Unscheduled Care Improvement Plan Update
North Ayrshire Council · 13 November 2025
Back to Integration Joint Board — 13 November 2025 and its agenda
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Integration Joint Board 13 November 2025 Subject : Unscheduled Care Improvement Plan Update Purpose : To update the IJB in relation Urgent and Unscheduled Care Funding, Performance and Improvement Plans. Recommendation : The IJB are asked to: a) Note the performance for Delayed Discharges in North Ayrshire and associated improvement plans. b) Note the updates provided in relation to Urgent and Unscheduled Care Funding and the Pan Ayrshire plans for spend c) Endorse continued progress at pace with plans to ensure optimal utilisation of allocated funds. d) Approve progression of plans to enhance Care at Home Reablement capacity via NHS Renewal Funding e) Note the funding risk associated with uncertainty of recurring elements of funding allocation 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 NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership IJB Integration Joint Board DwD Discharge without Delay AWI Adults with Incapacity MHO Mental Health Officer H@H Hospital at Home LoS Length of Stay D2A Discharge to Assess CAH Care at Home 1. Executive Summary 1.1 The report provides an update on urgent and unscheduled care funding, delayed discharge performance, and associated improvement plans for North Ayrshire HSCP within the Ayrshire & Arran system.
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1.2 Scottish Government confirmed £10.079m for NHS Ayrshire & Arran (June 2025), with £1.081m ring-fenced for North Ayrshire to enhance hospital-based MDT capacity (£746k) and Mental Health Officer (MHO) capacity (£335k). Additional £1.2m investment is proposed for Care at Home (CAH) reablement to support Discharge to Assess (D2A). Initiatives align with the Discharge without Delay (DwD) programme, NHS Renewal Framework, and Hospital at Home expansion, aiming to reduce hospital occupancy, improve patient flow, and shift care closer to home. 1.3 Increased MHO capacity has eliminated inpatient allocation waits and reduced Adults with Incapacity (AWI) delays by 48% since July 2025. Recruitment for a 7-day Enhanced MDT is underway, and is expected operational by January 2026. 1.4 Current delayed discharge levels remain high (average 90+ daily delays), primarily due to Care at Home capacity challenges. Revised trajectories show slower improvement due to delayed investment and non-recurring funding risks. Financial pressures continue, with a projected £4.167m overspend in Health & Community Care services. 2. Background 2.1 As highlighted in previous papers submitted to the IJB, Health and Social Care services across Scotland continue to face real pressures, including demographics, growing demand, healthcare needs, and increasing financial pressures. Unscheduled care performance, and in particular delayed discharge performance, is utilised as one of the key indicators to measure the efficiency and effectiveness of our health and care system. 2.2 The Partnership’s Health and Community Care teams, alongside Mental Health colleagues, successfully implemented local winter preparedness and delayed discharge improvement plan(s) in response to service performance levels through 2023 to 2025. These focused on enhancing Care at Home Capacity, Discharge to Assess and Adults with Incapacity and have provided a solid foundation to build further improvements in discharge performance. 2.3 NHS Renewal Framework The NHS Renewal Framework, launched by the Scottish Government in early 2025, sets out a long-term vision for health and social care reform built on five principles: prevention, people-centred care, community-based care, population planning, and digital integration. It includes three key products: - Operational Improvement Plan – focused on urgent and unscheduled care redesign. - Population Health Framework – addressing health inequalities and prevention.
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- Medium-Term Service Reform Plan (2025–2030) – outlining sustainable models of care. The framework prioritises reducing hospital occupancy, improving patient flow, and shifting care closer to home through initiatives such as Discharge Without Delay, front- door frailty services, and Hospital at Home expansion. Delivery of these outcomes is essential for continued and future funding. 2.4 National Discharge without Delay (DwD) Programme DwD is a national whole-system improvement programme designed to transform hospital discharge processes and patient flow across Scotland. Its core aim is to ensure that patients, particularly frail older adults, experience timely, safe, and person- centred transitions from hospital to home or community settings without unnecessary delays. DwD integrates best practice principles such as early discharge planning, MDT collaboration, and the use of Comprehensive Geriatric Assessment to prevent hospital-induced harm and dependency. By embedding DwD across acute and community services, Health Boards and HSCP’s can reduce hospital occupancy, improve patient outcomes, and create a more sustainable model of care that prioritises independence and recovery. The programme utilises core DwD principles and practices, designed to improve patient flow and reduce unnecessary delays in hospital discharge. They ensure that planning starts early, care is coordinated across settings, and patients receive timely support in the most appropriate environment, usually their own home. By embedding these practices, health systems can minimise hospital occupancy, enhance patient outcomes, and create a more sustainable, integrated model of care. The core DwD Principles & Practices include: • Advance Discharge Planning • “Home First” Approach • Integrated Access & Rapid Response • Community-Based Care Expansion • Workload Allocation & Leadership 2.4.1 Delivery of the core principles and practices is supported by the four key national delivery workstreams below:
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2.4.2 NHS Ayrshire and Arran formally adopted the DwD programme as part of Scotland’s national initiative to improve patient flow and reduce hospital occupancy. This programme replicates the national workstreams, learning from others and utilising national support to embed best practice principles appropriately to the Ayrshire and Arran population. Desired whole system outcomes from the DWD programme include: • Reduce acute geriatric length of stay (LOS) by >20% by end March 2026 including reduction in SSA and guardianship LOS and process. • Reduce community hospital/step-down LOS by > 20% (ideally less 28 days) by end March 2026. • Reduce respective HSCP delayed discharges by >20% by end March 2026 as consequence of improved flow. • With improved downstream capacity, the DwD programme aims to improve 4- hour whole system performance by 3-5% points. 2.4.3 North Ayrshire HSCP is actively participating in this whole-system transformation. Appropriate representatives are members of both National and Ayrshire and Arran workstreams. The Partnership has committed to implementing DwD principles and achieving the whole system outcomes through enhanced hospital-based assessment teams, expansion of Care at Home capacity, and the development of discharge-to- assess pathways. These actions are supported by targeted investment from the NHS Renewal funding, enabling North Ayrshire to strengthen its multi-disciplinary response and reduce delayed discharges, particularly for frail older people and those requiring complex social care interventions. A national DWD Needs Assessment Tool has been developed by the DWD Collaborative. The Ayrshire and Arran DWD Needs Assessment has recently been completed through collaboration with acute hospital and HSCP teams. The Needs
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Assessment demonstrates a RAG status, narrative on progress, and dependencies across four main categories: Frailty at the Front Door, Planned Day of Discharge, Community Hospitals and Discharge to Assess. It also supports development of an action plan to support successful delivery of Discharge without Delay. 2.5 Ayrshire and Arran Whole System Improvement Plan Ayrshire and Arran submitted a whole system plan to the Scottish Government in early 2025, with revised plans on a priority basis submitted thereafter. Details of these are provided below: The Ayrshire and Arran plan included an ask for the North HSCP totalling over £9m in funding requirements to deliver the desired whole system change and transformation. A similar plan was submitted to COSLA in June 2024, detailing the areas of investment that would be required to deliver performance improvement linked to delayed discharge. Details of the North specific funding ask to support system improvement are detailed below: Operational Improvement Plan -Pan-Ayrshire -Whole System Improvement Plan Priority 1-Combined Circa £17m 7 Day Frailty Service–direct access front door, core ED with integrated community frailty pathways Ayrshire Wide Clinician Support DWD Programme-Home First & SAFER Roll Out Across Crosshouse and Ayr Hospitals HSCP Submissions Including Pan- Ayrshire GP Capacity and Community Equipment Store Resource, Care at Home Capacity, MDT to support hospital interface Same Day Emergency Care (SDEC) Expansion–7 day and evening cover Hospital at Home & Virtual Capacity including palliative care and community respiratory services Priority 2-Combined Circa £4.915m HSCPs –including Complex Care, Digital & Technology, MHOs, Flow Navigation Service –enhance redirection in evenings and weekends Priority 3-Combined Circa £1.372m HSCP–Community Wards and Community Rehab
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The focus of the North Ayrshire Improvement Plan is to operationalise the Ayrshire & Arran DwD programme at a local level by addressing barriers to timely discharge and improving patient flow. The plan and associated investment focus on expanding Care at Home capacity, embedding D2A pathways, and strengthening hospital-based MDT’s to deliver early intervention and comprehensive discharge planning. The plan also prioritises reducing delayed discharges, in particular those linked to AWI, supporting a HomeFirst approach, ensuring patients return to the most appropriate setting with the right support. 2.6 In June 2025, the Scottish Government allocated up to £10.079 million to NHS Ayrshire & Arran as part of the NHS Renewal programme to improve urgent and unscheduled care. The level of funding confirmed is significantly less than the resource requested via the Ayrshire and Arran Whole System submission. Allocated funding supports delivery of the Operational Improvement Plan and aims to reduce hospital occupancy, improve patient flow, and shift care closer to home. The allocation includes funding for H@H, DwD and frailty services, alongside funding for core unscheduled care. Within this funding allocation, £1.081m was ring-fenced for North Ayrshire HSCP to enhance its hospital-based multi-disciplinary teams and to expand Mental Health Officer capacity. Funding is conditional on achieving agreed outcomes such as embedding DwD principles, implementing front-door frailty services, and expanding virtual capacity, with robust monitoring and trajectory reporting required to secure future recurrent funding. 2.7 The Partnership’s Health and Community Care teams have reformed the local winter preparedness and delayed discharge improvement plan group, made up of representation from across the HCC Senior Management Team. The group will North Ayrshire -Improvement Plan Reduce LOS Discharge to Assess Improve Community Capacity Fully deliver DwD principles Frailty – Preventative and Home first Community Pathways Priority 1-£5.6m Care home capacityinc interim bed capacity (780k) Community based MHO capacity (£335k) Enhanced HSCP MDT (£746k) Care at Home and reablement capacity (£3.8m) Priority 2 £2.2m Technology including enhanced responder services (£350k) Complex discharge planning and admission avoidance (£1m) Complex care home beds (£576k Anam Cara) or £861k (external care home Priority 3 -£1.3m Community Rehab Capacity (£410k) Community Wards (£952k)
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oversee discharge performance, implementation of the improvement plan and will centralise the robust monitoring and reporting needs required to secure future recurrent funding. The group also collates information from the National and Pan Ayrshire DwD groups and will coordinate local activity linked to this. 3. Current Situation 3.1 NHS Renewal Funding The NHS Renewal programme was introduced by the Scottish Government in early 2025 to accelerate health and social care reform and deliver sustainable improvements across urgent and unscheduled care. It is underpinned by the NHS Renewal Framework. The framework’s key product for 2025/26 is the Operational Improvement Plan. On 25 June 2025, the Scottish Government confirmed £10.079 million additional funding for NHS Ayrshire & Arran for 2025/26. This allocation is designed to support whole-system transformation and is broken down as follows: • £1.681m – Hospital at Home (H@H) expansion, including virtual capacity and care closer to home. • £6m – Discharge without Delay (DwD) and Frailty Services, embedding early discharge planning and front-door frailty models. • £2.399 million – Core Unscheduled Care funding to maintain essential flow and resilience. North Ayrshire HSCP has £1.081 million ring-fenced within this allocation as follows: • £746k – Enhanced hospital-based multi-disciplinary team (MDT) to deliver seven-day working, front-door frailty, and discharge-to-assess. • £335k – Mental Health Officer (MHO) capacity to address statutory compliance and reduce Adults with Incapacity (AWI)-related delays. 3.2 The NHS Renewal Funding is conditional on delivery of the following: • Full implementation of DwD principles across inpatient sites. • Delivery of front-door frailty services and virtual capacity (including H@H). • Robust monitoring and reporting of performance trajectories to the Scottish Government. • Demonstrating value for money and sustainable improvement. It is critical to note that future funding will only become recurrent if the agreed outcomes are achieved. With the Scottish Government reserving the right to withhold or withdraw funding if improvements are not delivered or funds are not used for their intended purpose.
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3.3 Following the confirmation of funding in June 2025 discussions commenced on a Pan Ayrshire basis to consider and agree the split for utilisation of the non-ringfenced remainder of the funding allocation (circa £4.9m). Early discussions in July 2025 agreed a set of principles as follows: • Plan remains as submitted – with further detail to be worked on how interventions/investment delivered • Plan for NHS AA in August board to seek balance of investment to fully fund Priority 1 investment circa £17m in total less SG investment • Hospital at home – further work required to determine funding already allocated and gap to deliver the submitted ask to SG – East and South to pull their contributions, new model designed around resource left with equity of access across the whole of Ayrshire and Arran, with further consideration required re the Islands • Seek to identify priority areas which can be progressed over the summer – high impact areas to support acute flow and on-off investment to use any slippage in funding but also provide capacity/flow for system This was followed by plans across the Ayrshire and Arran system directing funding in priority areas as follows: • Acute services – Homefirst 7-day cover, Ortho-geriatric investment and AHP Frailty. • East Ayrshire HSCP – MHO Capacity, East Ayrshire Community Hospital and Advanced Nurse Practitioner Capacity and Rehabilitation and Enablement • North Ayrshire HSCP – Care at Home Reablement • South Ayrshire HSCP – Pan Ayrshire Community Equipment, Moving and Handling Capacity, Reablement Step up and Step Down and Integrated Assessment Team 3.4 Following the presentation to the AA Board in August 2025 there was no confirmation of further funding to fully invest in the whole system priority one plans, and delays in approving the priority areas as described have impacted the mobilisation of plans. Some amendments to plans have been made and full confirmation of the £4.9m allocation has only been agreed in late October 2025. From a North Ayrshire perspective, the priority for the remainder of the non-ringfenced funding continues to be focussed on additional Care at Home capacity, with the highest proportion of North Ayrshire delays being standard delays associated with access to Care at Home services. 3.5 North HSCP Enhanced MDT and MHO Mobilisation As has been detailed, the North HSCP secured ring fenced funding of £1.081m from the Ayrshire and Arran allocation for an Enhanced MDT and Mental Health Officer (MHO) capacity.
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Plans for improvement centred on a hospital based Enhanced MDT delivering 7-day services with additional Social Work and AHP capacity to embed DwD principles at the front door. This included a focus on strengthened discharge pathways and commitment to Discharge Without Delay principles through early discharge planning, a Home First approach, and integrated assessment teams. Plans are also underway to develop criteria, pathways and an operational delivery model for D2A via Care at Home reablement. Recruitment to posts within the MDT is progressing well with several posts recruited to and the remainder in progress – it is anticipated that the 7-day MDT will be operational by January 2026. This will be critical to stabilise daily flow and enable weekend discharges and faster turnarounds. Hospital based MHO capacity was increased by 2 WTE immediately on confirmation of ring-fenced funding to expand critical MHO capacity within the hospital team. This was initially achieved through utilisation of agency, however permanent MHO’s have now been recruited and will enhance the delivery of MHO activity to support hospital discharge in a permanent and ongoing basis. In addition to the recruitment of posts to expand the North HSCP’s dedicated hospital-based MHO support for discharge planning, other improvement activity has included the implementation of guardianship activity trackers, anticipatory care planning protocols and enhanced collaboration with legal and advocacy services to streamline processes. The impact has been immediate and measurable, with no waits for hospital MHO allocation and a reduction in AWI delays by 48% since July 2025. North Ayrshire’s level of AWI delays are now close to the Scottish average, having previously been one of the highest in Scotland for most of early 2025. Early indicators suggest improved discharge planning and a reduced risk of prolonged hospital stays, with further measurable impact expected over the next 6–12 months. Recruitment to additional community-based MHO capacity, focussing on early access and early intervention, is also in progress. 3.6 Care at Home Reablement Proposal North Ayrshire HSCP faces significant challenges in managing delayed discharges, with performance since January 2025 averaging over 90 delays daily. A substantial proportion of these delays relate to patients awaiting Care at Home packages following short hospital stays. This situation has worsened since mid-2024 due to financial recovery measures that reduced Care at Home capacity. Reablement is a short-term, outcome-focused approach designed to help individuals regain independence and confidence after illness or injury, typically delivered over a period of up to 12 weeks. Evidence from North Ayrshires HSCP’s existing reablement service demonstrates its effectiveness in reducing long-term care needs and improving patient outcomes. Currently, over 100 people are supported weekly through reablement, but demand far exceeds capacity.
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The proposed investment of £1.2 million would fund a multi-disciplinary reablement team capable of delivering approximately 150 hours of care daily, equating to around 25 packages of care over seven days. This team would focus on short-stay discharges from CAU and Frailty Units, supported by robust seven-day multi-disciplinary input for ongoing assessment and rehabilitation. The anticipated benefits include: • Reduction in delayed discharge levels and hospital length of stay, easing pressure on acute sites. • Improved access to critical services and faster discharge planning, aligning with the principles of Discharge Without Delay. • Enhanced patient independence and wellbeing, reducing reliance on long-term care services and generating cost savings. • Strengthened collaboration between health and social care teams, ensuring a seamless patient journey and better integration of community-based care. This investment represents a strategic intervention to address systemic barriers to discharge, improve flow, and deliver sustainable outcomes for patients and the wider health and social care system. Whilst funding has now been confirmed for investment in North Care at Home capacity via the Ayrshire and Arran NHS Renewal allocation, there is no guarantee that this funding will be on a recurring basis and there are risks that funding may be directed elsewhere in the Ayrshire & Arran system or Scottish Government may withhold or withdraw funding if improvements are not delivered. 3.7 For North Ayrshire’s Health and Community Care Services, at month 6, there is a projected overspend of £4.167m (4.2%) and further actions are required for financial recovery. There are several areas within the overspend that can have a critical impact on hospital flow and delayed discharge performance including the budget for Care Home Placements, which has a net overspend of £0.565m, Care at Home, which has a projected overspend of £1.689m and Ward 1 and 2 within Woodland View which have a combined projected overspend of £0.774m. 3.8 Improvement Trajectories – Delayed Discharge (North Ayrshire) Whole system improvement targets were set in early 2025 as part of the improvement plan submissions – for North the specific areas for improvement are targeted on delayed discharge performance and the Table 1 below details the trajectories developed based on the full funding submission (£9m). Due to the reduced level of funding when compared to the initial funding submissions (around 25% of plans submitted were funded) and delay in confirmed resource allocation, whilst the North HSCP have been able to progress at pace plans associated with additional MHO capacity and an enhanced MDT, all plans to invest in additional Care at Home capacity have been on hold which has resulted in a significant change to the previously
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provided trajectories. The revised trajectories as at October 2025 are detailed in Table 2 below. Table 1 Core Metrics Feb-25 Actual ^ Jun-25 Sep-25 Dec-25 Mar-26 Delayed Discharge - total number of delays (Acute Hosps - North) 48 33 25 18 17 Delayed Discharge - total number of delays (Community Hosps- North) 19 14 10 8 4 Delayed Discharge - total number of delays (Mental Health Hosps- North) 12 8 7 6 5 Delayed Discharge - total number of delays (Total - North) 79 67 52 32 26 Table 2 Baseline Note: projected targets based on delayed investment as at 31/10/25 (2.261m) Core Metrics July 25 Actual Dec-25 Mar-26 Jun-26 Delayed Discharge - total number of delays (Acute Hosps - North) 72 62 58 48 Delayed Discharge - total number of delays (Community Hosps- North) 29 29 25 19 Delayed Discharge - total number of delays (Mental Health Hosps- North) 12 14 13 11 Delayed Discharge - total number of delays (Total - North) 113 105 96 78
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3.9 Within the NHS Renewal allocation for 2025/26, there is an anticipated non-recurring funding slippage of £2.299m across Ayrshire and Arran. To prevent underspend and ensure compliance with Scottish Government expectations, North Ayrshire HSCP has developed a plan to utilise £600,000 of this slippage in-year. The aim is to accelerate improvements in patient flow and discharge performance while aligning with the Discharge without Delay (DwD) and Home First principles. The Renewal Monies Slippage Proposal is detailed in Appendix A. 3.10 Delayed Discharge Performance – Ayrshire and Arran Monthly total number of delayed discharges (October 2023 to September 2025) The overall trend in total Delayed Discharges for Ayrshire and Arran indicates an upward trend and worsening position. North Ayrshire delays, at 73 in October 2023 fluctuated between 72-87 through 2024 and have seen a significant increase from 95 in February 2025 to 116 in September 2025. Total delays have increased by 24% since October 2023. Monthly number of bed days occupied due to delayed discharge (October 2023 to September 2025)
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The overall trend in Occupied bed days shows a gradual rise through 2024 with a sharp increase in 2025 to its highest point (7,885) in July 2025, with an overall 20% increase. North Ayrshire’s increase has been stark, mirroring the trend in the previous table of increased levels of delayed discharges. North delays – all hospital sites (November 2024 to October 2025) Delays start at around 82 in November 2024, fluctuating through early 2025, then rise steadily to a peak of 106 in August 2025 before dropping slightly and reducing to 104 in October 2025, indicating a persistent upward trend. AWI delays improved significantly after August 2025.
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Across Ayrshire and Arran, AWI-related delays have been a major contributor to prolonged hospital stays. In North Ayrshire, these delays accounted for approximately 25% of all delayed discharges in early 2025, with some individuals waiting months for legal authorisation under the Adults with Incapacity (Scotland) Act. This created significant risks for patient wellbeing and system flow. Despite improvements in AWI levels, overall performance continues to deteriorate due to persistent standard delays. 3.11 Community Unmet Need The HSCPs provide weekly data returns to the Scottish Government to illustrate unmet need across the system. This focusses particularly on waits for Care at Home Services, Statutory Social Care Assessments and Social Care Reviews. There continues to be a significant difference in the level of unmet need between individuals awaiting care in hospital compared to in the community. This is reflective of the continued focus on prioritising packages of care for individuals in hospital to support with wider hospital pressures. However, the impact of this is the continued risk posed to those individuals in the community who have been assessed as requiring support and this is not in place which is not in line with the early intervention approach to keeping people safe, fit and well. The Partnership has undertaken a number of initiatives linked to the management of demand for services and unmet need, including a programme of reviews, reablement initiatives and the introduction of a weekly unmet need oversight group.
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Number of people in the community awaiting a new package of care (October 2023 to October 2025) Demand for care packages remains high, especially for substantial needs, with critical cases also increasing. The average waiting time has increased by 50%, reaching over 4 months by late 2025 with the trend suggesting system capacity constraints, linked workforce and funding challenges. 4 Conclusion and Recommendations 4.1 Delayed discharge performance across Ayrshire & Arran has deteriorated significantly during 2025, with North Ayrshire HSCP experiencing the most acute challenges. Despite targeted improvements such as increased Mental Health Officer (MHO) capacity, which reduced Adults with Incapacity (AWI) delays by 48%, performance improvement remains constrained by Care at Home capacity. Average daily delays exceed 90, and occupied bed days have risen by 20% since 2023, reflecting systemic pressures and delayed mobilisation of improvement plans. Financial constraints, including a projected £4.167m overspend and reliance on non-recurring funding, further compound these challenges.
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The NHS Renewal allocation of £10.079m for Ayrshire & Arran, including £1.081m ring-fenced for North Ayrshire, has enabled progress on enhanced hospital-based MDTs and MHO capacity. However, delays in approval and recruitment have limited impact to date, and the non-recurring nature of funding poses significant risks to sustainability. Revised improvement trajectories show slower progress than originally planned, with delayed discharge numbers projected to remain high into mid-2026 unless additional interventions are implemented. Community unmet need is also escalating, with average waiting times for care packages for those who experience a delay in the community exceeding 120 days. To achieve meaningful improvement, urgent action is required to accelerate Care at Home reablement investment and secure recurrent funding commitments. Without these measures, the ability to deliver the Discharge Without Delay (DwD) principles and meet national targets will be compromised, prolonging hospital occupancy and increasing risk to patient wellbeing. 4.2 The IJB are asked to consider the following recommendations: a) Note the performance for Delayed Discharges in North Ayrshire and associated improvement plans. b) Note the updates provided in relation to Urgent and Unscheduled Care Funding and the Pan Ayrshire plans for spend. c) Endorse continued progress at pace with plans to ensure optimal utilisation of allocated funds. d) Approve progression of plans to enhance Care at Home Reablement capacity via NHS Renewal Funding e) Note the funding risk associated with uncertainty of recurring elements of funding allocation 4.3 Anticipated Outcomes Improved awareness for the IJB of current performance and challenges and the work underway to improve services for the citizens of Ayrshire and Arran and our local communities. 4.4 Measuring Impact Urgent and Unscheduled Care measures are tracked through the NHS Pentana Performance Framework and through the established governance arrangements. Performance linked to community unmet need, demand and planned transformational change projects will be tracked through existing Partnership oversight arrangements. The IJB will receive updates on progress.
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5. Implications 5.1 Financial North Ayrshire IJB is reporting a significant overspend for 2025-26 with recovery actions in progress, therefore there is no further resource available within the Partnership. Savings required as part of recovery plans are likely to impact current levels of performance and for people awaiting services. NHS Ayrshire and Arran are also projecting a significant overspend for 2025-26. Whilst funding has been secured via the Renewal funding, there remain risks regarding the recurring nature of funding. 5.2 Human Resources Workforce across the system remains a challenge, however recruitment plans are in place to proactively grow recently funded areas of service delivery. 5.3 Legal None 5.4 Equality/Socio-Economic None 5.5 Risk Health and Community Care Services are currently projecting a £4.167m overspend with actions required for financial recovery. The report highlights the risk associated with uncertainty over the recurring nature of Renewal funding. 5.6 Community Wealth Building None 5.7 Key Priorities Successful implementation of National Discharge without Delay Improvement Programme, access to services and whole system planning to support service demands and improve health outcomes aligns with the vision and values of the IJB. 6. Consultation 6.1 This report has been produced following consultation with Pan Ayrshire colleagues, relevant budget holders and the Health and Community Care Senior Management Team. Caroline Cameron, Director Kerry Logan, Head of Service, Health and Community Care klogan@north-ayrshire.gov.uk Previous Reports to IJB : IJB Oct 2023 - Unscheduled Care and Winter Planning IJB Mar 2024 – Unscheduled Care Update & North Ayrshire Improvement Plan IJB Aug 2024 – Delayed Discharge Performance
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APPENDIX A - Renewal Funding Slipping Proposal: Subject NHS Renewal – Additional Urgent & Unscheduled Care Funding 2025/26 – August 2025 Slippage Proposal Purpose To provide an overview on the NAHSCP plans to utilise £600k allocated slippage from the U&UC funds in financial year 25/26 Recommendation It is recommended to support the proposal and urgently progress with plans to reduce any risk of further slippage. Status For awareness and approval 1 Situation Within the allocation of NHS Renewal – Additional Urgent and Unscheduled Care Funding for 25/26, there remains £4,919m unallocated which the 3 x HSCP’s and acute have submitted plans for spend around agreed priority areas, based on initial priority plans. There is an expected non-recurring funding slippage of £2,299m in year and further plans require to be developed to ensure this is fully utilised in line with the expected funding outcomes for this financial year. 2 Background NHS Renewal Framework Health Boards received confirmation on 25 June 2025 of additional Urgent and Unscheduled Care Funding for 2025/26. Additional funding of up to £10.08 million will be provided to NHS Ayrshire and Arran as part of NHS Renewal funding for the 2025/26 financial year (Appendix A). This includes allocations for Hospital at Home (H@H), Discharge without Delay (DwD), Frailty Services, Mental Health Officer (MHO) capacity alongside core Unscheduled Care funding. Whole System Improvement Plan Ayrshire and Arran submitted a whole system plan in early 2025, with revised plans on a priority basis submitted thereafter. The Ayrshire and Arran plan included an ask for the North HSCP totalling over £9m in funding requirements to deliver the desired wholes system change and transformation. The level of funding confirmed is around £9m less than the resource requested via the Ayrshire and Arran Whole System submission. It is the expectation of the Scottish Government that NHS boards consider how they can use the additional funding to redesign services and realign existing budgets to
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fully deliver on whole system plans in a more sustainable way, ensuring reduced delays and improved patient care, allowing for a more resilient service for the future. Urgent and Unscheduled Care Funding for 2025/26 (appendix A) confirmed by the Scottish Government in June 2025 is summarised as follows: Total Funding Allocated: £10,079m Breakdown of Funding: 1. H@H: £1,681m (approximately half the H@H resource submission) 2. DwD & Frailty Services: £6,000m £1,081M of this is specifically allocated to NAHSCP for Enhanced MDT and Mental Health Officers The remaining funding to be negotiated between Acute, North, South and East Partnerships 3. Core Unscheduled Care Funding: £2,398m This funding is recurrent and mostly already committed for allocation by the board 3 Assessment Slippage Proposals Interim Beds Rate / Wk No of Beds No of Weeks Cost Based on Nursing Rate 1,021.57 10 26 250,000.00 Option 1 & 2 Rate No of Hours No of Weeks Cost Option 1 & Option 2 23.08 333.00 26.00 200,000.00 Technology Cost Telecare and M&H kit 50,000.00 Community Rehab Cost Wards, EICT, AHP 50,000.00 Discharge to Assess Cost BRC Proposal 50,000.00 Total Cost 600,000.00
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4 Recommendations Note the North Partnership’s plans to progress the detailed initiatives at pace. It is also worth highlighting the risks to delivering improvement against key performance trajectories which have been developed should there be further delays in funding approval.