services. 4. Established referral routes and co-location with key Health and Social Care and NHS services 5. The Advice Line delivery model implemented in 2025 which aims to ensure that those who choose to access the service by phone have their call answered, as far as possible, by a ‘duty’ adviser who can provide initial advice and support at point of contact. 6. The Financial Inclusion Partnership, through which we will: o Challenge stigma and fear as barriers to engagement, to encourage and motivate residents to access support at an early stage. o Build a more collaborative approach to communications to raise 271
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23 OFFICIAL INFORMATION OFFICIAL INFORMATION awareness of all advice and wider financial inclusion services and access points across North Ayrshire Wellbeing – Enabling Communities – to meet this ambition we will: 1. Pro-actively measure customer satisfaction and seek feedback and empower service users to identify potential service improvements and developments, to inform the content of campaigns and decision-making. 2. Build financial resilience through improving knowledge of and skills and confidence in the welfare rights system and managing personal finances to improve health and wellbeing 3. Raise awareness of welfare rights entitlements and systems through routine casework and promotion of ongoing welfare reforms and take-up campaigns. 4. Provide specialist debt advice to put debt strategies in place, maximise disposable income and effectively manage household budgets 5. Early engagement with residents signing up to council tenancies and existing tenants approaching state pension age, to support with maximising income/tenancy sustainment through established partnership with Housing Services 6. Build on the holistic approach to pro-actively identifying wider and underlying issues and support engagement with other service providers to achieve sustainable positive outcomes. Tackling Inequalities through Community Wealth Building – we will: 1. Reach out to marginalised people in our communities to promote our services, improve accessibility and support engagement, in particular those in our island communities, from minority ethnic groups, the more socially isolated, those experiencing in-work poverty and residents in gypsy traveller encampments 2. Evidencing the number of Money Smart clients who, as a result of advice and support received, are ‘more confident managing their household budget’ and who feel ‘better prepared for unplanned, and planned expenditures’, which provide an indication of sustainable positive outcomes and impact on child poverty 3. Through the Financial Inclusion Partnership, identify gaps in service provision and seek further opportunities for collaboration to ensure the needs of all people in our communities are met Develop and support our Workforce – to meet this ambition we will: 1. Ensure that in the current economic climate and with the increasing complexity of the welfare rights system, our people continue to be able to provide the expert, high quality welfare rights and debt/money advice which is much valued by people in our communities through the Performance Management and Quality assurance Framework. 2. Through the AdvicePro case management system and Performance Management and Quality Assurance Framework: o Encourage and support a culture of continuous improvement o Produce public performance reports for Money Smart which evidence the totality of our work and the outcomes achieved for 272
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24 OFFICIAL INFORMATION OFFICIAL INFORMATION people in our communities 3. Achieve accreditation to the Scottish National Standards for Information and Advice Providers for Welfare Rights and Money Advice, to evidence to funders and to the public, the high-quality services delivered by our team. 4. Ensure that the increasing demands and strain on our people does not impact on the essential time needed for ongoing training to maintain expert knowledge of ongoing welfare reforms and to ensure quality assurance measures are sustained. 5. Seek opportunities to use technology where appropriate, to deliver more efficient and effective services and maximise use of resources 6. Through the Financial Inclusion Partnership, share information, knowledge and expertise to enhance all services. North Ayrshire Council’s No Wrong Door policy builds on existing efforts to ensure that residents can access the funding of support they need, whether this be in relation to paying energy bills, accessing education grants for footwear and school meals or finding out more about state benefits. Through this strategy, our Money Smart team, via our priorities and ambitions and in collaboration with the Financial Inclusion Partnership aims to support a more financially healthy North Ayrshire for the benefit of individuals, their families, communities, businesses and the economy. 273
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25 OFFICIAL INFORMATION OFFICIAL INFORMATION Contact Information for Advice and Financial Inclusion Services Money Smart - call 01294 310000 or email moneysmart@north-ayrshire.gov.uk CHAP – Call 030 0002 0002 or email enquiries@chap.org.uk Lemon Aid – Lemon Aid Self Referral Form - Cunninghame Housing Association 1st Alliance Community Bank Call 01294 557123 or email info@allianceayrshire.co.uk Cunninghame Housing Association Call 01294 607553 Cairn/ANCHO Housing Association Call 0800 990 3405 Riverside/Irvine Housing Association Call 0345 112 6600 Citizens Advice Scotland Call 0800 028 1456 Stepchange Debt Charity Call 0800 138 1111 274
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26 OFFICIAL INFORMATION OFFICIAL INFORMATION Links NAHSCP Strategic Commissioning Plan Council Plan CWB Strategy References • What are the drivers of child poverty? - Tackling child poverty delivery plan 2018-2022: annex 2 - gov.scot • End Child Poverty Coalition. (Various years). Local Child Poverty Estimates. (Data modelled by Centre for Research in Social Policy, Loughborough University). North Ayrshire 2022/23 child poverty after housing costs figure. • Joseph Rowntree Foundation (JRF). (2025). UK Poverty 2025: The essential guide to understanding poverty in the UK. Joseph Rowntree Foundation. ‘very deep poverty’ statistics. • North Ayrshire Community Planning Partnership. (2018). People's Panel Survey 2018 Report. North Ayrshire Council. 2018 adult financial wellbeing data. • North Ayrshire Community Planning Partnership. (2022). People's Panel Survey 2022 Report. North Ayrshire Council. 2022/23 adult financial wellbeing data (e.g., % with no savings, % with unsecured debt, % not managing well. • SIMD. (2020v2). Scottish Index of Multiple Deprivation 2020. • Scottish Government. (2025). Poverty and Income Inequality in Scotland: 2021-24. Scottish Government. (Published March 2025). National Scottish child poverty rates (relative AHC and BHC) for 2023/24, and the proportion of children in poverty in working households for 2021-24. • Scottish Government. (2025) Labour market insight Living Wage data Local child poverty dashboard - gov.scot Poverty in Scotland 2024 | Joseph Rowntree Foundation Poverty: facts and figures | CPAG 275
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27 OFFICIAL INFORMATION OFFICIAL INFORMATION https://www.gov.scot/publications/scottish-house-condition-survey-2022-key- findings/pages/3-fuel-poverty/ Debt advice in the post-pandemic landscape | Money and Pensions Service (maps.org.uk) Missing out 2024: £23 billion of support is unclaimed each year | Policy in Practice https://www.gov.scot/publications/scottish-house-condition-survey-2023-key- findings/ What is the Poverty Premium - Fair By Design 276
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Integration Joint Board 25th September 2025 Subject: Chief Social Work Officer Annual Report 24/25 Purpose: To provide board members with awareness of the annual Chief Social Work Officer report which is required by the Scottish Government. Recommendation: The IJB are asked to note: 1. Notes the contents of this report, in particular the successes and challenges. 2. Acknowledges the three key issues brought to the attention of IJB. 3. Note that the CSWO will submit the annual report to Chief Social Work Advisor in Scottish Government. Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership CSWO Chief Social Work Officer MHO Mental Health Officer ASP Adult Support and Protection CP Child Protection LAG Local Authority Guardianship PWG Private Welfare Guardianship SOLACE Society of Local Authority Chief Executives HSCP Health and Social Care Partnership 1. EXECUTIVE SUMMARY 1.1 There is a requirement for every Local Authority to appoint a professionally qualified Chief Social Work Officer (CSWO) and this is contained within Section 3 of the Social Work (Scotland) Act 1968 as amended by Section 45 of the Local Government etc. (Scotland) Act 1994. 1.2 In line with the legislation and guidance, the CSWO is required to prepare an annual report for the Council, on all statutory, governance and leadership functions of the CSWO role. 1.3 This report will also be presented to the North Ayrshire Council Cabinet for consideration on the 30th September 2025. Agenda Item 14 277
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2. BACKGROUND 2.1 In 2014, the Office of the Chief Social Work Adviser, following consultation with CSWOs across Scotland, SOLACE and others, identified a more standardised approach to prepare the annual reports. 2.2 The report provides an overview by the CSWO of the partnership structures, governance arrangements and the performance of social services in the context of the demographic landscape of North Ayrshire. It looks more closely at the statutory functions of the service and the quality and workforce development within services. 2.3 The report highlights the range of Social Work activity throughout the year and places that in the context of the socioeconomic challenges faced locally. Within the report there are three key issues I would like to bring to the Board’s attention: Practice Practice remains strong. We have seen our workforce vacancy rate sit in to 10 – 12 percent range cross Social Work services. Our internal pipeline of graduates and dedication from our practice educators and team managers is allowing us to maintain staffing levels and to safely integrate newly qualified Social Workers. Case reviews across the year provide assurance on the leadership, value base and ethical nature of Social Work practice and decision making. Public Protection The year past has seen a new independent chair for APC and CPC, Derek Frew, who has offered fresh eyes and perspectives that have been supportive of our strategic aims in public protection. I would also wish to formally acknowledge John Pattersons many years of service to North Ayrshire following his retirement. Our level of children subject to statutory measures remains high at 258 however the number of orders terminating is down 30% from the previous year. Child Protection Orders are also at their highest levels since pre covid times. This data begins to evidence the complexities and increasing risk profile which directly impacts on our frontline Social Work capacity in children and families social work. Our justice services continue to see high levels of activity in relation to unpaid work, and bail assessments which would reflect the courts seeking community disposals given the pressures present within the prison estate. I would also commend the practice of our services in managing the early release scheme in the year past. Mental health and addiction services have maintained high levels of performance in terms of accessibility to services. The opening of the new Mental Health Unscheduled Care Hub is an important development from a social work perspective as last year’s concerns about the mental health and wellbeing of our residents has shown no sign of diminishing. In the year past we saw emergency and short-term detentions pass last year’s record numbers by 20% (emergency) and 14% (short term). Alongside this, the number of individuals for whom the CSWO is their legal guardian also increased to by 25% to 151. 278
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Our adult support and protection activity has also continued to see increased activity with AP1’s and AP2’s at their highest level. Underpinning this is a continued steady number of adult concern reports which evidences a good understanding from partners of risk and an understanding of the role of social work services in assessing and managing risk. Considerable efforts have been made to strengthen our position in relation to our understanding of how responses to the most significant incidents of domestic violence safeguard women and children. This is a complex area of practice for agencies working together within a pan Ayrshire context. With this in mind, North Ayrshire has been working to understand and address the issue of multiple referrals to the Multi Agency Risk Assessment Conference (MARAC). Alongside this, North Ayrshire Council have invested in a new lead officer post which is currently being recruited to in order to maximise the coordination and impact of our interventions in this critical area. Learning review requests continued to be received over the year with 2 reviews commissioned. Common themes reflect the increasing risk profile and levels of distress being experienced. The impact of the financial context Our risk exposure continues to grow with every passing month. Last year’s overspend of £3.593m of which £2.036 was in social care services placed financial strain on parent bodies and reflects the level of need and demand present in our communities and the increasing cost of delivering care. Work underway in development of the 2026-27 budget are worthy of early notification in terms of its impact on sustainable service delivery options. In the social work and social care sector the ability to manage services is critically driven by demand and capacity variables. Professional advice offered has been clear in relation to the risks of being able to meet all social work duties. A clear position has been taken in relation to the non-negotiable nature of leaving children or adults in situations where they are likely to experience significant harm. I am confident in the judgement being exercised by the professional social work leads across service areas in this regard. With the continued pressure on public finances in the immediate and longer term, the backdrop of local population need described in the annual report requires us to ensure the focus remains on managing risk and ensuring that every resource is utilised to its maximum and reaches our most vulnerable residents first. That invariably means that in some cases residents will experience an absence of service that will be difficult for them and their families. 3. PROPOSALS It is proposed that the Integration Joint Board notes the key themes and challenges detailed in the report and that it endorses the report as set out in Appendix 1 and note that the CSWO will this to Scottish Government. 3.1 Anticipated Outcomes That North Ayrshire Council, the Integration Joint Board, and the Scottish Government are made aware of the positive impact of Social Work Services in North Ayrshire as well as the significant challenges that are being faced. 279
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3.2 Measuring Impact Impact will be measured in terms of the direction and support to continue to transform the delivery of Social Work Services and manage the increased risk profile. 4. IMPLICATIONS Financial: None Human Resources: None Legal: The delivery of Social Work services remains a statutory duty of North Ayrshire Council whilst delegated to be delivered by the Health and Social Care Partnership. Equality: None Children and Young People None Environmental & Sustainability: None Key Priorities: This report covers matters which contribute to the key priorities within the Council and IJB Strategic Plans. Risk Implications: The delivery of Social Work Services is a statutory duty placed on North Ayrshire Council and delegated to the Integration Joint Board. Community Benefits: N/A United Nations Rights of the Child (UNCRC) This report highlights issues that have a direct and indirect impact on the rights of children and young people particularly in relation to article 3. Article 3 states that (1) in all actions concerning children the best interests of the child shall be a primary consideration. (2) States Parties undertake to ensure the child such protection and care as is necessary for his or her well-being, taking into account the rights and duties of his or her parents, legal guardians, or other individuals legally responsible for him or her, and, to this end, shall take all appropriate legislative and administrative measures. (3) States Parties shall ensure that the institutions, services and facilities responsible for the care or protection of children shall conform with the standards established by competent authorities, particularly in the areas of safety, health, in the number and suitability of their staff, as well as competent supervision. This report outlines child protection practices, a commitment to keeping families together wherever possible and on the quality of residential and fostering services which indicates how North Ayrshire works to uphold article 3. Direction to :- 1. No Direction Required X 280
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Direction Required to Council, Health Board or Both 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran 5. CONSULTATION 5.1 The Partnership Senior Management Team and operational services have contributed to the contents of this report. For further information, please contact Scott Hunter, Chief Social Work Officer on scotthunter@north-ayrshire.gov.uk Click here to enter text. 281
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Chief Social Work Officer Report 2024 – 2025 282
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Contents Introduction .............................................................................................................. 1 Demographics .......................................................................................................... 2 Locality Planning...................................................................................................... 3 Progress 2024 to 2025 .......................................................................................... 3 Localities – Initial Insight ..................................................................................... 3 Garnock Valley ................................................................................................... 3 Irvine ................................................................................................................... 4 Kilwinning ........................................................................................................... 5 North Coast and Cumbrae................................................................................. 5 Three Towns ....................................................................................................... 6 Arran ................................................................................................................... 7 Planned Activity .................................................................................................... 7 1. Governance, Accountability and Statutory Functions ................................... 8 1.1 Overview of the North Ayrshire Health and Social Care Partnership ......... 11 Visions, Values and Priorities............................................................................. 11 2. Service Quality and Performance................................................................... 12 2.1 Children, Families and Justice Services..................................................... 12 Brighter Pathways Programme Board ................................................................ 12 Whole Family Wellbeing Fund ........................................................................... 12 Promise Conference .......................................................................................... 13 Family Centred Wellbeing Service ..................................................................... 13 Child Protection Registrations ............................................................................ 14 Breastfeeding ..................................................................................................... 14 United Nation’s Convention on the Rights of the Child ...................................... 15 Child Healthy Weight ......................................................................................... 16 Health Visiting .................................................................................................... 16 Key Performance Indicators ............................................................................... 19 2.2 Adults ......................................................................................................... 22 North Ayrshire Drug and Alcohol Service ........................................................... 22 North Ayrshire Model for Enhanced Intermediate Care and Rehabilitation (eICT) ........................................................................................................................... 23 Anam Cara Refurbishment ................................................................................ 24 Mental Health Facility ......................................................................................... 26 283
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Trindlemoss Day Opportunities .......................................................................... 27 Out of Hours Social Work Service...................................................................... 28 Self-Directed Support ......................................................................................... 28 Care at Home..................................................................................................... 29 Carers ................................................................................................................ 30 2.3 Criminal Justice .......................................................................................... 31 Multi Agency Public Protection Arrangements (MAPPA) ................................... 31 Community Payback Orders .............................................................................. 31 Drug Treatment and Testing Order .................................................................... 32 Diversion from Prosecution ................................................................................ 33 Case Study: Employability Mentors ................................................................... 34 Key Performance Indicators ............................................................................... 36 3. Resources ........................................................................................................ 39 3.1 Financial Pressures ................................................................................... 39 3.1 2025-26 Budget ........................................................................................ 39 3.4 Medium Term Financial Outlook .................................................................. 42 4. Workforce ......................................................................................................... 44 4.1 Workforce Planning .................................................................................... 44 4.2 Workforce Support and Development ........................................................ 46 284
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1 Introduction Welcome. It is a pleasure to introduce this year’s Chief Social Work Officer report for North Ayrshire which covers the period 1st April 2024 through 31st March 2025. It is now very evident within the local context that because of sustained societal, economic and wider macro political factors we are seeing a worsening picture in terms of our ability to support everyone in our community who needs our support. This is counter intuitive to the Social Work task. We see increasing demands for services, rising complexity and comorbidity, escalating care costs, workforce challenges, policy and legislative developments. The solution to the challenges we face lies in our commitment to partnership working. From our interface with our NHS colleagues, Police Scotland and the wider North Ayrshire Council, Social Work services model an approach that respects and values difference and seeks the common ground to challenge inequality in our society. This report evidences that despite these challenges Social Work and Social Care services continue to deliver consistent services through the dedication of our practitioners and their commitment to support and protect the citizens of North Ayrshire. I am also pleased to report that our leadership and governance arrangements have remained strong in the year past. Engagement and questioning by the Integration Joint Board and NAC Executive Leadership Team on Social Work matters has been productive and supportive. Alongside this our Social Work Governance Board has offered direction on a range of key areas across all spheres of Social Work and remains a lively forum for professional discussion with representation from all levels of Social Work in North Ayrshire. Finally, I would like to place on record my appreciation for the compassion and commitment displayed day in, day out by our practitioners, managers, business support staff and partners to ensure that Social Work and Social Care services are delivered to the very best of our abilities. Scott Hunter Chief Social Work Officer North Ayrshire Health and Social Care Partnership 285
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2 Demographics North Ayrshire is home to approximately 133,570 people, (National Records for Scotland, Mid-2023 Population Estimates Scotland) all living in its many towns, villages, and islands, with slightly more females (52.1%) than males (47.9%). 15.8% of the population are aged 0 to 15 years, 9.3% are aged 16 to 24 years, 21.7% are aged 25 to 44, 29.1% are aged 45 to 64 years of age, 13.2% ages between 65 to 74 years of age, with 11.0% of our population aged 75 years and above. The latest update of the Scottish Index of Multiple Deprivation has reconfirmed the deep structural challenges faced by many communities in North Ayrshire, despite steady progress by North Ayrshire Council in its ongoing commitment to eradicate poverty. North Ayrshire is ranked as the fifth most deprived council area in Scotland. Some of the area’s most heavily affected by deprivation are concentrated in the Three Towns and Irvine areas but areas in Kilwinning and the Garnock Valley also have above average deprivation. 286
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3 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 5 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, 23 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 our residents still experience poorer outcomes when compared to the Scottish figures. For example, 40.3% of the population lives within the 20% most deprived areas and the child poverty rate in the Kilbirnie and Beith Ward at 29.5% is above the general North Ayrshire rate of 29%. 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%, 287
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4 and general health indicators are also around the middle of the other localities, though Garnock Valley does have highest deaths 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 etc. it still experiences 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 than the national levels 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. 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. 288
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5 • 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. 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 has 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 delated 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. 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 289
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6 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%. 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. 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. 290
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7 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. 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. 291
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8 1. Governance, Accountability and Statutory Functions The Chief Social Work Officer is a statutory appointment by virtue of Section 3 of the Social Work (Scotland) Act 1968. The Chief Social Work Officer is appointed for the purposes of the Council's functions under the 1968 Act and under those other enactments listed in Section 5(1B) of that Act. In broad terms, those functions cover all social work and social care services whether provided directly by the council, in partnership with other agencies, or procured by the council and provided by others on its behalf. Those functions are referred to as “social work services”. The qualifications required for the post are set out in the Qualifications of Chief Social Work Officers (Scotland) Regulations 1996. The Chief Social Work Officer is required by section 5(1) of the 1968 Act to carry out the duties of the post under the general guidance of the Scottish Ministers. The Scottish Ministers issued revised and finalised guidance in January 2010. The overall powers of the Chief Social Work Officer post are:- (a) To oversee the discharge of the council's statutory social work duties; (b) To ensure the provision of effective professional and objective advice to elected members and officers of the Council in the Council's provision of social work services; (c) To secure the effective provision of social work services. The powers of the Chief Social Work Officer fall into two broad categories; service provision and corporate responsibility: Service provision • To establish and develop social work services focussed on the needs of service users, to promote the continuous improvement of those services, and to monitor and raise standards of their delivery; • To ensure the effective governance of the balance of need, risk and civil liberties in the provision of social work services in accordance with professional practice; • To provide advice on all aspects of workforce planning including safe recruitment practice, supervision, monitoring and assessment of social work students, securing of professional qualifications and continuous learning and development for staff, and supporting and advising managers in all aspects of staff supervision; • To ensure the existence of systems to both promote good practice and identify and address poor practice in the provision of social work services; • To ensure that significant case reviews are undertaken of all critical incidents either resulting in, or which may have resulted in, serious harm or death; and 292
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9 Corporate Responsibilities Corporate responsibility The Chief Social Work Officer has the following corporate powers which require direct access to the Council's Chief Executive’, Elected Members of the Council and the Chief Officer, and the provision of forthright and independent advice to them:- • To ensure compliance with the Council’s statutory duties to prepare, publish and review plans for the provision of social work services. • To promote, communicate, support and review values and standards of professional practice, and to ensure that they are adhered to. • To establish, in conjunction with the Council's Corporate Management Team, appropriate experience and qualified cover for the post of Chief Social Work Officer during the post-holder's absence or incapacity. • To report to the Chief Executive and Chief Officer any failure in the Council's corporate policy or governance arrangements designed to reflect the proper balance amongst need, risk and civil liberties in the provision and management of social work services. • To report to the Chief Executive and Chief Officer any weaknesses and failures in the systems in place to promote good practice and identify and address poor practice in the provision of social work services. • To report and provide independent comment where necessary to the Chief Executive, Elected Members of the Council and the Chief Officer on the findings of significant case reviews and relevant performance reports and on any other social work related issues. • To provide an annual report to the Council on all of the statutory, governance and leadership functions of the role of the Chief Social Work Officer North Ayrshire continues to invest in its oversight of Social Work activity through the provision of a standalone Chief Social Work Officer, further supported by a formal Depute CSWO. The CSWO reports directly to the Director of the NAHSCP and has a direct line to the Chief Executive of the Council. The CSWO represents Social Work within a range of strategic groups including: IJB, IJB Performance and Audit Committee, IJB Strategic Planning Group, NAHSCP Health Care Governance Committee, HSCP Partnership Senior Management Team, Alcohol and Drugs Partnership, Child Protection Committee, Adult Protection Committee, Chief Officers Group, Carers Advisory Group, Children’s Services Strategic Planning Partnership; Corporate Parenting Board, Transitions Strategic Group amongst others. The CSWO also provides professional oversight as a member of the Care Home Oversight Group and the Care at Home Oversight Group. These groups continue to fulfil key governance activity in relation to the Social Care sector. 293
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10 The CSWO has regular contact with the Independent Chair of CPC and APC to ensure public protection oversight. The year past has seen North Ayrshire commission one learning review. Social Work and Social Care matters are regularly reported to the IJB and Clinical and Care Governance Committee. There is a particular focus on the impact of policy and external scrutiny activity. The CSWO maintains regular calls with our Care Inspectorate strategic link to share developments and hear of national developments that support activity in North Ayrshire. The CSWO also contributes to quarterly calls with the inspectorate and the broader PSMT. The primary governance of practice matters remains the Social Work Governance Board. The board terms of reference and membership have been refreshed in the current year with the support of the professional leadership group. The board has had a full agenda of issues over the year and has provided support and governance in relation to a range of matters including: • Practice Guidance for Social Workers Assessing Capacity and Practice Enhancement Notice: In Person Assessments for Complex Cases • Re-modelling of acute in-patient service for adults with learning disabilities • Chronology Training and Practice Improvement • Community Justice Outcome Implementation Plan (CJOIP) • HSCP Refugee and Resettlement Team Transition • National Social Work Agency Workforce Improvement • AWI Delayed Discharge - best practice • Test of Change – All Age Disability Service 294
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11 1.1 Overview of the North Ayrshire Health and Social Care Partnership Visions, Values and Priorities 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 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: 295
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12 2. Service Quality and Performance 2.1 Children, Families and Justice Services Brighter Pathways Programme Board 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. Whole Family Wellbeing Fund 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. 296
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13 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. Seven projects are Third Sector projects, six are NAC/HSCP projects while 3 are independent projects. Promise Conference 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: • Introduce young people to The Promise Plan 2024-2030. • 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. Family Centred Wellbeing Service 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. This approach allows us to ensure that 85% of families receiving support require no further interventions following this support. 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 297
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14 families to access local community resources and build further contacts within the community, reducing the impact of social isolation. Child Protection Registrations In 2024 to 2025 there were 156 Child Protection registrations and 178 De- registrations. The greatest number of registrations were found in September, when there were 22 registrations within the month. The lowest number of registrations occurred in November, when there were 5 registrations within the month. The median number of registrations per month across the year was 12.5. Breastfeeding Breastfeeding rates - 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: 298
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15 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. United Nation’s Convention on the Rights of the Child 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. 299
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16 Child Healthy Weight 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. Health Visiting 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. 300
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17 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. 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 1-1 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. Child to Adult Disability Transitions Prior to commencing an active role with the children with a disability team, a baseline of current functioning was obtained. The qualitative data for baseline was obtained through staff caseload reviews this included reviewing assessments and care plans, in addition to case notes held within CareFirst. This evidenced that current supports available to children, young people and their families is not sufficient in providing 301
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18 adequate support. The supports available are mainly social supports and residential respite. Although these supports offer families a short break from their caring responsibility, it is not fully addressing issues in relation to daily management of personal care and behaviours that challenge, leading to carer burnout and young people reaching crisis. Further findings of the service review found that current transition planning has become a process driven activity. Factors impacting transition planning include late referrals to Transition Planning Group (TPG) and an inability to screen/allocate staff in adult social work teams to screen referrals and/or allocate workers for assessments, leading to a tick-box exercise when completed. This approach ultimately has a negative impact on a young person's transition, with often late and/or rushed assessment and resource allocation. Current processes are not undertaken in a person-centred manner. In order for young people to thrive as they transition to adulthood, the following was identified: • Assessment and case note training for staff. • Outcome and Goal Setting training for staff. • Review eligibility criteria for children and adult social work. • Collaborative work with our partner agencies to promote skill generalisation between school, community supports and respite for better outcomes for young people. • Personal Care needs to be addressed to support families in the day-to-day care of children and young people with disabilities, through a Care at Home type service. This is multifaceted in relation to relieving carer burnout and also developing and promoting independent life skills in young people, which will support their transition to adulthood. • Proactive use of legislative measures to ensure children and young people are protected. • Review TPG and its Terms of Reference to return to a person-centred decision-making forum. • Referral screening processes to be developed. • Increased joint working from the age of 14-years from adult social work to provide advice and guidance. • Review age restrictions in children and adult social work to allow transitions to happen at the right time, between ages 16-years and 21-years. • Review of resource allocation processes for a more standardised approach. 302
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19 Key Performance Indicators Child Protection 2019–20 2020-21 2021–22 2022-23 2023-24 2024-25 Child Protection Concerns 849 885 756 570 361 444 Child Protection Investigations (CP1s) 447 443 432 375 197 421 Child Protection Initial Conferences 123 121 119 76 83 170 Pre – Birth Conferences 41 29 34 17 22 14 CP Initial/Pre-Birth Conferences 4 7 4 9 1 10 Looked after Children 2019–20 2020-21 2021–22 2022-23 2023-24 2024-25 Children newly accommodated in North Ayrshire 84 63 49 61 46 52 ** Where the number of children accommodated = the number of children either admitted into any placement type except “At Home with Parents”/”With Friends/Relatives” OR moved from “At Home with Parents”/”With Friends/Relatives” to any other placement type 2019–20 2020-21 2021–22 2022-23 2023-24 2024-25 Foster Carers 98 103 99 96 105 107 303
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20 Permanency Planning 2019–20 2020-21 2021–22 2022-23 2023-24 2024-25 Number of permanency plans approved 30 10 21 19 15 6 Adoption – approved and placed 3 8 5 7 4 2 Adoptions granted 8 4 5 5 7 5 Permanence orders approved 11 3 7 7 7 6 Permanence orders granted 8 0 1 2 9 2 2019–20 2020-21 2021–22 2022-23 2023-24 2024-25 Children Subject to Compulsory Supervision Orders 393 351 342 298 271 258 2019–20 2020-21 2021–22 2022-23 2023-24 2024-25 Children with Compulsory Supervision Orders Terminated 140 102 101 102 117 69 Emergency Placements 2019–20 2020-21 2021–22 2022-23 2023-24 2024-25 Child Protection Orders 32 39 11 18 14 22 Secure Placements 2019–20 2020–21 2021–22 2022-23 2023-24 2024-25 Number of secure placements 4 1 2 0 2 3 304
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21 Justice Services 2019–20 2020-21 2021–22 2022-23 2023-24 2024-25 Number of reports submitted to the courts (CJSW reports, Section 203, Short Notice CJSW & Supplementary CJSW) 763 430 606 606 668 707 Number of home leave and background reports submitted 151 (66 leave reports, 85 background reports) 114 (39 leave reports, 75 background reports) 93 (30 leave reports, 63 background reports) 91 (28 leave reports, 63 background reports) 112 (41 leave reports, 71 background reports) 112 (42 leave reports, 32 background reports 38 TARL) Unpaid Work Requirements 360 94 172 313 310 329 2019–20 2020-21 2021–22 2022-23 2023-24 2024-25 Level 1 Mappa 163 152 172 190 174 188 Level 2 Mappa 7 10 14 27 11 13 Level 3 Mappa 5 3 7 2 2 1 305
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22 2.2 Adults North Ayrshire Drug and Alcohol Service 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 306
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23 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. North Ayrshire Model for Enhanced Intermediate Care and Rehabilitation (eICT) The North Ayrshire Model for Enhanced Intermediate Care and Rehabilitation (eICT) utilises multidisciplinary holistic interventions to focus on providing high-quality care and support, through proactive early intervention and preventative action. They aim to assist patients presenting with falls, frailty, low grade infections and general functional decline to avoid hospital admission where possible and facilitating early discharge home from hospitals. 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 1,325 307
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24 The North Ayrshire Enhanced Intermediate Care Team brings together the expertise of dedicated Physiotherapists, Occupational Therapists, Technical Instructors, Dieticians, Community Psychiatric Nurses, Pharmacists, Admin workers, Rehabilitation Nurses, Advanced Nurse Practitioners, and Intermediate Care GP with special interest into one single multidisciplinary and interdisciplinary team; focused on problem-solving for patients in their own homes across all of mainland North Ayrshire. The seven-day rehabilitation service facilitates early discharge from hospital and provides a rapid alternative to acute hospital admissions. The Enhanced part of the team addresses medical and clinical issues that limit a patient’s ability to engage in rehabilitation via a shared care model with the patients registered GP. Anam Cara Refurbishment 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 308
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25 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. 309
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26 Mental Health Facility 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. 310
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27 Trindlemoss Day Opportunities 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. 311
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28 Out of Hours Social Work Service Date Period North Ayrshire South Ayrshire East Ayrshire Total 2020-2021 4165 2337 2800 9302 2021-2022 4000 2202 2613 8815 2022-2023 3185 1783 2366 7334 2023-2024 3832 2103 3159 9094 2024-2025 3935 2167 3353 9455 These figures do not include the calls taken which did not result in a referral being made to day services. Self-Directed Support 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 • Option 2 – you direct the available support • Option 3 – the local council arranges the support • Option 4 – a mix of the above 0 50 100 150 200 250 300 350 400 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 AOOH Referrals NAC SAC EAC 312
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29 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. Care at Home 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. 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. 313
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30 Carers 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. 314
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31 2.3 Criminal Justice Multi Agency Public Protection Arrangements (MAPPA) 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 etc. 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”. Community Payback Orders 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 which equates to 52.5 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. Our Justice Services continue to have a positive impact on the local community through the Community Payback Order (CPO) unpaid work scheme. For the twelfth year we continue to 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. 315
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32 Drug Treatment and Testing Order 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. 316
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33 Diversion from Prosecution 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, 2023 to 2024 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. 317
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34 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 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 318
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35 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 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. 319
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36 Key Performance Indicators MHO Service Mental Health (Care and Treatments) 2003 2018–19 2019–20 2020–21 2021-22 2022-23 2023-24 2024-25 Emergency Detentions 54 54 81 96 92 99 121 Short Term Detentions 74 67 134 There has been a total of 171 requests (of which consent was given to 134, with the other 37 being assessed but consent not given) There has been a total of 127 requests (of which consent was given to 108, with the other 19 being assessed but consent not given) There has been a total of 182 requests (of which consent was given to 151, with the other 31 being assessed and consent not given) There has been a total of 202 requests (of which consent was given to 170, with the other 32 being assessed and consent not given) 320
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37 Compulsory Treatment 38 51 59 There has been a total of 70 new CTOs granted (of which 27 had been Interim CTOs, with 14 of these moving to full CTO following a further Mental Health Tribunal) There has been a total of 60 new CTOs granted (of which 17 had been Interim CTOs, with 12 of these moving to full CTO following a further Mental Health Tribunal) There has been a total of 47 new CTOs granted (of which 10 had been Interim CTOs, with 4 of these moving to full CTO following a further Mental Health Tribunal) There has been a total of 60 new CTOs granted (of which 24 had been Interim CTOs, with 18 of these moving to full CTO following a further Mental Health Tribunal) Warrants Undertaken 1 6 6 4 4 3 2 Criminal Justice Act Scotland 1995 2018–19 2019–20 2020–21 2021-22 2022-23 2023-24 2024-25 Compulsion Order and Restriction Order 4 3 3 2 0 0 0 Compulsion Orders 2 6 6 3 3 3 6 Hospital Directions 1 1 1 0 0 0 0 Assessment Orders 2 2 2 6 5 6 4 Treatment Orders 4 2 2 6 2 3 4 Transfer for Treatment 2 1 3 1 1 1 1 321
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38 Adults with Incapacity Act (Scotland) 2000 2018–19 2019–20 2020–21 2021-22 2022-23 2023-24 2024-25 Private Welfare Guardianships 411 (58 new) 272 (67 new) 314 (57 new) 402 (102 new) 371 (99 new) 422 (125 new) 450 (63 new) CSWO Guardianships 40 (16 new) 64 (24) 71 (24) 91 (26) 85 (27 new) 121 (54 new) 151 (40 new) Financial Intervention Order (LAG) 26 31 n/a n/a n/a n/a n/a MHO Report PWG Application 38 104 75 156 139 141 101 Adult Protection 2019–20 2020–21 2021-22 2022-23 2023-24 2024-25 ASP Referrals (AP1) 568 558 643 722 915 1092 ASP Investigations (AP2) 108 132 102 72 112 100 ASP Case Conferences 66 64 40 41 57 43 Protection Orders 0 3 1 0 1 0 Adult Concern Reports 2335 2215 2070 2370 2103 2538 322
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39 3. Resources 3.1 Financial Pressures The IJB set a balanced budget for 2024/25 on 14th March 2024. This did not require any draw on reserves but did include the approval of £10.290m of savings to achieve financial balance. 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. Financial balance was not been achieved in 2024-25 and the 2025-26 budget highlights several areas of significant risk. Financial modelling also anticipates a very challenging position in subsequent years. From the initial budget monitoring report in month 3 the projected position was 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. The IJB agreed some initial recovery actions at the meeting in June 2024 and a more detailed financial recovery plan was developed and approved by the August 2024 IJB. Since the initial recovery plan was agreed in June 2024 there was a £4.002m reduction in costs. Despite this, against the full-year budget of £326.629m there is a reported overspend of £1.212m pre-earmarking. After earmarking the overspend of £3.593m consists of an overspend of £2.036m in social care services and an overspend of £1.557m in health services. Following additional funding contributions this position was brought on-line. 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. 3.1 2025-26 Budget As part of the Scottish Government budget and finance settlement funding letters were issued to NHS Boards and Councils, these detailed the requirements in relation to the level of funding to be delegated to IJBs in 2025-26. The specific requirements and funding provision is as follows: NHS Ayrshire and Arran • NHS Ayrshire and Arran are required to passport the 3% through to IJBs (£4.040m to North Ayrshire) – “In 2025-26, NHS payments to Integration Authorities (IA) for delegated health functions must pass on an uplift of 3% over 2024-25 agreed recurring budgets.” 323
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40 • Additionally, there is funding of £150m nationally for Agenda for Change Pay Reform. A share of this funding will be allocated to the IJB to meet the associated costs for NHS staff. This is being followed to ensure the correct roll-forward into 2025-26 and it is anticipated at this stage that the costs of the pay reform will be fully funded. • Moving into 2025-26, brokerage will no longer be available to NHS Boards and all Boards must work towards break-even. Should financial balance not be achieved this would be shown as an overspend in financial statements, leading to potential qualification of accounts and Section 22 report, as well as consideration of escalation status. • The NHS budget includes a commitment of additional funding to reduce waiting lists and to help support reduction of delayed discharge; as well as a commitment to renew primary care enhancements, including new core funding to GMS to deliver enhanced frailty, cardiovascular disease and other essential services in General Practice, a critical dental workforce and training package and a community eye care programme to transfer patients from waiting lists. Further details of the allocation of funding is to follow but a submission from NHS AA incorporates the request for funding from North Ayrshire IJB and this was submitted to the Scottish Government early March 2025. • Similarly to Local Government NHS Boards have also been advised to plan on the assumption of 60% funding for the Employers National Insurance Increase. North Ayrshire Council • Based on the 2025-26 Finance Settlement the Health and Social Care Portfolio will transfer additional funding of £140 million to Local Government to support social care and integration for 2025-26. • The funding allocated to Integration Authorities should be additional and not substitutional to each Council’s 2024-25 recurring budgets for services delegated to IAs and therefore, Local Authority social care budgets for allocation to IAs must be at least £140 million greater than 2024-25 recurring budgets. • The increase in Employers National Insurance from April 2025 has not been fully funded for the public sector in Scotland and has created a significant financial pressure. For Local Government funding of around 60% of the cost will be provided by Scottish Government for directly employed staff. There is zero funding being provided for any commissioned services. • Specific funding for the IJB was received for the following areas: • Real Living Wage • Free Personal and Nursing Care 324
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41 • Additionally, North Ayrshire Council have passed through a share of the Local Government Grant uplift of £2.114m and have fully funded the increase in Employers’ NI costs of £1.898m for NAC contracted staff. previous years and were already assumed in the Partnership base budget and this is shown in the table below. Moving into 2025-26 the Partnership is proactively working to provide safe and effective services for the residents of North Ayrshire within the financial envelope, this is supported by approving a balanced budget. The IJB approved a one-year balanced budget for 2025-26 on 20 March 2025. More information about the budget can be found here - 25-26 Budget This budget included new budget pressures for health and social care services totalling £14.943m. These were developed in partnership, with Finance supporting front line services to identify current and emerging financial pressures considering historic demand and costs and potential future variations. The provision of funding for pressures has the impact of increasing the budget gap to be addressed through savings, therefore the pressures are only included in budget plans where these are absolutely unavoidable. The new cost and demand pressures resulted in a requirement to identify and approve additional savings of £4.019m 3.3 Financial Planning 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 2022-30 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 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. The IJB has a strong reputation in delivering savings. The IJB will continue to pursue transformational change in how it supports individuals, families and communities to live independently from statutory services for as long as they can safely do so. This is not just about changing the ways in which services are structured but will require a change in how they are planned and delivered. Our health and social care services should reflect and respond to the needs of local people. To support this, we will help to build greater capacity in our communities and provide more ways for service users and local people to share their views with us to help shape services. We are fully committed to planning and designing services together with local people, our staff and our key partners including acute health services, housing, community planning and the third and independent sectors. 325
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42 The IJB, through the Strategic Plan, outlines the belief that together we can transform health and social care services to achieve the joint vision for the future “all people who live in North Ayrshire are able to have a safe, healthy and active life.” Moving into 2025- 26, we are working proactively to address the financial challenges, while at the same time, providing high-quality and sustainable health and social care services for the communities in North Ayrshire. 3.4 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. 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 2026-27 and 2027-28. The Integration Joint Board, in common with most Public Sector bodies, is facing a period of significant financial challenge with cost and demand pressures. The most significant financial pressures continue to be pay awards for staff, inflationary cost increases for contracted services and demographic changes driving increased demand for services - funding these unavoidable pressures year-on-year drives our savings requirement. There are a number of highlighted financial risk areas that may impact on the 2025-26 budget during the year, these include: 326
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43 These risks will be monitored during 2025-26 and the financial impact reported to the IJB. The next three years will be the greatest financial challenge that the IJB has been asked to manage since its inception. North Ayrshire IJB is clear about the challenges which are ahead and its aspirations for its services, however we will also need to be realistic about what can be delivered within the funding envelope available. Transformation alone will not address the financial gap, and this will require the IJB to prioritise decisions for investment and disinvestment in order to support delivery of the Strategic Plan. This will result in some services being reduced or stopped altogether but this action is required to ensure the available resource reaches those most at risk and in need of care and support. Legacy Overspends Growing demand for services Provider market –cost pressures and potential market failure Performance expectations –Maintain and Improve SG Policy Commitments not fully funded& funding reducing or ceasing Wider system financial challenges –NAC and NHS Meeting needs of population –with rising costs of care NHS Reform priorities Zero Unearmarked reserves 327
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44 4. Workforce 4.1 Workforce Planning Following the implementation of the HSCP “Be the Best You Can Be” Learning & Development Strategy (Social Work and Social Care) in September 2023 there has been a clear indicator of the HSCP organisational offer and expectations in relation to professional development for the social work and social care workforce. While the strategy enters its third year it continues to outline our approach to articulating to our practitioners how much we are investing in their development and aims to embed the development of leadership and management capabilities. The issues in relation to professional staff sufficiency remain across all areas of social work both locally and nationally. The recent SSSC Annual Workforce Data Report shows there was an increase of 23% in the social work workforce in NAHSCP. This is testament to the implementation of the “Be the Best You can Be” Learning and development Strategy 2023/28 which outlines the qualification pathways and annual development offers to staff. We can continue to offer annual sponsorship opportunities for the Undergraduate Social Work Degree and “fast track” routes including the Post Graduate Diploma in Social work. As a direct result of the “Growing Our Own” programme we have 9 employees undertaking a social Work qualification and a further 4 employees who have completed a social work qualification and will graduate in the autumn. This programme has seen 12 employees qualify as social workers. To further support the “Growing Our Own” programme we have embarked on the journey to create a NAHSCP Practice Education qualification through SQA and SSSC approval processes this will ensure a sustainable, local and self-sufficient delivery method of the qualification which will secure the pathway for development and social work students in NAHSCP. As part of the strategy and the Growing Our Own programme there is a visual pathway which demonstrates from school leavers to senior levels what is on offer including the opportunity to undertake an HNC in Social Services & Healthcare and 12 employees were successful in the completion of this qualification earlier in the year and a further offer has been disseminated to staff. We are continuing to develop robust relationships and ways of working with Universities in the West and the local Ayrshire College. Through these more direct ways of working and collaboration we continue to explore the variety of degree level, post graduate and post qualifications on offer and practice learning opportunities is one of our optimum responsibilities. Through such collaborations we have developed in partnership with Ayrshire Hospice an enhanced approach to the quality of palliative care through comprehensive training opportunities. This will support the increased number of citizens who choose to remain at home in the final stages of life rather than in a clinical setting and equip social work and social care staff with the knowledge and skills to provide compassionate care. 328
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45 Our commitment to the provision of Mental Health Officers within the organisation is another key component of the Learning & Development Strategy. Following the “pilot” delivery of the mental health qualification from a different HEI where the aim was to offer a more bespoke and flexible qualification with a local context we have 2 employees nearing successful completion of this qualification and a further 2 sponsored on this course for the next cohort. The strategy seeks to strengthen the newly qualified first year for Social Workers in cognisance of the directive from the implementation of SSSC Newly Qualified Workers Supported Year. This is critical as the first year greatly influences professional autonomy and authority which are key to good social work practice. With the introduction of mentoring training and support for teams who will have NQSW’s and an offer to extend our support to NQSW’s from 12 months to 18 months with a monthly planned programme delivered by the social work practice team this will nourish new social workers. This approach continues to be embedded after the initial implementation year and feedback from a “deep dive” quality assurance exercise carried out by the SSSC highlighted instances of “exceptional” examples of practice from our NQSW’s. Leadership & Role Modelling has been seen as one of the key areas where managers and supervisors can influence professional standards and practice and promote a leadership culture. With Aspiring Leaders Programmes for aspiring/new managers and Systems Management Programmes for senior managers these programmes offer reflective space and coaching to allow practitioners to explore complex systems and leadership at all levels within an organisation. Both courses have been delivered and continue to demonstrate extremely successful outcomes in the development of a cross section of practitioners. In relation to the key area of Good reflective Supervision outlined in the document “Supervision Standards” have been developed following the ongoing work in relation to supervision practice being undertaken by external consultant Bridget Rothwell. The standards are contained in the “Be The Best You Can Be” Learning and Development Strategy. The Supervision Standards outline expectations in relation to good reflective supervision, values and conduct which can be used to develop bespoke service specific supervision guidance and there is clear guidance around expectations and usefulness of face to supervision provision. The strategy includes an overarching focus on the wellbeing of the workforce and is included as a key component of the supervision standards. Further input from Bridget will commence in the summer and will focus on bespoke development support for frontline managers. In relation to ongoing in house training we have been able to increase the number of courses on offer by more than 100%. The variation of courses on offer has increased following consultation with the workforce and driven by other national agendas including Trauma Informed Practice. This has resulted in 417 practitioners attend the various offers of Trauma Training since it was launched 9 months ago and a further 11 completing the Professional Development Award which is an accredited qualification. Our offer to the workforce for accredited qualifications has increased significantly with a variety of Professional Development Awards including, Mental Health, Leadership and Management and Supervision available. These offers enhance the knowledge and skill of the workforce in both social work and social care and contributes the mandatory requirements outlined by our regulatory bodies. 329
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46 As the strategy continues to be embedded the “appetite” for development from the workforce is evident with the participation at events and information sessions. 4.2 Workforce Support and Development 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. 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. 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 330
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47 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 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. 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 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. 331
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48 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. 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.“ 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. 332
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49 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.” 333
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50 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 service 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 3 334
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51 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 62 335
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52 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. 336
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53 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 4 337
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