Agenda Document Pack - Integration Joint Board - 13/11/2025
North Ayrshire Council · 13 November 2025
Back to Integration Joint Board — 13 November 2025 and its agenda
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Integration Joint Board Meeting Thursday, 13 November 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 25 September 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 Unscheduled Care Improvement Plan Update Submit report by Kerry Logan, Head of Service (Health & Community Care) on Urgent and Unscheduled Care Funding, Performance and Improvement Plans (copy enclosed). 5 Director’s Report Submit report by Caroline Cameron, Director (NAHSCP), on developments within the North Ayrshire Health and Social Care Partnership (copy enclosed). 6 Brighter Pathways: Re-Modelling Care Options Submit report by Elizabeth Stewart, Head of Service (Children, Families and Justice) on on the Brighter Pathways Programme (copy enclosed). 1
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7 Child and Adolescent Mental Health Services (CAMHS) Submit report by Thelma Bowers, Head of Service (Mental Health) on Neurodiverse CAMHS Team Waiting Times and Mitigation Plans (copy enclosed). 8 2025-26 – Month 6 Financial Performance Submit report by Eleanor Currie, Chief Finance Officer, providing an overview of the Integration Joint Board’s financial performance as at month 6 (September) (copy enclosed). 9 Meeting Dates 2026 Submit report by Caroline Cameron, Director (NAHSCP) on the proposed timetable for meetings of the IJB, PAC and SPG for 2026 (copy enclosed). 10 Strategic Planning Group Meeting Minutes Submit for information the minutes of the Strategic Planning Group Meeting on 4 June 2025 (copy enclosed). 11 Urgent Items Any other items which the Chair considers to be urgent. Webcasting Please note: this meeting may be filmed/recorded/live-streamed to the Council's internet site and available to view at https://north-ayrshire.public- i.tv/core/portal/home, where it will be capable of repeated viewing. At the start of the meeting, the Provost/Chair will confirm if all or part of the meeting is being filmed/recorded/live-streamed. You should be aware that the Council is a Data Controller under the Data Protection Act 2018. Data collected during the webcast will be retained in accordance with the Council’s published policy, including, but not limited to, for the purpose of keeping historical records and making those records available via the Council’s internet site. Generally, the press and public will not be filmed. However, by entering the Council Chambers and using the press or public seating area, you acknowledge that you may be filmed and that any information pertaining to you contained in the video and oral recording of the meeting will be used for webcasting or training purposes and for the purpose of keeping historical records and making those records available to the public. In making this use of your information the Council is processing data which is necessary for the performance of a task carried out in the public interest. 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, 2
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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 25 September 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 Councillor Chloe Robertson, North Ayrshire Council (Vice-Chair) Councillor Tom Marshall, North Ayrshire Council Tom Hopkins, NHS Ayrshire and Arran 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 Sharon Hackney, Lead Allied Health Professional Lisa Davidson, Public Health Representative Scott Hunter, Chief Social Work Officer Stakeholder Representative Lorna Sim, Staff Representative NHS Ayrshire and Arran Lynda MacFarlane, Staff Representative Present (Remote Participation) Voting Members Joyce White, NHS Ayrshire and Arran (Chair) Professional Advisers 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) Michelle Sutherland, Partnership Facilitator (Health & Community Care) Debbie McGill, Head of Primary and Urgent Care Services Peter McArthur, Senior Manager, Alcohol & Drug Services Michael McLennan, Lead Officer (Alcohol & Drugs Partnership) Fiona Mitchell-Knight, Audit Scotland Agenda Item 3 5
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David Jamieson, Audit Scotland Angus Brown, Audit Scotland Karen Andrews, Team Manager (Governance) Annie Johnston, Principal Manager (Business Support) Ruth Wilson, Team Leader (Litigation) Craig Stewart, Committee Services Officer Mark Sugden, Communications Officer Apologies Councillor Anthea Dickson, North Ayrshire Council Councillor Nairn Angus-McDonald, North Ayrshire Council Linda Semple, NHS Ayrshire and Arran Marc Mazzucco, NHS Ayrshire and Arran Aileen Craig, IJB Monitoring Officer 1. Chair’s Remarks Prior to commencing with the business of the meeting, Councillor Robertson (Vice- Chair) advised that in agreement with the Chair, Joyce White, she would chair this meeting of the Partnership as the Chair was not available to attend the meeting in person due to personal reasons. 2. Apologies for Absence Apologies for Absence were noted. 3. 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. Joyce White declared a voluntary role, as a Board Member on a sub-group, of Phoenix Futures. 4. Minutes The accuracy of the Minutes of the meeting held on 21 August 2025 were confirmed and the Minutes signed in accordance with Paragraph 7(10 of Schedule 7 of the Local Government (Scotland) Act 1973. 5. 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. 6. Primary Care Update Submitted a report by Debbie McGill, Head of Primary and Urgent Care Services, on the provision of Primary Care Services across Ayrshire and Arran. 6
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Officers responded to members’ questions on various aspects of the report. Noted. 7. Primary Urgent Care Update Submitted a report by Debbie McGill, Head of Primary and Urgent Care Services, on provision of primary urgent care services delivered through the Ayrshire Urgent Care Service (AUCS). The report provided an update on the innovative pathways developed and tested throughout 2024. Officers responded to members’ questions on various aspects of the report. Noted. 8. North Ayrshire HSCP & ADP Annual Performance Management Report – 2024/25 Alcohol and Drugs Submitted a report by Peter McArthur, Alcohol and Drug Services on the annual performance information in relation to the partnership’s Alcohol and Drug services. The Annual performance report was set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. Noted. 9. North Ayrshire HSCP & ADP Medication Assisted Treatment - Annual Report Submitted a report by Peter McArthur, Alcohol and Drug Services on the North Ayrshire HSCP & ADP Medication Assisted Treatment - Annual Report, set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. Noted. 10. 2024/2025 Audited Annual Accounts Submitted a report by Eleanor Currie, Chief Finance Officer, on the audited annual accounts for 2024-25 and the report from External Audit. The Audited Annual Account 2024-25 were set out at Appendix 1 and the letter of representation set out at Appendix 2 to the report. Officers responded to members’ questions on various aspects of the report. The Board agreed to (a) note that Audit Scotland had completed their audit of the annual accounts for 2024-25 and issued an unqualified independent report auditor’s report; and (b) approve the Audited Annual Accounts to be signed for issue. 11. External Audit Report 2024/2025 Submitted report by Audit Scotland on the External Audit Final Report of the audit Financial Statements. 7
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Fiona Mitchell-Knight of Audit Scotland provided a verbal report on the appendices to the report, including highlighting key aspects in relation to the findings of their audit, and also responded to members’ questions in relation to their report. The key messages of the report were • in 2024/25 a budget overspend of £3.593 million was reported, covered by additional funding contributions from partners; • 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; • 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; and • 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. The Chair thanked Audit Scotland for their work in auditing the IJB. Noted. 12. 2025-26 – Month 4 Financial Performance Submitted report by Eleanor Currie, Interim Chief Financial Officer (HSCP) on the Integration Joint Board’s financial performance as at Month 4 (July). 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 £5.259m reducing to £1.733m after planned recovery actions; (b) note the progress with delivery of agreed savings; (c) approve 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 8
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presented to the IJB on 29 October 2025 for formal approval; and (f) note the remaining financial risks for 2025-26. 13. IJB – Reserves Policy Submitted report by Eleanor Currie, Interim Chief Financial Officer (HSCP) on the Reserves Policy following review, with the Policy set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. The Board agreed to approve the Reserves Policy set out at Appendix 1 to the report. 14. Financial Inclusion Strategy 2025-30 Submitted report by Annie Johnson, Principal Manager, on the Financial Inclusion Strategy 2023-28 and the updated Strategy for 2025-30, set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. The Board agreed to approve the Financial Inclusion Strategy for 2025-30 set out at Appendix 1 to the report. 15. Chief Social Work Officer Annual Report 24/25 Submitted report by Scott Hunter, Chief Social Work Officer (NAHSCP) on the annual Chief Social Work Officer report required by the Scottish Government, set out at Appendix 1 to the report. Officers responded to members’ questions on various aspects of the report. Noted. The meeting ended at 12.40 p.m. The full meeting proceedings can be viewed at https://north-ayrshire.public-i.tv/core/portal/home 9
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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. Agenda Item 4 11
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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. 12
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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: 13
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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 14
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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 15
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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) 16
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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. 17
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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. 18
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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. 19
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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 20
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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 21
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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) 22
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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. 23
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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. 24
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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. 25
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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. 26
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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 27
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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 28
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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 29
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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. 30
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Integration Joint Board 13th November 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 NDIP National Dental Inspection Programme CHES Collaboration for Health Equity in Scotland SIMD Scottish Index of Multiple Deprivation IHE Institute of Health Equity SHS Scottish Health Survey ADP Alcohol and Drug Partnership 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. Agenda Item 5 31
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3. CURRENT POSITION National Developments 3.1 National Dental Inspection Programme Report 2025 The 2025 National Dental Inspection Programme (NDIP) report was published on 21 October 2025. NDIP has been instrumental in informing parents/guardians about their child’s oral health, monitoring the oral health level of children in Scotland, and assessing the impact of the national oral health improvement programme, Childsmile. All Primary 1 (P1, age 5) and Primary 7 (P7, age 11) pupils are offered a Basic Inspection each year. A Detailed Inspection is conducted in alternating years - focusing on either P1 or P7 pupils. This year the report covers the dental health of P7 children in local authority schools in Scotland. The key findings from the 2025 report are: • In 2025, an estimated 81.5% of P7 children in Scotland had no signs of obvious dental decay, similar to the 2023 figure of 81.9%. • The average number of teeth affected by obvious decay was estimated at 0.40, comparable to 0.36 in 2023. • Since 2005, obvious decay experience has declined, although this downward trend appears to have plateaued since the COVID-19 pandemic. • Oral health inequalities remain: in 2025, 71.4% of children living in the most socioeconomically deprived areas had no obvious decay experience, compared to 89.6% in the least deprived areas. Deprivation is measured using Scottish Index of Multiple Deprivation (SIMD) A more in-depth presentation of the results (including a Basic Dental Inspection of P1 and P7) can be found at https://publichealthscotland.scot/publications/national-dental- inspection-programme/national-dental-inspection-programme-20242025/. 3.2 Collaboration for Health Equity in Scotland The second Collaboration for Health Equity in Scotland (CHES) report: An Overview of the Social Determinants of Health in Scotland: The Collaboration for Health Equity in Scotland, written by the Institute of Health Equity (IHE) was published on 13th October 2025. The report can be found here: An Overview of the Social Determinants of Health in Scotland: The Collaboration for Health Equity in Scotland. 32
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This report provides an overview of key social determinants of health across the Marmot 8 principles. It follows IHE’s first report published as part of the CHES programme titled An Overview of Health Inequalities in Scotland: The Collaboration for Health Equity in Scotland which focused on the extent of health inequalities in Scotland and within the CHES local areas of Aberdeen City, North Ayrshire and South Lanarkshire. Further information on CHES can also be found on the Public Health Scotland website: Background - Collaboration for Health Equity in Scotland - Environmental health impacts - Population health - Public Health Scotland 3.3 Accounts Commission Report – Improving Care Experience -Delivering The Promise The Improving Care Experience: Delivering The Promise - Accounts Commission Report – prepared by Audit Scotland report was published in October 2025. The Key facts highlighted in in the document were : • 150 organisations with corporate parenting duties in Scotland spread across 26 different types of organisation • 11,842 looked-after children on 31 July 24 • 88.8% proportion of looked-after children in community care • £20.6m value of grants distributed through The Promise Partnership Fund between 2021 and 2025 • £1.2bn identifiable spending on care experience by local authorities in 23/24 • £148m funding allocated out of a total £500m Whole Family Wellbeing fund since 2022/23 • £2.9m funding allocation available for The Promise Scotland in 2024/25 Recommendations for Children’s Services Planning Partnerships include: • Where not already in place, set out in local plans how they will involve, and seek and respond to views from care-experienced people. • Utilise the 25 supporting Plan 24–30 ‘route maps’ (due to be published by end of 2025) to enable collective responsibility and accountability for The Promise, ensuring clarity of roles across all sectors. • Set out in local strategic plans priority areas for investment to deliver The Promise, by 2030 and beyond. 3.4 Scottish Health Survey The Scottish Health Survey was published 21 October 25 and presents results for the Scottish Health Survey 2024. The Scottish Health Survey (SHS) plays an important role in assessing health outcomes, health risks and the extent of health inequalities in Scotland and how these have changed over time. 33
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Key findings include: • Half of all adults now have at least one long-term condition, continuing the upward trend. Almost two in five adults (39%) reporting having a long-term condition that limits their activities. • Prevalence of any CVD (excluding diabetes or high blood pressure) remained in line with recent years at 16% of adults. • Prevalence of doctor-diagnosed asthma amongst adults reached 18%, the highest proportion recorded since the timeseries began in 2003. • In 2023/2024 combined, 15% of adults reported being unpaid carers. • Eight percent of adults report having doctor-diagnosed diabetes, the highest level recorded. Other areas covered by this survey include chronic pain, mental health, CVD, diet, alcohol, smoking & drugs, physical activity, and dental health. The Scottish Health Survey together with other population level data is used to inform the Strategic Needs Assessment for the HSCP and the priorities in our Strategic Plan which is currently being reviewed. 3.5 Health And Social Care Reform Portfolio and Programme Governance The Health and Social Care Service Renewal Framework (SRF) and Population Health Framework (PHF) were published in June, following the Operational Improvement Plan (March). These frameworks guide the long-term reform and renewal of health and social care in Scotland. Scottish Government has now finalised plans for portfolio and programme governance with three discrete governance boards being established. 1. Reform Oversight Board - The Scottish Government and COSLA will convene the Reform Oversight Board, which will deliver shared leadership, ensure whole system oversight and assurance and provide clear accountability for the delivery of long-term Health and Social Care reform and renewal. This group will bring together national and local accountability for delivery of the aims, priorities, major changes and enabling shifts set out in the PHF and SRF. The Board will complement, not replace, local and national reform governance. It will be jointly accountable to Scottish Ministers and COSLA Leaders. 2. PHF Programme Board - The PHF Programme Board will oversee and drive delivery of the PHF. Initially focused on providing oversight of the early actions outlined in the Framework, the Board will also set strategic direction beyond the initial two-year period, ensuring the Framework can adapt to evolving needs and challenges across the decade. The Board will play a key role in ensuring delivery is monitored and evaluated, so that gaps can be identified and addressed, and future actions can be developed. 34
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3. SRF Programme Board - The SRF Programme Board will provide strategic system oversight for delivery of SRF Programme objectives and maintain focus on outcomes, benefits and the overarching change plan. The Board will be supported by programme structures including an internal Scottish Government SRF Delivery Board which will focus on delivery of the actions set out in the SRF via 6 Major Change areas and 3 Enabling Shifts. North Ayrshire Developments 3.6 Accounts Commission : Best Value : North Ayrshire Council The Accounts Commission published the Controller of Audit’s Statutory Report on Best Value in North Ayrshire on 28th October. The report highlighted that :- • North Ayrshire ‘thinks big’ as it looks to the future, with a focus on improving services, reducing poverty and inequality, and proactively tackling a projected £47 million funding gap. • Other councils can learn from North Ayrshire’s approach to change and innovation, with strong governance, funding and support in place to help deliver savings and wider benefits for the future. • The council is committed to consulting and engaging with local people. These trusted relationships with the community are critical, with difficult decisions ahead. In the report, the Accounts Commission highlights how the council is working with the other Ayrshire councils and local partners, exploring sharing services and doing things differently. The report recognises that like other Councils North Ayrshire faces significant medium term financial risks particularly in relation to spending on health and social care services, the Accounts Commission noted they are encouraged that relationships across the IJB are positive, and oversight and scrutiny arrangements are robust. The full report can be accessed Best Value: North Ayrshire Council. 35
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3.7 Unseen, Unheard, Unbroken Exhibition – Harbour Arts Centre Part of this year’s North Ayrshire Mental Health Arts Festival, ‘Unseen, Unheard, Unbroken’ is a moving exhibition created by adult and young unpaid carers working with Carers Gateway North Ayrshire. Developed over six weeks of community-based workshops, led by artists Michelle Winslow and Tragic O’Hara, the exhibition explores the emotional and mental health impacts of caring through diverse visual art. Blending natural materials and bold street-art techniques, the works offer honest, creative reflections on the realities of unpaid care. The exhibition ran at the Harbour Arts Centre until Saturday 1 November. 3.8 Dads Worker Shortlisted for top Health and Social Care Award Congratulations to Dads Worker Ryan Warren, who has been shortlisted in the ‘Unsung Hero – Reader’s Choice Award’ category at this year’s Scotland’s Health Awards. The awards, hosted by The Scotsman in partnership with NHS Scotland and the Scottish Government, offer an opportunity to recognise and celebrate the extraordinary individuals and teams who go above and beyond to deliver compassionate, high- quality health and social care across Scotland. Ryan, who works for charity Dads Rock and sits within our Children and Families Health team, was nominated for his work in providing support to dads in North Ayrshire, helping them to be the best dads they can be and supporting them to give their children the best possible start in life. You can read more about the event on the Scotland’s Health Awards website. The winners will be announced on Thursday 6 November at an awards ceremony in Edinburgh. 3.9 Hard Hitting Play – Drug Use Dangers A thought-provoking play highlighting the risks involved in illegal substance use has been touring North Ayrshire secondary schools this month. 36
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S3 pupils watched a presentation of Mark Wheeler’s ‘I Love You Mum, I Promise I Won’t Die’ as part of Tie It Up Theatre's autumn schools tour. The play was developed in conjunction with drug education charity the DSM Foundation, which was set up in January 2014 by Tim and Fiona Spargo-Mabbs in response to the loss of their 16-year-old son Daniel who died after taking ecstasy. The performance was followed by a drug education workshop, which shared key facts that will help them make informed decisions, as well as offering important strategies to help them put their decisions into practice in a pressured situation. 3.10 Homeless Prevention Strategy Partnership Event A consultation event around the Ask & Act duty that is part of the Housing Bill for Homeless Prevention was held on Thursday 30 October at Fullarton ConneXions in Irvine. Staff and partners attended to : • Find out more about the forthcoming changes in relation to Homeless Prevention under the Housing (Scotland) Bill • Provide feedback on emerging priorities and challenges for the Ask & Act Duty • Take part in collaboration across services to ensure a joined-up and effective response • Help to shape the direction of the strategy 3.11 Free Appointments – Specialist Dementia Nurse Dementia UK, in partnership with Nationwide Fairer Futures, is offering free, confidential appointments with a specialist dementia nurse at Nationwide Building Societies across the country. Those who care for someone with dementia (or know someone who has a diagnosis themselves who would like to go along) can book an appointment at one of the following venues by clicking on the relevant link below: Kilmarnock, 116 King Street: Tuesday 25 November Ayr, 178 High Street: Wednesday 26 November Irvine, 16 Bridgegate: Thursday 27 November Greenock, 41 West Blackhall Street: Wednesday 5 and Thursday 6 November 37
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The nurse will be able to provide expert, tailored support, whatever your questions or concerns, and you do not need to be a customer of Nationwide in order to book a session. If you have any further questions, please contact nationwide@dementiauk.org 3.12 Silver award success for analogue to digital project NAHSCP has achieved the Silver Digital Telecare Implementation Award from Digital Telecare for Scottish Local Government. The award is in recognition of the recent progress of our analogue to digital telecare transition project, where all of our analogue community alarm and telecare equipment is being switched to digital ahead of analogue telephone lines being switched off in the UK in early 2027. You can read more about the award and the work being carried out in North Ayrshire on the Digital Telecare for Scottish Local Government website. Well done to all of our staff involved in achieving this fantastic result! 3.13 Sponsored Walk – Café Solace Members of our NAADP Support Team joined a team from the PHOENIx pilot and volunteers of Café Solace in Irvine for a sponsored walk to raise funds for the charity’s ‘Pay It Forward’ campaign, which provides meals for the most vulnerable in our community. Starting at Ardrossan South Beach, the team walked 10 miles to Irvine Harbour, in adverse weather, but the heavy rainfall, spirits remained high as the group raised an impressive £930. Well done to you all for this fantastic achievement. 38
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The Pay it Forward initiative will this year cover the cost of some extra festive cheer, with Café Solace opening its doors to provide a warm and welcoming Christmas dinner at a time when limited support is available. Those accessing services at Caley Court in Stevenston can also use the scheme to enjoy a roll and a cuppa from the Caley Court café. 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 39
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Integration Joint Board 13th November 2025 Subject: Brighter Pathways: Re-Modelling Care Options Purpose: The report updates on the Brighter Pathways Programme, a strategic initiative aimed at transforming children’s services in North Ayrshire. It focuses on improving outcomes for care- experienced children and young people, addressing systemic challenges, and ensuring sustainable care models. The Strategic Vision emphasises collaboration, investment, and a rights-based approach to create a sustainable, responsive, and a nurturing care system for children and young people in North Ayrshire and aligns with The Promise. Recommendation: The Integration Joint Board are asked to: a) To note the current challenges we face, including over- occupancy in residential houses, reliance on external placements, decline in foster care capacity, supporting unaccompanied asylum-seeking children (UASC) and financial impacts. b) To endorse the Brighter Pathways Strategic Vision and the actions therein. c) Approve the financial proposals outlined which includes investment in internal Fostering to attract and retain Foster Carers and a Supported Accommodation Model of care for transitions, noting the forecast pay-back period. d) To note the financial position and future financial modelling based on re-investment of resources on a spend to save basis. 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 Agenda Item 6 41
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1. EXECUTIVE SUMMARY A previous update was provided to IJB on 9th May 2024 on the Brighter Pathways Programme, which was established to explore and implement sustainable, child-centred improvements across North Ayrshire’s care and support system for children, young people, and families. The Brighter Pathways Strategic Vision Report included as Appendix 2 details the breadth of transformation, action plan and the financial projections from the Brighter Pathways programme. The Strategic Vision sets our aspiration for the future of specific areas within children’s services in North Ayrshire. It consolidates all work undertaken through the Brighter Pathways Programme, incorporating detailed analysis and reports from each workstream, the legislative context, and the local challenges we face. This comprehensive approach ensures alignment between strategic objectives and operational delivery, providing a clear roadmap for transformation. The report also outlines a series of strategic recommendations, focusing on service developments and areas of significant transformation and investment as part of a “spend to save” and cost avoidance strategy. Key priorities include the development of a supported accommodation resource, fostering reform, and the redesign of intensive support services. These initiatives aim to reduce reliance on high-cost external placements while improving outcomes for children and young people. The key aims are to expand local capacity to reduce reliance on costly external placements. strengthen fostering, kinship, and supported accommodation and to redesign intensive family support and specialist care for complex needs. The work of the Brighter Pathways Programme Board is aligned with The Promise development plan and the work of the Corporate Parenting Steering Group which is responsible for overseeing the six Corporate Parenting duties, ensuring that each corporate parent upholds the rights and safeguards the wellbeing of Care Experienced people. 2. BACKGROUND 2.1 The Brighter Programmes Programme Board was established in February 2024 and has provided strategic leadership with a strong corporate parenting collaboration. The transformation and service developments were delivered through focussed workstreams on the following areas: 1. Housing and Throughcare 2. Fostering and Kinship 3. Education including Residential School Placements 4. Internal Children’s Houses – Model of Care 42
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5. Early Intervention & Intensive Family Support 6. Strategic Needs Assessment/Data/Workforce 7. Best Practice Models and Research Each of the established workstreams has reported on challenges, outcomes and recommendations which are detailed in the report at Appendix 2. Key themes and challenges emerging from the workstreams are: • Placement Pressures and Over-occupancy. • Workforce Wellbeing and Sustainability. • Fostering Capacity. • Transitions and Continuing Care. • Early and Intensive Support Gaps. • System Complexity and Coordination. • Use of Data and Evidence. • Housing and Throughcare Pressures. In addition to our commitment to enhancing outcomes for children and young people in North Ayrshire, we recognise that transformation is vital to tackling the financial challenges arising from current models of practice and service delivery. A “spend to save” investment approach is therefore required to ensure high-quality outcomes are achieved in a way that remains financially sustainable. 2.2 Children’s Placements North Ayrshire has one of the highest national rates of looked after children and young people, ranking fourth highest in Scotland. The national rate for children looked after is 12.3 per one thousand with North Ayrshire’s being 18. Despite this, overall, the number of Looked After Children has steadily reduced over the last few years but the numbers in residential care have not followed the same trend, and the number of requests for Continuing Care has increased significantly. This reflects the decline in foster care provision and a reliance on residential care. Positively the number of kinship placements has increased over the same period. Currently the lack of local placement availability necessitates children being placed out with their local area and is an increasing concern that the level of displacement will grow further due to lack of local options and capacity. The current situation with regards to care options and alternative resources for children and young people is very challenging and there is a need for transformational change and to consider different models to support and care for young people and consider re- modelling of current resources with a view to having alternative options for young people moving on from care and to create capacity in the residential houses to prevent children being placed in high cost external resources. 43
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The current position within North Ayrshire is that there is a lack of alternative options to support young people’s transition from residential care to supported care and semi- independent living and them requesting continuing care is an option of choice due to lack of alternative resources/options. 3. PROPOSALS 3.1 The strategic report provides comprehensive details from the seven workstreams, identifying key challenges, presenting data, and outlining the strategic progress achieved to date. It also sets out a suite of recommendations, proposed service developments, and an accompanying action plan to guide implementation and ensure alignment with the overall transformation objectives. The report outlines the challenges and pressures facing the partnership in relation to looked after children and care leavers. Each workstream has undertaken a wide-ranging scope of activity, resulting in recommendations and strategic direction aimed at reforming services to address capacity issues, respond to the evolving landscape, and mitigate financial pressures linked to external residential placements. High level recommendations are: • Expand Local Capacity Increase internal residential provision, through the development of a Supported Accommodation Service. • In line with Care Inspectorate Guidance, we will look to scope the development of smaller four-bedded children’s residential homes in the future. • As a Service we will continue to invest in fostering recruitment and retention through the development of a new scheme and enhanced support and training. • Develop Supported Accommodation Explore and implement a supported accommodation model for young people aged 16–21, providing a stepping stone to independence and easing pressure on residential care. • Strengthen Early and Intensive Support Develop a flexible, dedicated service to provide intensive support across the week. Improve visibility and accessibility of early intervention services through digital tools and updated directories. • Embed Trauma-Informed and Therapeutic Practice Provide regular reflective supervision and training for staff. Support the implementation of nurture frameworks and therapeutic approaches across services. • Improve Planning and Transitions Reinforce matching protocols and ensure transitions are planned and supported. Develop supported accommodation options for young people leaving care. 44
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• Enhance Governance and Leadership Clarify roles and responsibilities across services. Encourage leadership that is open to innovation and willing to explore improvement options such as ‘spend to save’ approaches. • Use Data to Drive Improvement Improve data collection and ensure it informs strategic planning and service development. Embed data use in management discussions at all levels. • Support Staff Wellbeing Recognise the emotional demands of care work and ensure staff feel valued and supported. Explore flexible working arrangements and workforce planning to reduce pressure. Many of the areas are to strengthen our approach to practice, operational management and how Children’s Services work in collaboration with wider Corporate Parents, including for example Housing and Education. Several service actions have already been implemented, including: • Revised Supported Care Scheme – updated to better support young people over the age of sixteen. • Unaccompanied Asylum-Seeking Children Practice Guidance and Welcome Booklets – providing clear guidance and resources for young people arriving in North Ayrshire. • Moving On Forum and Tracker – established to review and plan transitions for young people moving on from care settings. • Revised Housing Protocol – ensuring a coordinated response to the accommodation and support needs of care leavers. • New Referral Template – introduced for intensive support referrals to Rosemount for children in family-based care. • Pilot with Children’s House – offering psychological consultation to support children and young people. • Placement Assurance Forum – established to provide oversight of all external placements, ensuring suitability and addressing any barriers experienced which could hinder a return to a more suitable environment for our young people 3.2 There are two areas of significant transformation and investment that the Integration Joint Board is asked to endorse. This transformation is to shift the balance of care from residential care to family-based care and community-based support for young people leaving care. This investment is essential to mitigate the critical pressure points relating to looked after and care experienced young people and aligns with a spend to save cost avoidance approach. The spend on External Placements is in excess of £8m, the investment in alternative supports and strengthening our Fostering service is relatively modest compared to the potential benefits from reducing spend in this area. 45
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3.3 Foster Care Recruiting foster carers has always been a challenge across Scotland, and North Ayrshire is no exception. Despite our efforts, we faced increasing competition from other local authorities and independent fostering agencies, alongside changing family dynamics and economic pressures that made fostering less accessible for many households. Traditional recruitment methods such as print advertising, use of local media and community events did not yield positive results. To meet the growing demand for local placements and reduce reliance on external providers, we have required to modernise our approach and make fostering more attractive and sustainable for carers. North Ayrshire’s fostering schemes have remained unchanged since 2010. The only increase in payments to carers came because of the Scottish Government’s implementation of the Scottish Recommended Allowance in 2023. However, because North Ayrshire was already paying higher allowances, this adjustment only benefited carers looking after young people aged 16 and 17 years of age. At present, two fostering schemes operate in North Ayrshire: • Fostering Extra: £550 per week for children under 16, and £622.97 per week for those aged 16 and over. • Fostering First: £400 per week for children under 16, and £472.97 per week for those aged 16 and over. From 1st April 2026, a new scheme will be introduced to strengthen support for foster carers. Under this plan, we will introduce one scheme in North Ayrshire • Fostering First: £450 per week for children under 16, and £522.97 per week for those aged 16 and over. The annual uplift in costs for introducing this new scheme is £270k, reflecting our commitment to improving retention and making fostering a viable option for more families. These enhancements will result in fostering households receiving an annual increase of approximately £2,600 per year, per child/young person cared for. In addition, several new measures will be implemented: • A retainer payment for up to 12 weeks, providing financial stability for carers who may be without a placement until a suitable match is made. • A loyalty payment of £1,000 for foster carers who join North Ayrshire and remain with us for at least 12 months • An enhanced needs payment will be introduced to acknowledge that some young people have additional and complex care requirements. This payment is designed to ensure carers receive appropriate support when meeting these higher-level needs. It will be assessed on a case-by-case basis 46
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The introduction of this new fostering scheme with enhanced terms and conditions has been designed to attract and retain carers and will offer greater opportunities for children and young people to experience family-based care when they are unable to remain living within their birth (or wider) family. Alongside the new fostering scheme, we have committed to investing in digital recruitment strategies by partnering with the Council Advertising Network. This approach enables us to reach potential carers through targeted online campaigns and social platforms, showcasing the rewards and flexibility of fostering. Over a three-year period, we are investing £36,000 in this initiative to ensure we connect with people where they are and strengthen our recruitment efforts. In total, we have committed £306,000 to transform foster care recruitment and retention in North Ayrshire. This investment will help us build a stronger, more resilient fostering community, ensuring that children and young people can stay close to home in safe, loving environments. The full new proposed Fostering Scheme is appended to Appendix 2. The IJB is asked to endorse the new scheme which would come into effect from 1st April 2026. 3.4 Supported Accommodation Model – Boyle Street In North Ayrshire, we are committed to ensuring that every young person leaving care receives the right support to thrive as they transition to independence. Through our engagement with care-experienced young people, we identified a gap in provision for those who do not require full residential care but still need additional support. To address this, we are introducing a supported accommodation model of care, offering a safe and supportive environment for young people aged 16–21 years. The service wil be registered as Housing Support Service not a Children’s Residential House and will provide a springboard for young people to move to fuller independence. Located in Irvine, the facility will provide individual ensuite rooms, shared spaces, and dedicated staff support available 24/7 with proactive in-reach support from a range of services and agencies including Housing, Employability, Money Smart, Mental Health Teams and wider HSCP services . This approach bridges the gap between residential care and independent living, equipping young people with the skills, confidence, and stability they need for a successful future. The development of this resource, currently progressing through an active procurement process, represents an investment of £440k in the commissioned service and building costs. The new model will provide a vital alternative for young people transitioning from residential care, reduce reliance on external placements, and support long-term financial sustainability. Boyle Street is planned to come on-line in April 2026, and the Children and Families Team are currently in the process of identifying young people to move into the 47
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accommodation. The IJB are asked to support the investment in this accommodation on a pro-active spend to save basis. 3.5 Anticipated Outcomes • Reduce external residential placements to address overspend. • Development of supported care resource will support young people to transition from internal and external residential care. • Prioritise local and family-based care (kinship & foster care) • Increase capacity in internal residential houses, (transitions, alternative options for young people) • Increase foster care recruitment and retention (new fostering scheme improved terms and conditions (Boost Recruitment via digital strategies) • Strengthen intensive support pathways – services are flexible (evenings/weekends) and responsive to family’s needs, focus on prevention and children remining with parents/family in own community to reduce formal care entry/family breakdown. • Support children and young people to return to North Ayrshire from external provision, internal houses, supported care, family or independent living. • Strengthen support to care experienced learners within education, improved outcomes and prevent care and education provision – Virtual Head Teacher will have an active role in achieving these outcomes. • All care experienced children and young people in North Ayrshire grow up feeling loved, safe and respected so they can realise their potential. 3.6 Measuring Impact There will be ongoing governance and monitoring of both areas via the Corporate Parenting Group and the Children’s Services Strategic Partnership. These structures will ensure accountability, track progress against The Promise, and support continuous improvement in family support and care-experienced outcomes. Given the significant investment in internal foster care capacity and supported accommodation resource, there will be ongoing scrutiny of the impact these transformational changes have on children and young people’s outcomes including placement stability, wellbeing and progression. There will be ongoing scrutiny on financial sustainability and cost avoidance and the reducing the reliance on external residential care provision. There is also enhanced oversight with the HSCP and Children’s Services for the plans for movements in residential placements, the target timescales for individual moves will be monitored through these groups. 48
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4. IMPLICATIONS 4.1 Financial Appendix 1 provides a financial forecast overview from the current year (2025/26) to Year 5 (2030/31). Due to the funding flexibilities from the local government employers pension contributions, the IJB provided an additional £4m of resource as a budget pressure in 2024/25. This was reduced to £3m in 2025/26. This funding flexibility is removed in 2026/27 when the rate is due to increase and is a significant driver of the IJB projected budget gap next year. The proposed targeted investment in foster care, including the development of a new fostering scheme with improved terms and conditions to increase recruitment and retain existing carers is included in the financial forecasts from 2026/27 onwards. The HSCP values foster carers and is committed to ensuring that children experience family-based care, which provides stability and better outcomes. This investment reflects the importance placed on current foster carers and aims to encourage more individuals to become foster carers with the Council, supporting a more cost effective sustainable and high-quality care model. The model also factors in the proposed investment from 1 April 2026 in a Supported Accommodation model of care which will be a key pathway to supporting step down from internal and external residential care. Both of these represent an investment anticipated to reduce the cost and reliance on external placements from the current £8.4m to £1.2m by Year 5. The financial model will be used as a baseline to re-base all care placement budgets to allow clear financial performance monitoring against the plans and targets. The net impact for 2026/27 will be the requirement to factor an overall budget pressure into the Medium-Term Financial Outlook, with savings being released from 2027/28 onwards, where savings are projected at that point to be over £4m. 4.2 Human Resources Any possible impact on staff due to re-modelling or service redesign will be explored fully and will follow the governance process and Human Resources will be consulted. 4.3 Legal There are established legislative frameworks and policies governing looked after children and care-experienced young people, and the programme of work will fully adhere to these requirements. All actions and developments will be aligned with relevant regulations to ensure compliance, safeguard standards, and uphold the rights and wellbeing of children and young people throughout the transformation process. Legal services have been consulted on any legal matters that have arisen throughout the programme of work. 49
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4.4 Equality/Socio-Economic The aspirations of the programme board are in line with the vision of The Promise to address the inequality of outcomes experienced by our children and young people who have been, or are in, the care system. If the ambitions of The Promise are realised, not only will there be improved outcomes but also a reduction, and ideally, an elimination of the inequity that exists between care experienced children and young people and children and young people with no experience of care. Equality & Children’s Rights Impact Assessments have been completed relating to the areas of transformation within Brighter Pathways to ensure the needs and rights of people with protected characteristics have been considered. 4.5 Risk When trying to project and plan resources for looked after children there is an element of uncertainty as children who require alternative care are generally received into care in a crisis and their admission to care is unplanned with limited opportunity to plan and seek appropriate resource. The current care system is under significant pressure, with capacity issues in both foster care and residential care, and limited options to support care leavers. Without embarking on the proposed programme of work and transformational change, there is a substantial risk of escalating costs for external provisions and further overspend. Addressing these challenges through strategic investment and service redesign is essential to ensure sustainability and improved outcomes for children and young people. The landscape of looked after children and care placements remains fluid and unpredictable, introducing an element of risk and variability into financial and operational planning. There are significant challenges locally and nationally in the recruitment of Foster Carers, our new Scheme should strengthen our position, but there is an ongoing risk of recruitment and retention and Foster Care growth is the key success factor in strengthening our care pathways. The Children (Care, Care Experience and Services Planning) (Scotland) Bill was introduced on 17th June 2025 to implement key recommendations from the Promise – the national commitment to improve outcomes for care experienced children and young people. The Bill, once agreed, will introduce significant legal reforms to Scotland’s care system. It will amend existing legislation and create new statutory duties, the extent of which will not be known until the Bill fully passes through Parliament. 4.6 Community Wealth Building None. 50
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4.7 Key Priorities The work of the Brighter Pathways fully aligns and supports national objectives and the Councils strategic plans: • The Promise – Plan 24-30 • The United Nations Convention on the Rights of the Child (UNCRC) • Getting it Right for Every Child (GIRFEC) • North Ayrshire Council’s Corporate Parenting Plan 2023-2026 • Council Plan 2023-28 Key Priority: Improving outcomes for care experienced young people including implementation of The Promise • Children’s Services Plan 2023-26 The proposal and recommendations support the spirit of The Children and Young People (Scotland) Act 2014, which outlines the need for appropriate accommodation for young people over 16 years of age, to support them to prepare for independent living. 5. CONSULTATION Throughout the programme of work there has been ongoing consultation and collaboration with service areas, national bodies, third sector colleagues, young people, families, and carers. The Brighter Pathways Programme Board included representation from a range of agencies and partners, with a collaborative approach to co-designing solutions and leading the work of the work-streams. Care Experienced young people have played an active and valued role in shaping the service specification for the Supported Care Accommodation. Their involvement has included consultation on the service model, including what support, environment, and relationships they feel are essential for successful transitions. Co-designing a key question for prospective providers, ensuring that lived experience informs the commissioning process. Participation in the evaluation of provider responses, contributing to scoring, feedback, and decision-making. This approach reflects a commitment to rights-based practice, The Promise, and the principles of co-production, ensuring that services are not only designed for young people, but with them. In developing the new Fostering Scheme, the service undertook a targeted engagement exercise to ensure the model was informed by the lived experience and professional insight of those closest to the work. This included a structured survey distributed to current foster carers to obtain their views on barriers to recruitment, challenges in retention, and areas for improvement. 51
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Caroline Cameron Director HSCP For further information please contact Elizabeth Stewart, Head of Service, Children, Families and Justice, on 01294 317727 52
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Overall Financial Modelling APPENDIX 1 * The financial modelling is based on demand and numbers anticipated in each care setting and does not factor in any annual inflationary impact including contract and pay inflation which would be considered at part of future years annual budget process 53
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finance. Appendix Two Brighter Pathways Board Strategic Vision Abstract This Paper provides a Strategic Update to the IJB. Authors- Kevin McGinn/Arthur Coutts 54
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NORTH AYRSHIRE Health and Social Care Partnership 1 Delivering care together Table of Contents Table of Contents ............................................................................................................... 1 Table of Papers ................................................................................................................... 2 Table of Figures ................................................................................................................... 2 1- Executive Summary ........................................................................................................ 3 2. Brighter Pathways – Transforming Children’s Services in North Ayrshire ..................... 5 3. Strategic Direction ........................................................................................................ 11 Strategic Needs Assessment Data/Workforce Workstream .......................................... 11 Strategic Needs Assessment Data/Workforce Workstream- Outcome Summary ... 13 Housing and Throughcare Workstream .......................................................................... 15 Housing & Throughcare – Outcome Summary ........................................................... 18 Fostering & Kinship Workstream ....................................................................................... 18 Fostering & Kinship – Outcomes Summary .................................................................. 25 Education Including Residential Placements Workstream ............................................ 26 Education Including Residential Placements – Outcomes Summary ....................... 27 Internal Children’s Houses- Model of Care Workstream ................................................ 29 Internal Children’s Houses -Model of Care- Outputs Summary: ................................ 32 Early Intervention and Intensive Support Pathways Workstream .................................. 33 Early Intervention and Crisis/Intensive Support Pathways - Outputs Summary: ..... 36 Best Practice Models and Research Workstream .......................................................... 37 Best Practice Models and Research – Outputs Summary: ........................................ 41 4. Financial Modelling & Sustainability ............................................................................ 42 Current Position ............................................................................................................. 44 Medium Term Planning ................................................................................................. 45 Fostering ......................................................................................................................... 46 Kinship ............................................................................................................................ 48 Supported Accommodation Model ........................................................................... 49 5. Strategic Recommendations & Implementation ....................................................... 50 Implemented Service Improvements: ......................................................................... 50 Area to be progressed/Action Plan ............................................................................ 51 6. Conclusion ..................................................................................................................... 51 55
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NORTH AYRSHIRE Health and Social Care Partnership 2 Delivering care together Table of Papers Appendix1-Brighter Pathways TOR ........................................................................... 52 Appendix2- Strategic Needs/Data/Workforce Position Paper .............................. 60 Appendix3-Housing & Throughcare Workstream Position Paper ........................... 87 Appendix4- Moving on Forum- Terms of Reference ............................................. 101 Appendix5- Care Leavers Housing Protocol ......................................................... 105 Appendix6- Supported Accommodation Business Case ..................................... 122 Appendix7- Fostering & Kinship Position Paper ..................................................... 144 Appendix8-Foster Carer Survey Report .................................................................. 150 Appendix9- Education – Including Residential Placements -Position Paper ...... 169 Appendix10- Internal Children’s Houses – Model of Care – Position Paper ........ 183 Appendix11Early Intervention and Intensive Support Pathways Position Paper 202 Appendix12 Best Practice Models & Research Position Paper ............................ 226 Appendix13 Pilot CEYP Service ............................................................................... 237 Table of Figures Figure 1 Strategic Needs Data/Workforce Workstream -Key Challenges ................... 11 Figure 2- Strategic Needs Data/Workforce Workstream - Outcome Summary .......... 15 Figure 3 Housing and Throughcare Workstream - Key Challenges .............................. 15 Figure 4 Housing & throughcare Workstream -Outcome Summary Table ................... 18 Figure 5 Fostering & Kinship - Key Challenges ................................................................ 19 Figure 6- Fostering Recruitment Activity .......................................................................... 21 Figure 7- Foster Carer Enquiries ........................................................................................ 22 Figure 8- Fostering & Kinship - Outcomes Summary ....................................................... 25 Figure 9- Education Including Residential Placements - Key Challenges .................... 26 Figure 10- Education Including Residential Placements- Outcomes Summary ........... 29 Figure 11-Internal Children’s Houses- Model of Care Workstream- Key Challenges ... 29 Figure 12-Internal Children’s Houses -Model of Care- Outputs Summary .................... 33 Figure 13-Early/ Intensive Support Pathways Workstream- Key Challenges ................ 33 Figure 14-Best Practice Models and Research Workstream- Key Challenges ............. 38 Figure 15-Best Practice Models and Research – Outputs Summary ............................. 42 56
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NORTH AYRSHIRE Health and Social Care Partnership 3 Delivering care together 1- Executive Summary The Brighter Pathways Programme was established to explore and implement sustainable, child-centred improvements across North Ayrshire’s care and support system for children, young people, and families. This executive summary brings together the collective learning, challenges, and strategic recommendations from the programme’s key workstreams: • Strategic Needs/Data Workforce • Education & Residential Placements • Internal Children’s Houses – Model of Care • Early Intervention & Crisis Support • Best Practice Models & Research • Housing & Throughcare • Fostering & Kinship Shared Context and Drivers for Change Across all workstreams, there is a shared recognition of the increasing complexity of need among children and young people, alongside significant pressures on capacity, workforce resilience, and financial sustainability. The system is currently managing high levels of demand, with over-occupancy in residential houses, limited fostering capacity, and a growing reliance on external placements. Staff are working in increasingly complex environments, and there is a clear need for more consistent, trauma-informed, and joined-up approaches. This work has highlighted that without decisive action, we risk failing those who rely on our services the most, while continuing to operate a system that is financially unsustainable and increasingly unable to meet the needs of our children and young people within North Ayrshire. Key Themes & Challenges Emerging Across Workstreams • Placement Pressures and Over-occupancy. • Workforce Wellbeing and Sustainability. • Fostering Capacity. • Transitions and Continuing Care. • Early and Intensive Support Gaps. • System Complexity and Coordination. • Use of Data and Evidence. • Housing and Throughcare Pressures. 57
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NORTH AYRSHIRE Health and Social Care Partnership 4 Delivering care together Strategic Recommendations • Expand Local Capacity Increase internal residential provision, through the development of a Supported Accommodation Service. • In line with Care Inspectorate Guidance, we will look to scope the development of smaller four-bedded children’s residential homes in the future for Children under the age of Twelve. • As a Service we will continue to invest in fostering recruitment and retention through the development of a new scheme and enhanced support and training. • Develop Supported Accommodation Explore and implement a supported accommodation model for young people aged 16–21, providing a stepping stone to independence and easing pressure on residential care. • Strengthen Early and Intensive Support Develop a flexible, dedicated service to provide intensive support across the week. Improve visibility and accessibility of early intervention services through digital tools and updated directories. • Embed Trauma-Informed and Therapeutic Practice Provide regular reflective supervision and training for staff. Support the implementation of nurture frameworks and therapeutic approaches across services. • Improve Planning and Transitions Reinforce matching protocols and ensure transitions are planned and supported. Develop supported accommodation options for young people leaving care. • Enhance Governance and Leadership Clarify roles and responsibilities across services. Encourage leadership that is open to innovation and willing to explore improvement options such as ‘spend to save’ approaches. • Use Data to Drive Improvement Improve data collection and ensure it informs strategic planning and service development. Embed data use in management discussions at all levels. • Support Staff Wellbeing Recognise the emotional demands of care work and ensure staff feel valued and supported. Explore flexible working arrangements and workforce planning to reduce pressure. Conclusion The Brighter Pathways Programme has highlighted the need for a whole-system approach to improving outcomes for children and young people in North Ayrshire. While some improvements can be made within existing resources, addressing the underlying pressures will require investment, strong leadership, and a commitment to collaborative working. 58
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NORTH AYRSHIRE Health and Social Care Partnership 5 Delivering care together The recommendations outlined aim to support a more sustainable, responsive, and nurturing care system that places children and young people at the centre of decision-making. 2. Brighter Pathways – Transforming Children’s Services in North Ayrshire The Brighter Pathways Programme was established with a clear and ambitious vision to reshape the landscape of children’s services in North Ayrshire. For the full terms of Reference see Appendix1. Rooted in the principles of The Promise, the programme set out to deliver holistic, whole- family support and ensure high-quality, sustainable models of alternative care for children who are unable to remain within their family network. A key focus has been on improving outcomes for care-experienced young people as they move towards adulthood and greater independence. Central to this has been the development of more localised resources and increasing capacity within the system to better support both looked after children and those with care experience. Another significant driver has been the financial pressure associated with the commissioning of high-cost external residential placements. These placements have often been required due to limited internal capacity or the complexity of individual needs. The programme has sought to address this by creating a more balanced and sustainable model of care. The work of Brighter Pathways has brought together corporate parents, fostering a shared understanding of the challenges and opportunities across the system. Through the workstreams and Programme Board, there is clear evidence of strengthened collaboration, improved relationships, and a shift away from siloed working in relation to care-experienced young people. The Project Board worked in partnership with key stakeholders to deliver a wide-ranging transformation agenda. This includes shifting the balance of care away from high-cost residential placements towards community-based alternatives, supported carers, supported accommodation, and family-based placements such as foster and kinship care. There is also a strong focus on providing intensive support to families to help them stay together wherever possible or to support reunification. There is a robust evidence base demonstrating that flexible, tailored support—delivered early and within the community—leads to better outcomes for children and young people. This includes improved behaviour, stronger engagement in education and community life, and greater stability within families. The Promise and North Ayrshire’s Commitment to Children’s Rights and Care The Promise was published by the Independent Care Review on 5 February 2020, with the Scottish Government formally committing to the actions it sets out. To support delivery, The Promise Scotland was established in March 2021 to oversee implementation. Central to The Promise are key themes and a clear commitment to improving the lives and experiences of children within the care system. 59
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NORTH AYRSHIRE Health and Social Care Partnership 6 Delivering care together At its heart, The Promise advocates for a rights-based, child-centred approach to care, where every child in Scotland has the opportunity to grow up in a loving and supportive family environment. The human rights of children and young people must be upheld at all times, as outlined in the UN Convention on the Rights of the Child (UNCRC). The Children (Care, Care Experience and Services Planning) (Scotland) Bill The Bill is a landmark piece of legislation introduced by the Scottish Government on 17 June 2025. It aims to reform Scotland’s care system and deliver on the commitments made in The Promise—the outcome of the Independent Care Review, which seeks to transform the lives of care-experienced children and young people. This Bill is a direct response to the Independent Care Review and plays a central role in Scotland’s pledge to “Keep the Promise” by 2030. Its purpose is to ensure that care- experienced children and young people feel safe, loved, and respected—not just in policy, but in everyday practice. It also establishes the right to Aftercare support for those who were ‘looked after’ before their 16th birthday, following an assessment of their eligible needs. As of September 2025, the Bill is at Stage 1 of the Scottish Parliament’s legislative process. Key Provisions of the Bill 1. Expanded Support for Care-Experienced Individuals • Aftercare Rights: Extends eligibility for Aftercare to anyone who was looked after at any point during childhood, even if they left care before turning 16. • Access to Advocacy: Guarantees care-experienced individuals' access to advocacy services, helping them navigate systems and assert their rights. 2. Reform of Foster and Residential Care • Charity Registration Requirement: Fostering services must register as charities, aiming to reduce profit-driven motives in care provision. • Profit Limits: Scottish Ministers will have powers to cap profits from residential childcare, encouraging reinvestment into high-quality care. • National Register: Introduces a national register of foster carers to improve transparency and oversight. 3. Children’s Hearings System Reform • Updates the legal framework to better reflect children’s needs and rights. However, some proposals—such as hearings with a single panel member—have raised concerns about their impact on children’s rights. • Reinforces the Kilbrandon principle, which focuses on the child’s needs rather than their actions. 4. Shared Responsibility for Service Planning • Integration Joint Boards will now share responsibility for planning children’s services alongside local authorities and health boards, promoting more coordinated and accountable service delivery. 5. A Rights-Based Approach 60
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NORTH AYRSHIRE Health and Social Care Partnership 7 Delivering care together • Aligns with the UN Convention on the Rights of the Child (UNCRC), although some provisions may fall outside the scope of the UNCRC Incorporation (Scotland) Act 2024. • Promotes a clearer understanding of “care” and “care experience” through statutory guidance. North Ayrshire is fully committed to embedding a rights-based culture and practice across its services, with a focus on the following areas: Children’s Rights Framework Guided by the UNCRC, North Ayrshire’s Children’s Services Plan and Rights Report reinforce the principle that children are rights holders, not passive recipients of care. This includes the right to family life, education, protection, and meaningful participation in decisions that affect them. Family Support and Reunification Our local approach prioritises the preservation of family relationships and, where appropriate, supports reunification. This is in direct alignment with The Promise, and North Ayrshire continues to actively implement its recommendations to ensure care-experienced children can return to safe, loving family environments. Support Within the Community Children and young people are supported to remain within their birth families, wider family networks, and local communities wherever possible. This is underpinned by the Signs of Safety approach and our Kinship Care Strategy, which promotes a ‘kinship first’ culture. Where alternative care is required, kinship care is considered as the first option and reviewed regularly for looked after children. Continuing Care North Ayrshire Council is committed to the principles of Continuing Care legislation and the Staying Put agenda. This legal right enables young people who have been in foster, kinship, or residential care to remain in their placement beyond the age of 18, up to 21, ensuring continuity and stability. Connection to Community We are dedicated to ensuring children remain connected to their communities and networks. Where children require alternative care, every effort is made to support them to remain in North Ayrshire or return if placed out with the authority. Planning with Purpose The Children’s Services Plan 2023–2026 sets out five strategic priorities, including early intervention, fairness, and mental health promotion—all rooted in a rights-based ethos. Legislative Developments: The Children (Care, Care Experience and Services Planning) (Scotland) Bill. The Bill was introduced on 17 June 2025 and is at Stage 1. This Bill proposes a series of legislative changes to ensure care-experienced children and young people grow up loved, safe, and respected. Key measures include: • Extension of Aftercare Support: A new right for those formerly looked after (prior to age 16) to request an assessment of need for aftercare support from their 16th birthday, supporting a positive transition into adulthood. 61
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NORTH AYRSHIRE Health and Social Care Partnership 8 Delivering care together • Legal Right to Advocacy: A statutory requirement for Scottish Ministers to provide independent advocacy support to care-experienced children, young people, and adults. • Statutory Guidance on Care Experience: A duty on Scottish Ministers to publish guidance, with service providers required to have regard to it. • Financial Transparency in Residential Care: Powers to introduce regulations requiring financial disclosure from residential childcare providers, and to limit excessive profit- making. • Strengthening Not-for-Profit Foster Care: A requirement for Independent Fostering Agencies to register as charities before being authorised to operate, with associated governance and administrative implications. • National Register for Foster Carers: Enabling powers for the creation of a register, to be developed collaboratively with foster carers and partners. • Children’s Hearings System Reform: Legislative changes to implement reforms following the Hearings System Working Group report. • Extended Duties for Integration Joint Boards (IJBs): A statutory responsibility for IJBs in the development of Children’s Services Plans, creating shared accountability with local authorities and health boards. Moving On – Supporting Transitions from Care Supporting young people as they transition from care to independence is a central theme of The Promise. It recognises the significant challenges care-experienced young people face when moving into adulthood and living independently of formal care services. The Promise highlights the importance of planned transitions, where young people are fully informed and involved in decisions about their future. As stated in the report: “Parenting does not stop at 18. Throughout The Plan, Scotland must continue to consider how to create greater equity and opportunity for care experienced young adults. That consideration must include how to increase opportunity for care experienced people to access employment, training, stable housing and support.” (The Promise, 2020, p.93) Changing Landscape – Challenges and Pressures Several factors have contributed to the increasing pressures on services for children requiring alternative care and for care-experienced young people moving on from care. In recent years, demand for residential care has risen, resulting in Children’s Houses operating over capacity and exceeding their registered limits. A series of recent policy and legislative developments have further intensified existing pressures. In particular, the Continuing Care legislation, which permits young people to remain in their care placements until the age of 21, has experienced a notable and welcome increase in uptake across North Ayrshire. While this represents a positive advancement in supporting young people, it has simultaneously generated significant capacity challenges within internal residential services and imposed substantial financial 62
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NORTH AYRSHIRE Health and Social Care Partnership 9 Delivering care together pressures, particularly in circumstances where young people continue to reside in external placements. The National Transfer Scheme (NTS) for unaccompanied asylum-seeking children (UASC), introduced under the Immigration Act 2016 and implemented in 2022, mandates North Ayrshire Council to support 24 young people via the Home Office dispersal scheme, young people often arrive with little notice—particularly trafficked young people who present as spontaneous arrivals, typically through out-of-hours services. This limits the ability to plan and secure appropriate accommodation in advance. Internal residential care has primarily supported young people under 16, including 12 UASC at its peak—now reduced to five. This was largely due to a lack of alternative provision, such as foster care or supported accommodation, further compounding capacity issues. Despite these challenges, North Ayrshire remains proud of the support offered to displaced and disadvantaged young people. We are committed to supporting their asylum journey, educational needs, and transition from residential care to semi-independent or independent living. All young people arriving via the NTS or identified as trafficked are accommodated under Section 25 of the Children (Scotland) Act 1995, as children in need. Foster Care – A Diminishing Resource The national crisis in foster carer recruitment and retention is well documented. Across Scotland and the UK, there is a significant shortfall in available foster carers. In North Ayrshire, deregistration’s have outpaced new approvals, placing further strain on the system. Continuing Care has also contributed, with many young people choosing to remain with their foster carers until age 21, limiting the availability of placements for other children. A high percentage of foster carers have committed to care for children on a long term or permanent basis which limits their availability to care for any other children. The most pressing challenge is the recruitment and retention of high-quality foster carers who can meet the needs of children with complex behaviours and trauma histories. There is a particular shortage of carers able to support teenagers and children with neurodevelopmental or emotional needs. Wider System Pressures The combined impact of Continuing Care, the NTS, and the foster care shortfall has placed considerable pressure on internal residential services, often necessitating the use of external placements. The Children (Scotland) Act 2020, alongside the Looked After Children (Scotland) Amendment Regulations 2021, introduced a duty to support siblings to remain together. While this is a welcome development, it has proven difficult to implement due to limited capacity in both foster care and residential settings. Overoccupancy in Children’s Houses has further restricted the ability to accommodate sibling groups. Kinship Care – A Strengthened Approach There has been notable progress in the use of kinship care across North Ayrshire. Kinship options are now explored at the earliest opportunity, supported by the Signs of Safety approach and aligned with the HSCP Kinship Care Strategy and the ethos of The Promise. 63
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NORTH AYRSHIRE Health and Social Care Partnership 10 Delivering care together Kinship care is the preferred and first option for children requiring alternative care and is continually reviewed throughout a child’s care journey. It is recognised that kinship carers and the children they support often face similar challenges to those in other care settings. Ongoing support is essential to sustain these placements and ensure stability. Complex Needs and Specialist Provision Evidence from the workstreams indicates that the profile of children requiring care is becoming increasingly complex. Many children present with needs linked to trauma, adverse childhood experiences, and attachment difficulties, often resulting in mental health concerns. There is also a growing number of looked after children with neurodevelopmental disorders, reflecting the impact of early trauma on development. It is acknowledged that some children will be unable to thrive in family-based care due to the complexity of their needs. For these young people, bespoke and specialist care settings are required to ensure their safety, wellbeing, and development. Practice Development – Embedding Signs of Safety The introduction of the Signs of Safety framework in North Ayrshire in 2023 marked a significant shift in practice and culture across children’s services. This strengths-based approach focuses on comprehensive risk assessment, considering not only dangers but also protective factors and periods of safety. The aim is to stabilise and strengthen the child and family’s situation by building on what is already working well. This approach aligns closely with the principles of The Promise, which advocates for providing the right support and scaffolding to families to prevent children entering care unnecessarily. It also promotes the involvement of the wider family network as a support mechanism or alternative care option, reinforcing North Ayrshire’s commitment to a kinship-first culture for children requiring care. Signs of Safety operationalizes many UNCRC principles by ensuring children are actively involved in planning and decision-making, Signs of Safety was also highlighted as a model of good practice within the National Child Protection Guidance for Scotland. Signs of Safety represents a move away from deficit-based, crisis-driven practice. It encourages meaningful participation from children, young people, and their families in planning and decision-making processes that affect their lives. The implementation of Signs of Safety has brought about change at multiple levels, practice, culture, systems, and service delivery. It is recognised that this transformation is complex and ongoing. Central to the model is the principle that children should only be accommodated when there is a risk of significant harm, and all other options have been exhausted. Strategic Reform and Financial Pressures This report outlines the challenges and pressures facing the partnership in relation to looked after children and care leavers. Each workstream has undertaken a wide-ranging scope of activity, resulting in recommendations and strategic direction aimed at reforming services to address capacity issues, the evolving landscape, and the financial pressures linked to external residential placements. 64
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NORTH AYRSHIRE Health and Social Care Partnership 11 Delivering care together Alongside our commitment to improving outcomes for children and young people in North Ayrshire, it is acknowledged that service transformation is essential to address the financial challenges associated with current models of practice and delivery. The work of the Brighter Pathways Programme Board is closely aligned with The Promise development plan and the Corporate Parenting Steering Group, which oversees the six Corporate Parenting duties. This ensures that every corporate parent upholds the rights and promotes the wellbeing of care-experienced children and young people. 3. Strategic Direction The Brighter Pathways programme has brought to light several interconnected challenges across Corporate Parents, including Housing, Education & the HSCP. While these issues are complex, they also presented a valuable opportunity to reflect, realign, and strengthen our collective approach to supporting children, young people, and families in North Ayrshire. Workstreams Each of the Workstreams was tasked with analysing the current landscape, with a view of identifying any challenges or issues being faced within our services, this was detailed in the form of a workstream position paper, detailing the views of its Stakeholders, these are summarised in the following section: Strategic Needs Assessment Data/Workforce Workstream This Strategic Needs Assessment Workstream members collaborated together to provide a data informed insight into the current landscape of North Ayrshire. The Position Paper can be found in Appendix2 it offers a considered overview of the current landscape for looked after and care experienced children and young people in North Ayrshire. It brings together a wide range of data and insights to support informed decision-making and to guide the future direction of services. The findings highlight areas of strength, as well as opportunities for improvement, particularly in relation to placement sufficiency, early intervention, and the wider determinants of wellbeing. Figure 1 Strategic Needs Data/Workforce Workstream -Key Challenges Key Challenges Identified: • Over-occupancy in residential houses. • Increasing volume of External Residential Placements. • Decline in foster care capacity. • Data limitations & Inconsistency. • Increasing Volume of Kinship Carers. • Increasing Numbers of Unaccompanied Asylum-Seeking Children (UASC). 65
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NORTH AYRSHIRE Health and Social Care Partnership 12 Delivering care together Strategic Needs Assessment Data/Workforce Workstream- Strategic Response: This position paper outlines the strategic vision and data-informed direction of the Brighter Pathways transformation programme in North Ayrshire. It focuses on the needs, challenges, and opportunities in planning and delivering services for looked after and care experienced infants, children, and young people (CYP), including those on the edge of care. The paper highlights the importance of a public health approach, improved data systems, and collaborative planning to ensure sustainable, equitable outcomes. Over-Occupancy in Residential Houses Internal residential provision remains under sustained pressure, with consistent over- occupancy. Strategic Response: • A Business Case for Supported Accommodation has been developed to provide more appropriate and sustainable options for young people. • A Placement Assurance Forum has been proposed, with Terms of Reference drafted, to strengthen oversight and improve placement planning. Rationale: These measures aim to reduce pressure on internal provision and ensure placements are better matched to need. Increasing Volume of External Residential Placements The use of high-cost external placements continues to rise due to limited local capacity and increasing complexity of need. Strategic Response: • Expansion of supported accommodation and improved internal planning through the Placement Assurance and Moving on Forum. • Use of the Brighter Pathways Dashboard to monitor placement trends and inform decision-making. Rationale: These actions aim to reduce reliance on external placements by improving local capacity and planning. Decline in Foster Care Capacity The number of approved foster carers has declined significantly, with deregistration’s continuing to outpace new approvals. Strategic Response: • Accelerate digital recruitment via CAN Digital, with targeted campaigns and streamlined approval processes and a standalone webpage for the fostering service. • Develop financial proposals for new fostering schemes through the Fostering & Kinship Workstream. Rationale: A refreshed offer and modernised recruitment approach are essential to rebuild capacity and meet current and future demand. 66
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NORTH AYRSHIRE Health and Social Care Partnership 13 Delivering care together Data Limitations and Inconsistency Current systems are fragmented and operate on different timelines, making it difficult to get a clear picture of need and performance. Strategic Response: • Improve data sharing between all corporate parents to enable cohesive planning and monitoring. • Launch and embed the Brighter Pathways Dashboard to provide up-to-date, accessible data for strategic oversight. Rationale: Better integration and real-time data will support more effective decision-making and help track progress consistently. Increasing Volume of Kinship Carers Kinship care continues to grow and is a key strength locally, but carers are supporting children with increasingly complex needs. Strategic Response: • Revise and implement updated Kinship Care Strategy. • Ensure appropriate financial and ongoing support to all kinship placements. • Expand trauma-informed training and peer support networks for kinship carers. • Formal kinship care arrangements will be recognised within North Ayrshire Councils Housing Allocation Policy. Kinship carers will be awarded additional points if there is a housing need which will assist kinship carers to secure larger tenancies to care for family members. Rationale: A more structured and responsive support offer is needed to sustain placements and promote long-term stability. Increasing Numbers of Unaccompanied Asylum-Seeking Children (UASC) UASC are a unique group of young people who may have experienced significant disruption and adversity. Strategic Response: • Develop a dedicated pathway for UASC, including trauma-informed support and cultural competence. Rationale: Tailored approaches are essential to ensure these young people receive appropriate care and support that reflects their individual needs. Strategic Needs Assessment Data/Workforce Workstream- Outcome Summary Identified Issue: Strategic Response: Rationale: Placement Pressures and Residential Capacity. • Business Case for Supported Accommodation has been presented at PSMT • Terms of Reference for “Placement Assurance Forum” has been drafted for approval. Internal residential provision remains under sustained pressure, with consistent over- occupancy. Supported accommodation offers a 67
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NORTH AYRSHIRE Health and Social Care Partnership 14 Delivering care together • Business case was approved by PSMT. more appropriate and sustainable option for some young people, while the forum will strengthen oversight and improve placement planning. Foster Care – Recruitment and Retention Challenges • Accelerate digital recruitment via CAN Digital, with targeted campaigns and streamlined approval processes. • Financial Proposals for new Fostering Schemes are in development within Fostering & Kinship Workstream. The number of approved foster carers has declined significantly, and deregistration’s continuing to outpace new approvals. A refreshed offer and modernised recruitment approach are essential to rebuild capacity and meet current and future demand. Data limitations & Inconsistency • Improve Data sharing between all corporate parents to enable cohesive planning & monitoring. Current systems are fragmented and operate on different timelines, making it difficult to get a clear picture. Better integration will support more effective decision- making and help track progress more consistently. Kinship Care – Kinship First Culture, first option when children require alternative care that is supported with financial and ongoing practical and emotional support • Revised and implement revised kinship care strategy • Ensure appropriate financial and ongoing support to all kinship placements • Expand trauma-informed training and peer support networks for kinship carers. • Kinship Carers to receive additional points for housing allocation. Kinship care continues to grow and is a key strength locally, but carers are supporting children with increasingly complex needs. A more structured and responsive support offer is needed to sustain placements and promote stability. Increasing Numbers of Unaccompanied Asylum-Seeking Children (UASC) • Develop a dedicated pathway for UASC, including trauma- informed support and cultural competence. UASC are a unique group of young people who may have experienced significant disruption and adversity. Their arrival brings additional considerations for planning and support, and it’s important that we continue to develop approaches that are sensitive to their individual needs, including trauma- 68
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NORTH AYRSHIRE Health and Social Care Partnership 15 Delivering care together informed and culturally responsive care. Figure 2- Strategic Needs Data/Workforce Workstream - Outcome Summary Housing and Throughcare Workstream The role of the Housing & Throughcare Workstream was to ascertain the current issues being faced by both our Housing & Throughcare Services. In addition to this, the Workstream was tasked with providing the Board with Strategic Direction to support care experienced young people in North Ayrshire, the Workstream Position Paper can be found in Appendix3. The workstream is shaped by key legislation including the Children and Young People (Scotland) Act 2014 and Continuing Care provisions, which extend support for care- experienced young people up to the age of 26. These changes have significantly increased demand for Throughcare services and suitable accommodation, particularly for young people remaining in care settings until the age 21. The Promise and the Scottish Government’s ‘Moving On’ programme further reinforce the need for planned, person-centred transitions into adulthood, with a focus on equity, stability, and long-term support. At the time of writing North Ayrshire have Thirty-Nine Young people in Continuing Care. Within the Workstream the following Challenges were identified by Stakeholders: Figure 3 Housing and Throughcare Workstream - Key Challenges Housing & Throughcare Strategic Response: To Address these issues the Workstream members made the following recommendations: The workstream acknowledged that there was an increasing number of young people who were eligible for throughcare support due to continuing care legislation and the National Transfer Scheme. Key Challenges Identified: • Gaps in Joint Working and Outdated Protocols Between Services. • Limited Suitable Housing/Accommodation Options for Care Leavers. • Increased Demand due to Continuing Care and UASC Responsibilities. • Complex needs and tenancy breakdowns. • Gap in Supported Accommodation Model for Older Young People. 69
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NORTH AYRSHIRE Health and Social Care Partnership 16 Delivering care together It was agreed that significant improvements were necessary to improve the process and joint working between social work and housing to ensure young people leaving care were allocated suitable housing when they were ready to leave their care setting and to consider alternative models to support young people before they transition to independent living. Gaps in Joint Working Within the Workstream it was noted by both services that previously there had been joint meetings where the services would track housing applications for young people with a view of identifying their housing requirements and working together to provide accommodation for young people aspiring to leave care. In order to address this the ‘Moving on Forum’ was established the Terms of Reference can be found in Appendix4 in addition to this, an escalation process for this forum has been identified as a need, this will allow for the forum to highlight any issues with regards to lack of suitable accommodation for care leavers. The aim of the forum is to have monthly meetings with representation from both the Housing & Throughcare Services. The forum was established to review all young people’s housing applications and to allow early planning and preparation for transitions to their own tenancy. To address these issues social work and housing colleagues worked on a revised care leavers housing protocol, please see Appendix5 for the full report, to ensure a co-ordinated response to the accommodation and support needs of care leavers. Key areas that have been strengthened in the Care Leavers Housing Protocol: • All care leavers will be in Group 2 housing allocation which is the second highest priority group. • The protocol reflects the commitment of each party to strengthen existing services and joint working arrangements, detailing the duties and responsibilities of each department. • A range of accommodation and support solutions will be made available to young care leavers on discharge from care and until their 21st birthday, with advice and guidance available until their 26th birthday. • Improved information sharing, earlier planning and preparation for transitions, and that support should be person-centred, meeting the unique needs of everyone. • Access to an appeals and resolution service, which is described and understood by young people. There have been developments and an update to the supported care scheme as an alternative option for USAC and young people moving on from residential care who are over sixteen. Whilst recruitment for this scheme has been limited, we endeavour to build momentum and continue in our work to attract new supported carers. Work is ongoing to develop an accredited tenancy skills programme for care leavers in North Ayrshire. It was highlighted in the Transitions for Care Experienced Young People, Thematic Review (2024) that this was beneficial in preparing young people who were transitioning from care settings with the necessary skills and knowledge for independent living. This is currently being developed in conjunction with Throughcare, our Corporate Parenting Team, and 70
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NORTH AYRSHIRE Health and Social Care Partnership 17 Delivering care together housing colleagues. There is currently no structured tenancy skills programme to increase capacity for independent living. The aspiration of the HSCP is to have a multifaceted approach to support care leavers which would include the enhancement of our supported care scheme, sitting alongside the development of a supported care accommodation model alongside the provision of satellite tenancies and of course for young people to live independently in their own tenancies with the appropriate support they require. Supported Care Scheme This scheme provides young people, aged 16-21, with a safe living environment and practical and emotional support, who may have a range of needs. It offers a stepping stone to independence, helping young people develop skills for independent living whilst also fostering a sense of belonging and confidence. We have recently made improvements to the scheme to attract more interested parties to come forward to be assessed as a Supported Carer. Satellite Tenancies There are ongoing discussions and commitment from colleagues in housing to identify properties than can be utilised as satellite tenancies, which are self-contained properties with support which allows for a balance between independence and ongoing assistance. This provides another option for young people leaving care to ensure they receive ongoing support and helps young people develop the skills and confidence needed for independent living. Housing is pursuing suitable tenancies for this purpose. Unaccompanied Asylum-Seeking Children – Practice Guidance In response to the growing number of UASC, members of the workstream have proactively come together to develop dedicated practice guidance to support consistent and effective service delivery. Supported Accommodation Development North Ayrshire HSCP do not currently have a resource to support young people over sixteen who are transitioning from a childcare setting, that provides tailored support with independent living skills. Benchmarking and visits have been undertaken to several supported accommodation resources in other local authorities that were inhouse provision or commissioned service. A suitable council property is being considered for a supported accommodation model, a business case and paper was presented at PSMT on 3rd July 2025. The proposal was for the development of a 6-bed supported accommodation service for young people over sixteen who are ready to transition from their care setting and would be an alternative to remaining in internal and external residential care facility under continuing care legislation. The PSMT fully supported the development of a supported accommodation and agreed that the commissioning process should be commenced. 71
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NORTH AYRSHIRE Health and Social Care Partnership 18 Delivering care together This resource would provide a resource for supporting and increasing young people’s capacity for independent living and would be a stepping stone to living in the community in their own tenancy. This resource would allow young people to move from residential care and would create some capacity within internal children’s houses and reduce the number of young people in high-cost external residential resources. Initial discussions have taken place with the Care Inspectorate who have advised that the service could be registered as a housing support service. The business case and paper for PSMT fully details the operational costs, staffing options and service delivery model and rationale for the development of this resource, see Appendix6 for detail. Housing & Throughcare – Outcome Summary Identified Issue: Strategic Response: Rationale: Gaps in Joint Working “Moving on Forum” Monthly meetings to track applications & discuss/highlight issues being faced by both services. Outdated Protocols Revised Care Leavers Protocol To ensure a co- ordinated response to the accommodation and support needs of care leavers. Limited Suitable Housing/Accommodation Options for Care Leavers. “Moving on Forum” Escalation Process This will provide the opportunity to escalate any issues with regards to a lack of suitable accommodation for our care leavers. Increased Demand due to UASC Responsibilities UASC Practice Guidance /Welcome Booklets The new UASC policy will provide new processes to assist with providing support to Children & Young People seeking Asylum. Improved preparation and independent living skills for young people transitioning from care settings. Structured/Accredited Tenancy Skills Programme Increase capacity for independence via a tenancy skills programme. Gap in a Supported Accommodation Model that will provide an alternative to continuing care. Development of a new Supported Accommodation Service within North Ayrshire This Service will provide a bespoke alternative to continuing care for the Children & Young People of North Ayrshire. Figure 4 Housing & throughcare Workstream -Outcome Summary Table Fostering & Kinship Workstream Our aspiration is that children who require alternative care are best placed in family-based care. It is projected that North Ayrshire requires an additional thirty new interim carers over the next five years to meet the needs of children in North Ayrshire. Previous reports to the IJB 72
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NORTH AYRSHIRE Health and Social Care Partnership 19 Delivering care together have highlighted the challenges both nationally and locally in recruiting and retaining high quality foster carers to meet the needs of children in North Ayrshire. The role of the Fostering & Kinship Workstream was to understand the current pressures facing our fostering and kinship care services, and to provide strategic direction that supports the delivery of safe, stable, and nurturing care arrangements for children and young people in North Ayrshire. The Fostering Service is experiencing significant challenges in both the recruitment and retention of foster carers, with a notable decline in fostering households and an ageing carer demographic, the Fostering & Kinship Position Paper can be found Appendix7 Financial disparities between local authority and independent fostering agencies, coupled with an increasing reliance on high-cost external placements, have prompted the workstream to explore the development of a new fostering scheme. Stakeholders have also highlighted the need for improved engagement with carers and the use of digital solutions to support recruitment and retention efforts. The lack of foster carers is a contributing factor in children under twelve, being placed in internal residential care which has created capacity issues with lack of space for any new admissions and for children to return from high-cost external provision. The service has a target to recruit six new carers per year; however, this has not been achieved over the last five years. The service has seen a significant reduction in the number of enquiries from potential foster carers and is currently at the lowest number for five years. There were only 196 applications to foster in Scotland in 2023, 4.8% decrease from 2022 and lowest in 6 years, research by The Fostering Network has indicated 12 per cent of foster carers retire or leave every year and that another 500 foster families are required across Scotland. Within the foster care workstream, recruitment of foster carers was identified as a priority area that required urgent attention. Within North Ayrshire there has been a higher number deregistration than carer approvals which has resulted in a decline in fostering provision. Figure 5 Fostering & Kinship - Key Challenges Fostering & Kinship Strategic Response: In order to assist the Workstream members to understand the rationale behind why we are struggling to recruit & retain foster carers it was suggested that an engagement exercise was Key Challenges Identified: • Acute Crisis in Recruitment & Retention of Carers. • Ageing Foster Carer Demographic. • Funding Constraints within the Service. • Limited Placement Availability. • Reliance on Limited External Foster Placements. 73
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NORTH AYRSHIRE Health and Social Care Partnership 20 Delivering care together to be undertaken to ascertain the views of our existing foster carers, the full report can be found Appendix8 in taking this and the views of our workstream members the following strategic suggestions were suggested: Acute Crisis in Recruitment & Retention of Foster Carers To address the issues being faced with both recruiting new carers a review of our existing recruitment practices and online information which could be a potential barrier in recruiting new carers. It was identified that there were opportunities to both modernise and expand our reach in the type of individuals we would aspire to recruit. To address these concerns there were consultations with the Council Advertising Network who specialise in supporting public bodies with digital marketing campaigns. They have extensive experience and expertise in foster care recruitment campaigns and digital user experience. In October 2024 the Board and PSMT approved the workstream to commission the services of Council Advertising Network to assist with digital approaches to foster care recruitment, this would also include a new landing page for the service with all enquiries going through the new standalone page and not through the HSCP website: Foster With North Ayrshire Health and Social Care Partnership This proposal is in line with a spend to save strategy which would assist in the recruitment and approval of foster carers and would potentially lead to cost savings if we increased fostering resources. This would also prevent children being placed within high-cost external providers. Average annual placement costs: • Internal fostering provision £22, 640. • External fostering provision £59,799. • Internal residential provision £125,000. • External residential care £247, 219. Evidence has shown that traditional advertising from Local Authorities most often drives potential fosterer carers to internet search engines such as Google, where they will look up fostering in North Ayrshire. Invariably, this leads them straight to the independent agencies rather than our current website, and we miss out on potential carers. The digital advertising campaign employing the same techniques as the Independent Fostering Agencies could help us to counteract this problem and would put the service on an equal footing with independent providers. The programme board and PSMT have approved the funding for the Council Advertising Network to support foster care recruitment over a three-year period. This development will also provide a separate webpage for the fostering service that will improve user experience and journey, alongside targeted digital recruitment strategies that have proven to be successful, with increased recruitment activity and conversions to approved quality foster carers. The digital approaches to foster care recruitment in North Ayrshire have resulted in significant activity and increased enquiries. The last six months’ recruitment activity has led to higher number of enquiries than we have experienced in totality over the last five years, however, that said, it is too early in the process to fully analyse if enquiries will lead to the conversion of higher numbers of approved carers. 74
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NORTH AYRSHIRE Health and Social Care Partnership 21 Delivering care together The new approach to advertising and recruitment of foster carers went live in November 2024 and there have been enquiries to the service that includes interest in short break and interim foster care. The Council Advertising Network use analytics to provide data on results of the digital campaign, number of clicks on search engines, how we compare with independent fostering agencies and the location and demographic of potential carers who access the landing page are provided in quarterly reports. Recruitment Activity from January 2025 -Sept 2025 Figure 6- Fostering Recruitment Activity There are potentially three interim and one long-term, three short break carers being progressed via the preparation process and will move to assessment stage. The approach is to nurture the enquires and support people to take the next step which increases chances of more approved quality foster carers. Research suggests that it can take up to two years for potential carers to actively progress their fostering application. 122 28 13 8 7 0 20 40 60 80 100 120 140 Initial Enquiry Phone call Home visit Enquiries at Prep Group stage Enquiries at assessment stage Enquiries -January-September 75
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NORTH AYRSHIRE Health and Social Care Partnership 22 Delivering care together Figure 7- Foster Carer Enquiries Ageing Foster Carer Demographic It is acknowledged that due to the ageing demographic of current approved carers there will likely be carers who retire or are unable to continue fostering due to health-related issues. To address this there will be a tailored recruitment activity to target a younger demographic of potential foster carers (e.g. 30-50 age group) through tailored messaging that highlights flexibility, community impact, and career change opportunities etc. Ongoing digital recruitment activity to increase fostering provision and recruit a diverse range of foster carers for children in North Ayrshire. Funding Constraints within the Service Out with the uplifts associated with Scottish Recommended Allowances (SRA) which has only related to young people aged sixteen and seventeen as North Ayrshire currently pay more than the SRA for children under sixteen. There has been no increase to the fostering fee or allowance to North Ayrshire foster carers since the schemes were revised in 2010. There has been significant research and consultation with key findings that carers leave or don’t consider fostering due to inadequate financial renumeration, many carers feel the allowances and fees don’t reflect the complexity and demands of the role. The Future of Foster Care Consultation by the Scottish Government highlighted that 47% of respondents felt the current financial model for foster carers pay and allowances they receive were not effective. In addition, the cost-of-living crisis, rising household costs have made fostering financially unsustainable for some families. Revised fostering scheme with increased fee and retainer payments, will provide additional financial support to current carers and will be an incentive to attract new carers. Limited Placement Availability 76
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NORTH AYRSHIRE Health and Social Care Partnership 23 Delivering care together The Fostering Service has been under considerable pressure over recent years; the service has tried to balance available carers with demands of providing foster care to children who need alternative care out with their family. There are several factors that have led to the current challenges, foster care recruitment locally and nationally, higher number of carers leaving than the numbers of newly approved carers, high number of current carers are providing permanent or supported care which prevents them caring for any other children. Despite these challenges, the service and where at all possible have stretched existing carers which has resulted in carers being out with their approval in terms of number of children or age range. Over the course of 2025 so far, 21 carers have been out with approval. The current position is that the fostering service has limited capacity for children of any age, this has resulted in younger children being placed in internal and external residential provisions. There are also significant challenges in accessing external fostering provision as the independent agencies have a lack of available carers and are also experiencing challenges with recruitment and retention. This can only be mitigated by the recruitment and approval of newly approved interim foster carers that can provide care to children of different ages and need. The recruitment activity and revised fostering scheme will be in place to support this. The process from enquiry to approval can take nine to twelve months, so there is not a quick solution to increasing foster care provision. The service is also actively seeking to recruit foster carers who have the space and commitment to care for sibling groups, given we recognise the importance of keeping brothers and sisters together. Revised Fostering Scheme To further address the recruitment and retention issues of foster carers in North Ayrshire, work had commenced to devise a new fostering scheme which would replace the two schemes that have been in operation since 2010. There has been consultation and feedback from current approved carers on the rewards and challenges of foster care and any areas that would provide better support and prevent them considering leaving fostering. The feedback from carers will be used to inform the new fostering schemes in North Ayrshire. The Scottish Government is firmly aware of the acute crisis in recruitment and retention of foster carers throughout the country. The Future of Foster Care public consultation went live on 24th October and closed on 6th February 2025. The purpose of the consultation was to hear views on Scottish Government’s proposed vision for fostering and flexible fostering approach, which seek to meet the specific and unique needs of children and young people, respond to changes in the sector and support the delivery of The Promise. The consultation also looked to understand how they can improve the status, recognition and value given to foster carers and how they can meet the challenges in the retention and recruitment of foster carers. The consultation has also been set out to ascertain the views related to finance and non- financial matters that will impact on the current and revised fostering schemes in North Ayrshire. The Scottish Government advised of an investment and uplift to the Scottish Recommended Allowance (SRA) for foster care and kinship care, the only category who would get uplift in 77
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NORTH AYRSHIRE Health and Social Care Partnership 24 Delivering care together North Ayrshire would be for young people aged 16-17 as North Ayrshire currently pay more than the SRA for the other age groups Following the announcement of the SRA it was agreed that the work on the fostering schemes would reconvene as there was need for a revised fostering scheme with a review of the financial support which was a key area in the foster care consultation and could be a contributing factor in recruitment and retention of foster carers. The Scottish Government also funded a national Fostering Recruitment campaign, with a highly visible television, radio and online presence, with a focus on increasing local authority foster carer numbers. To date, North Ayrshire and many other local authorities has not felt the benefits of this national campaign. A Revised fostering scheme will be implemented in North Ayrshire; the new fostering scheme aims to reflect the financial challenges and risks associated with fostering and the lack of financial security for potential carers. The new scheme will have an increased fee in recognition of the complex role and a retainer payment to ensure carers have some financial support during periods they have no children in their care. The current scheme does not have a retainer payments and carers do not receive any income if they have no children placed. The new proposed scheme will also recognise carers who care for children with enhanced needs and carers who can care for children who are in residential, care will receive an enhanced payment. Renfrewshire & Inverclyde two of our neighbouring authorities have increased their fostering fees, Renfrewshire has increased to £305.00 per week per child and Inverclyde have just announced an increase to their fostering fee to £350.00 per week per child. South Ayrshire’s fee is slightly less than North Ayrshire at £197 per week and East Ayrshire Council’s fostering fee is £270.00 for one child placed, 2 children £405.00, 3+children £540.00 – sliding scale dependant on number of children you care for and not paid per child in placement. North Ayrshire is the second lowest payer than the four neighbouring authorities, East Ayrshire pay higher rate when only one child placed. The increase to fostering fees and revised fostering scheme is part of a wider strategy to support family-based care within the community. North Ayrshire HSCP (Health and Social Care Partnership) recognizes the value of foster care and is investing in existing and new foster carers. The goal is to provide more children with stable, family-based care within their local community. Foster care plays a critical role in the care system, offering vulnerable children and young people a safe, stable, and nurturing environment when their birth families are unable to care for them. North Ayrshire Council will take appropriate action to recruit and retain high quality foster carers and to ensure foster carers are renumerated appropriately for the role and given the appropriate preparation and ongoing training and support in undertaking the fostering role. The Scottish Government consultation acknowledged concerns regarding foster care recognition which is an area for proposed improvements nationally. Kinship Care There has been significant progress and increasing numbers of children in kinship care in North Ayrshire and this is being explored at an early stage with families which is supported further by the Signs of Safety approach, kinship care is the preferred and first option for children who require alternative care which aligns to the HSCP Kinship Care Strategy and the ethos of The 78
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NORTH AYRSHIRE Health and Social Care Partnership 25 Delivering care together Promise. Kinship options are being explored and are continually considered throughout a child/young person’s care journey and before a permanence plan is agreed. The allowances for young people over eighteen in kinship under continuing care was aligned with the amount foster carers receive for young people in continuing care. This was to reflect that the SRA did not apply to young people in continuing care, this was up to individual local authority to agree this allowance to carers. The decision to align the payment with foster carers was agreed at PSMT. Fostering & Kinship – Outcomes Summary Identified Issue: Strategic Response: Rationale: Acute Crisis in Recruitment & Retention of Carers Launch a targeted recruitment and retention campaign, underpinned by improved support, recognition, and flexible models of care. The current crisis is undermining placement stability and increasing reliance on costly alternatives. A bold, well- resourced campaign is essential to rebuild capacity and restore confidence in the system. Ageing Foster Carer Demographic Introduce a generational renewal strategy, including outreach to younger carers, working families, and underrepresented groups. Without generational renewal, the fostering workforce will continue to shrink. A proactive approach is needed to future-proof the service. Funding Constraints within the Service Rebalance investment through a ‘spend to save’ model — prioritising local capacity, early intervention, and carer support. Current funding is reactive and inefficient. Strategic investment can reduce long-term costs, improve outcomes, and reduce reliance on external placements. Limited Placement Availability Expand internal fostering and residential provision, including emergency and specialist placements. Placement shortages lead to poor matching, instability, and increased use of external providers. Expanding local options improves outcomes and system control. Reliance on External Foster Placements/Residential care for young children Strengthen internal capacity through carer support, improved matching, and retention strategies. External placements are costly and often less integrated with local services. Building internal capacity enhances quality, continuity, and financial sustainability. Figure 8- Fostering & Kinship - Outcomes Summary 79
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NORTH AYRSHIRE Health and Social Care Partnership 26 Delivering care together Education Including Residential Placements Workstream Figure 9- Education Including Residential Placements - Key Challenges Education including Residential Placements- Strategic Response: The Workstream position paper, please see Appendix9, outlines the current context and emerging themes within the Education Including Residential Placements workstream. It reflects collaborative efforts between Education and HSCP colleagues to better understand the financial, operational, and strategic considerations associated with supporting children and young people (CYP) with complex needs. The paper highlights the need for greater clarity around funding arrangements, improved joint decision-making, early and preventive strategies and enhanced local capacity. Need for Formal Funding Agreements While current funding arrangements are generally understood in practice, there is no formal written agreement in place. This can lead to inconsistencies, particularly in more complex or time-sensitive cases. A formalised Standard Operating procedure (SOP) would help to ensure transparency and shared understanding across services. Strategic Proposal: Develop a clear SOP between HSCP and Education to support consistent and equitable decision-making. Increasing Complexity of Needs There has been a noticeable rise in the number of Children and Young People presenting with social, emotional, behavioural, and communication needs. Despite significant investment in local provision, some needs are such that external placements are required. This reflects both the increasing complexity of individual cases and the limitations of current in-house capacity. Consideration: Continued investment in local supports, alongside flexible and responsive planning, will be key to meeting these evolving needs. Key Challenges Identified: • Need for formal Funding Agreements. • Increasing Complexity of Needs/strengthening support to care experienced learners • Budget Pressures & Reliance on External Placements. • Improved processes and Joint Decision Making between Services. • Limited Local Placement Capacity. • Monitoring & Oversight of Placements. 80
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NORTH AYRSHIRE Health and Social Care Partnership 27 Delivering care together Budget Pressures & Reliance on External Placements Budget reductions over recent years, combined with rising placement costs, have placed pressure on both Education and HSCP budgets. While the aspiration has been to reduce reliance on external placements, demand has remained high. This has implications not only for cost but also for continuity and quality of care and education. Reflection: A more sustainable approach may where possible, involve rebalancing investment towards local provision and early intervention. Lack of Joint Decision-Making Between Services Although joint working has improved, particularly through the Care Experienced Forum, there remain opportunities to strengthen collaboration. In some cases, decisions must be made quickly, which can limit the scope for shared planning and assessment. Opportunity: Further development of the Care Experienced forum and the further development of shared processes could support more robust and timely decision-making. Post-16 Funding Responsibilities Current arrangements place full funding responsibility with HSCP for young people over 16, based on assumptions about education engagement. However, this does not always reflect the lived experience of young people, particularly those with additional needs who may continue in education or training. Recommendation: Consider a more flexible funding model that reflects actual educational engagement and supports smoother transitions. Limited Local Placement Capacity Local residential capacity is limited, and current models do not always align with regulatory preferences or the needs of Children and Young People. This has led to increased use of external placements, which may not always offer the best match or value for money. Strategic Aim: Explore opportunities to expand and diversify local provision, including smaller- scale residential models and enhanced specialist education supports. Monitoring & Oversight of Placements At present, there is limited capacity within Education to consistently monitor the quality and outcomes of external placements. While information is shared between services, the approach can vary, and there is scope to develop a more structured and consistent framework for oversight. Suggested Action: Consider strengthening monitoring arrangements through dedicated roles and clearer expectations around data sharing and provider engagement, to support continuous improvement and ensure placements remain responsive to the needs of care experienced children and young people. Education Including Residential Placements – Outcomes Summary Identified Issue: Strategic Response: Rationale: Need for Formal Funding Arrangements. • A Standard Operating Procedure should be developed to provide clarity and consistency. A formal agreement will help ensure shared understanding and transparency between 81
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NORTH AYRSHIRE Health and Social Care Partnership 28 Delivering care together services, supporting more consistent and equitable funding decisions. Increasing Complexity of Needs. • Continue to invest in local support services, including enhanced nurture resources and outreach services • Strengthen early intervention efforts to help children remain within their families and local schools. • Use options appraisals to ensure all local alternatives are considered before external placements are pursued. • Introduction of Virtual Head Teacher Post. As the needs of children and young people become more complex, strengthening local provision and intervening early can help reduce the need for more intensive support and improve long-term outcomes. Education is investing in outreach services to ensure early and preventative strategies to reduce external day placements and care and education resources. The role of Virtual School Head Teacher (VSHT) is a strategic position focused on improving the educational outcomes of care experienced learners. Budget Pressures & Reliance on External Placements. • Revisit funding models to ensure they reflect current needs and pressures. • Explore opportunities to expand local residential provision, including smaller-scale children’s houses. • Enhance support for foster and kinship carers to reduce the need for residential placements. Reducing the use of external placements can help manage financial pressures while also supporting children to remain closer to their communities and familiar networks. Improved joint processes for Decision Making Between Services. • Strengthen the role of the Care Experienced Forum to support joint discussions and planning. • Develop clearer criteria for forum discussions and improve documentation and information flow. • Adopt shared frameworks such as Signs of Safety/options appraisal framework to support collaborative working. Improved joint working helps ensure decisions are well-informed, timely, and focused on the best interests of the child, while also promoting shared responsibility across services. Position relating for Post -16 Funding Responsibilities. • Clarify funding responsibilities, with Education supporting placements until the end of the academic year and HSCP funding college or bespoke packages. • Ensure planning reflects the Continuing Care legislation, which allows young people to remain in care settings until age 21. Clear guidance on funding responsibilities helps avoid confusion and ensures young people receive consistent and appropriate support as they transition into adulthood. Limited Local Placement Capacity. • Increase local capacity, to reduce external dependency Expanding local provision supports 82
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NORTH AYRSHIRE Health and Social Care Partnership 29 Delivering care together and improve outcomes for children and young people. children to remain within their communities, reduces disruption, and helps ensure placements are better matched to individual needs. Figure 10- Education Including Residential Placements- Outcomes Summary Internal Children’s Houses- Model of Care Workstream This workstream examined the pressures facing our internal residential provision, particularly around over-occupancy, emergency admissions, staffing, and placement matching. The findings reflect a system under strain, with increasing complexity of need and limited flexibility to respond effectively. Figure 11-Internal Children’s Houses- Model of Care Workstream- Key Challenges Internal Children’s Houses – Model of Care - Strategic Response: The Workstream position paper Insert Position Paper Appendix10 outlines the current context and emerging themes within the Children’s Houses Workstream. The Position paper acknowledges that over-occupancy and emergency admissions have become a consistent feature across the Children’s Houses, often impacting the ability to follow planned matching processes. To address this, the strategic direction includes: • Exploring the development of smaller, four-bedded houses in line with Care Inspectorate guidance. • Strengthening admissions procedures to support more considered placements. • Recognising the importance of creating environments that promote stability and wellbeing for young people. Over Occupancy & Emergency Admissions Key Challenges Identified: • Over Occupancy & Emergency Admissions. • Staffing Pressures Due to High Absence Levels. • Placement of Children Under the Age of Twelve. • Lack of Matching & Planned Transitions. • Care Inspectorate Feedback & Quality Standards. • Changing Demographics & Complexity of Needs. • Continuing Care Legislation. • Fostering Capacity. 83
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NORTH AYRSHIRE Health and Social Care Partnership 30 Delivering care together Strategic Response: • Reinforce planned admissions and matching protocols. • Explore increasing capacity by developing a supported accommodation service, in addition the workstream recommends exploring the development of smaller, four- bedded houses aligned with Care Inspectorate guidance should funding become available. • Continue to promote and explore alternative options such as supported carer options, family networks and independent living. • The HSCP has a statutory responsibility to provide emergency care to children who are in need of care and protection. To support improved matching and preplacement considerations an increase in fostering provision and capacity in internal residential houses is required. Rationale: Planned admissions and appropriate matching help ensure placements are stable and well- suited to the needs of the young person and the wider group. Increasing capacity in line with best practice supports a more nurturing and manageable environment, reducing the risk of re-traumatisation and improving inspection outcomes. Staffing Pressures Due to High Absence Strategic Response: • Review staffing levels to ensure they reflect the complexity and number of children. • Collaborate with staff to explore ways to improve wellbeing and reduce absence. Rationale: Ensuring staffing levels are appropriate helps maintain quality of care and supports staff wellbeing. Engaging with staff to identify solutions promotes a positive and sustainable working environment, reducing burnout and improving consistency of care. Placement of Children Under the Age of Twelve Strategic Response: • Continue efforts to recruit foster carers. • Consider in the future developing smaller homes suitable for younger children and sibling groups. Rationale: Younger children benefit from family-based care where possible. Expanding fostering options and smaller residential settings helps ensure placements are developmentally appropriate and supportive, in line with national policy and best practice. Lack of Matching & Planned Transitions Strategic Response: • Reinforce the importance of matching and planned transitions which can prevent disruptions. 84
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NORTH AYRSHIRE Health and Social Care Partnership 31 Delivering care together • Ensure staff have the time and resources to support thoughtful admissions. • Look to increase capacity and options for placements. Rationale: Careful planning and matching help reduce placement breakdowns and support better outcomes for children and young people. Providing staff with the right tools and time is key to achieving this and aligns with Care Inspectorate expectations for safe and nurturing care environments. Care Inspectorate Feedback & Quality Standards Strategic Response: • Address inspection concerns by improving admissions processes and ensuring environments meet the quality indicators set out by the Care Inspectorate Rationale: Responding to inspection feedback helps ensure services meet national standards and provide safe, nurturing environments for children and young people. This also supports the delivery of trauma-informed care and strengthens leadership and governance. Changing Demographics & Complexity of Needs Strategic Response: • Adapt services to meet the needs of a more diverse and complex group of young people. Rationale: As the needs of young people evolve, services must remain flexible and responsive to ensure support is appropriate and effective. This includes recognising neurodiversity, trauma, cultural backgrounds, and health needs within the residential population. Continuing Care Legislation Strategic Response: • Support young people to remain in care settings and provide them with the support and skills to transition to independent living or supported care. • Develop supported accommodation options to aid transition to independence. Rationale: Continuing Care provides young people with stability and support as they move towards adulthood. Supported accommodation helps bridge the gap between care and independent living, promoting positive outcomes and reducing pressure on residential placements. Fostering Capacity Strategic Response: • Continue to invest in foster care recruitment and retention to reduce reliance on residential care. 85
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NORTH AYRSHIRE Health and Social Care Partnership 32 Delivering care together Rationale: A strong fostering service offers children the opportunity to grow up in family settings, reducing the need for residential placements and supporting better long-term outcomes. This is particularly critical for younger children and sibling groups. Internal Children’s Houses -Model of Care- Outputs Summary: Identified Issue: Strategic Response: Rationale: Over Occupancy & Emergency Admissions. • Reinforce planned admissions and matching protocols. • Explore increasing capacity through smaller, four-bedded houses aligned with Care Inspectorate guidance. Planned admissions and appropriate matching help ensure placements are stable and well- suited to the needs of the young person and the wider group. Increasing capacity in line with best practice supports a more nurturing and manageable environment. Staffing Pressures Due to High Absence. • Review staffing levels to ensure they reflect the complexity and number of children. • Collaborate with staff to explore ways to improve wellbeing and reduce absence. Ensuring staffing levels are appropriate helps maintain quality of care and supports staff wellbeing. Engaging with staff to identify solutions promotes a positive and sustainable working environment. Placement of Children Under the Age of Twelve. • Continue efforts to recruit foster carers. • Consider in the future developing smaller homes suitable for younger children and sibling groups. Younger children benefit from family-based care where possible. Expanding fostering options and smaller residential settings helps ensure placements are developmentally appropriate and supportive. Lack of Matching & Planned Transitions. • Reinforce the importance of matching and planned transitions. • Ensure staff have the time and resources to support thoughtful admissions. • Look to increase capacity & options for placements. Careful planning and matching help reduce placement breakdowns and support better outcomes for children and young people. Providing staff with the right tools and time is key to achieving this. Care Inspectorate Feedback & Quality Standards. • Address inspection concerns by improving admissions processes and ensuring environments meet quality indicators 7.1 and 7.2. Responding to inspection feedback helps ensure services meet national standards and provide safe, nurturing environments for children and young people. Changing Demographics & Complexity of Needs. • Adapt services to meet the needs of a more diverse and complex group of young people. As the needs of young people evolve, services must remain flexible and responsive to ensure 86
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NORTH AYRSHIRE Health and Social Care Partnership 33 Delivering care together support is appropriate and effective. Continuing Care Legislation. • Support young people to remain in care settings until they are ready to move on. • Develop supported accommodation options to aid transition to independence. Continuing Care provides young people with stability and support as they move towards adulthood. Supported accommodation helps bridge the gap between care and independent living. Fostering Capacity. • Continue to invest in foster care recruitment and retention to reduce reliance on residential care. A strong fostering service offers children the opportunity to grow up in family settings, reducing the need for residential placements and supporting better long-term outcomes. Figure 12-Internal Children’s Houses -Model of Care- Outputs Summary Early Intervention and Intensive Support Pathways Workstream Figure 13-Early/ Intensive Support Pathways Workstream- Key Challenges Early Intervention/Intensive Support Pathways –Strategic Response: The workstream brought together colleagues from across health, social care, education, and the third sector, each offering valuable perspectives on the current landscape. Through a series of focused discussions and collaborative analysis, the group developed a position paper Appendix11 that highlighted areas where improvement is both necessary and achievable, particularly in relation to service accessibility, coordination, workforce sustainability, and equity of provision. The following sections outline the key issues identified by the group, alongside proposed strategic responses and the rationale underpinning each. This work is intended to inform local Key Challenges Identified: • Limited Availability of Intensive Support. • Awareness & Accessibility of Early intervention Services. • Gaps in out of Hours Support. • Reliance on Short-Term Funding. • Co-Ordination of Early Intervention Planning. • Barriers/Criteria for Accessing Support. • Workforce Pressures & Sustainability. • Rural & Island Access to Supports. 87
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NORTH AYRSHIRE Health and Social Care Partnership 34 Delivering care together planning, support continuous improvement, and ensure that children, young people, and families receive the right support at the right time, wherever they live. Limited Availability of Intensive Support There remains a disparity between the availability of early intervention and intensive support services. Many intensive supports are not accessible during evenings or weekends, which limits responsiveness at times of greatest need. Strategic Response: • Review and strengthen the structure and accessibility of intensive support provision. • Draw on learning from established intensive support models such as REACH (Perth & Kinross) and GIFSS (Glasgow Intensive Family Support Service) to inform future development. • Explore the development of a flexible, dedicated Service to provide support across the full week, including evenings and weekends. Rationale: Strengthening intensive support ensures families can access the right help at the right time. Learning from established models and offering flexible support can help prevent escalation and promote stability. Awareness and Accessibility of Early Intervention Services There is a lack of consistent awareness among professionals and families regarding the range of services available. This can lead to missed opportunities for early help or duplication of support. Strategic Response: • Improve visibility and communication of services through updated directories and digital tools. • Develop a central, accessible resource to help families and staff navigate available supports. • Strengthen collaboration and information sharing across sectors. Rationale: Improving awareness and accessibility helps ensure families and professionals can make informed choices and access support early, reducing the need for more intensive interventions later on. Gaps in Out-of-Hours Support Many services operate within standard working hours, which may not align with when families most need support. Strategic Response: • Review current working patterns and explore more flexible arrangements where appropriate. • Build on existing good practice, such as Rosemount’s weekend planning, to extend support availability. 88
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NORTH AYRSHIRE Health and Social Care Partnership 35 Delivering care together Rationale: Families often need support outside of standard hours. Extending availability helps ensure services are responsive and able to meet needs when they arise. In order to achieve this the Board authorised a standalone review of our Intensive Suport Services, this findings of this are due to be published in September 2025. Reliance on Short-Term Funding A number of valued services are currently funded on a short-term basis, creating uncertainty and limiting the ability to plan for the longer term. Strategic Response: • Identify ways to secure longer-term funding for key services. • Emphasise the value of early intervention in reducing future demand on crisis services. Rationale: Securing sustainable funding helps maintain continuity of support and allows services to plan and develop with confidence. Coordination of Early Intervention Planning While early intervention services are well represented, there is scope to improve coordination and integration, particularly with third sector partners. Strategic Response: • Establish a partner engagement group under the GIRFEC strategic group to support joined-up planning. • Ensure third sector partners are included in assessment and planning processes. Rationale: Better coordination supports more consistent and effective planning, ensuring that all partners are working together to meet the needs of children and families. Barriers to Accessing Support Referral processes and eligibility criteria can be complex and may feel inaccessible for some families. Self-referral options are limited. Strategic Response: • Review referral pathways and explore the potential for self-referral. • Consider more supportive introductions to services to help families feel confident in engaging. Rationale: Making access to support more straightforward and welcoming helps reduce stigma and encourages earlier engagement, which can lead to better outcomes. Workforce Pressures and Sustainability Staff often go above and beyond their contracted hours, which can impact wellbeing and the long-term sustainability of services. Strategic Response: 89
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NORTH AYRSHIRE Health and Social Care Partnership 36 Delivering care together • Recognise and support staff wellbeing through workforce planning and flexible resourcing. • Explore how to better support those delivering intensive interventions. Rationale: Supporting the workforce is essential to sustaining high-quality services. A well-supported team is better equipped to meet the needs of families and young people. Rural and Island Access to Supports Families in areas such as Arran and Millport may face additional barriers due to geography and limited local provision. Strategic Response: • Explore creative, localised solutions to ensure families in rural areas can access timely support. • Consider outreach or digital models to bridge the gap. Rationale: Families in rural and island communities may face additional barriers. Tailored, flexible approaches help ensure equity of access regardless of location. Early Intervention and Crisis/Intensive Support Pathways - Outputs Summary: Identified Issue: Strategic Response: Rationale: Limited Availability of Intensive Support. • Explore opportunities to review and strengthen intensive support provision, including how services are structured and accessed. • Consider learning from other models (e.g. REACH, GIFSS) to inform future development. • Look at how a flexible, dedicated team could offer support across the week, including evenings and weekends. Strengthening intensive support ensures families can access the right help at the right time. Learning from established models and offering flexible support can help prevent escalation and promote stability. Awareness & Accessibility of Early intervention Services. • Improve visibility and communication of services through updated directories and digital tools. • Develop a central, accessible resource for families and staff to navigate available supports. • Strengthen collaboration and information sharing across sectors. Improving awareness and accessibility helps ensure families and professionals can make informed choices and access support early, reducing the need for more intensive interventions later on. Gaps in out of Hours Support. • Review current working patterns and explore more flexible arrangements where appropriate. • Build on existing good practice, such as Rosemount’s weekend planning, to extend support availability. Families often need support outside of standard hours. Extending availability helps ensure services are responsive and able to meet needs when they arise. Reliance on Short-Term Funding. • Identify ways to secure longer- term funding for key services. Securing sustainable funding helps maintain continuity of support and 90
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NORTH AYRSHIRE Health and Social Care Partnership 37 Delivering care together • Emphasise the value of early intervention in reducing future demand on crisis services. allows services to plan and develop with confidence. Co-Ordination of Early Intervention Planning. • Establish a partner engagement group under the GIRFEC strategic group to support joined-up planning. • Ensure third sector partners are included in assessment and planning processes. Better coordination supports more consistent and effective planning, ensuring that all partners are working together to meet the needs of children and families. Barriers/Criteria for Accessing Support. • Review referral pathways and explore the potential for self- referral. • Consider more supportive introductions to services to help families feel confident in engaging. Making access to support more straightforward and welcoming helps reduce stigma and encourages earlier engagement, which can lead to better outcomes. Workforce Pressures & Sustainability. • Recognise and support staff wellbeing through workforce planning and flexible resourcing. • Explore how to better support those delivering intensive interventions. Supporting the workforce is essential to sustaining high-quality services. A well- supported team is better equipped to meet the needs of families and young people. Rural & Island Access to Supports. • Explore creative, localised solutions to ensure families in rural areas can access timely support. • Consider outreach or digital models to bridge the gap. Families in rural and island communities may face additional barriers. Tailored, flexible approaches help ensure equity of access regardless of location. Best Practice Models and Research Workstream The workstream focused on how best to support foster carers, kinship carers, and internal residential staff to care for children and young people with complex needs. The aim was to sustain placements, improve outcomes, and reduce reliance on high-cost external provision. 91
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NORTH AYRSHIRE Health and Social Care Partnership 38 Delivering care together Figure 14-Best Practice Models and Research Workstream- Key Challenges Best Practice Models & Research- Strategic Response: The Workstream Position Paper, see Appendix12 outlines strategic responses to the key challenges identified across children’s services in North Ayrshire. Each issue is addressed with a targeted response and a rationale grounded in best practice and national policy alignment. The workstreams focus was on how best we can support foster carers, kinship carers and internal residential houses to better support children and young people with complex needs and behaviours, with an objective of sustaining their placement, and provide better outcomes and prevent escalation to external high-cost resource. Services within North Ayrshire utilise a plethora of models, frameworks and approaches to support care experienced children and young people which are consistent with trauma informed and therapeutic parenting approaches, these models are widely used across the country. It was accepted that there is no “off the shelf approach” or need to “reinvent the wheel” which would offer a solution to this highly complex area of practice. The care experienced population has specific needs and risks that need dedicated time and expertise, furthermore, the over occupancy in residential care and foster care out with approvals combined with the level of need and complexity in caring for multiple children are all factors in care staff and foster carers requiring time and space to offer the nurturing care and therapeutic interventions our children deserve and require. Due to the capacity issues that have been highlighted, this has been difficult to achieve. One of the early identified gaps is the regular and consistent support for case discussions when problems for a particular child is more complex and/or supports that have been put in place are no longer sufficient. This might also include considering the impact on the overall home environment and distress that might be seen in the overall group of children and staff. Making sense of the changing situation, formulating the problem and considering how to Key Challenges Identified: • Complexity and Interconnectedness of Services. • Limited Data Usage to Inform Planning. • Staff Wellbeing and Support. • Placement Stability and Matching. • Recruitment and Retention of Foster Carers. • Over-occupancy in Residential Houses. • Communication & Co-ordination Gaps • Embedding Trauma-Informed and Therapeutic Practice. • Supporting Transitions for Young People. 92
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NORTH AYRSHIRE Health and Social Care Partnership 39 Delivering care together best respond will be important to prevent escalation and potential breakdown of placements. A proposed pilot for a Care Experienced Young Person’s Team (CEYP) to support Children’s Houses. The pilot will give the opportunity for further assessment of training and supports needs for staff and inform future service development. The CEYP consultation team will aim to: • Give opportunity for regular ongoing support with complex case and systemic issues. • Build supportive relationships with the staff to create a safe environment for more in- dept assessment of staff needs. • To seek opportunities for joined learning and training. Making a commitment to the teams for a link with one psychologist over a period of time is going to be essential to build the safety and strength of relationships, which will increase the chance of a positive outcome of this pilot. If we are asking staff to provide an emotionally safe home environment with consistent care, we should provide the staff emotionally safe and consistent support. Complexity and Interconnectedness of Services Strategic Response: • Encourage collaborative approaches across services to sustain and support care experienced children and young people. • Recognise that meaningful change may require time and coordinated effort. Rationale: The care system is made up of many interlinked services. Working together in a coordinated way ensures consistent and effective support. Acknowledging complexity allows for realistic planning and shared responsibility. Limited Data Usage to Inform Planning Strategic Response: • Improve data collection and analysis to inform service development. • Make data a standing item in management meetings at all levels. Rationale: Effective use of data supports evidence-based planning, helping services understand what works and where improvements are needed. Staff Wellbeing and Support Strategic Response: • Provide regular opportunities for reflection, consultation, and training. • Recognise and respond to the emotional demands of care work. • Pilot of Supports to be implemented by Psychological Services Appendix13 Rationale: Supporting staff wellbeing builds a resilient workforce, essential for delivering high- quality care to children and young people. Placement Stability and Matching 93
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NORTH AYRSHIRE Health and Social Care Partnership 40 Delivering care together Strategic Response: • Reinforce the use of matching protocols and plan transitions carefully. • Consider the impact of decisions on the wider group and home environment. Rationale: Careful matching and planning lead to more stable placements, reducing disruption and improving outcomes for all involved. Recruitment and Retention of Foster Carers Strategic Response: • Continue to invest in recruitment and support for foster carers. • Promote therapeutic approaches and training to build resilience. Rationale: A strong fostering service ensures children grow up in family settings. Supporting carers helps them feel confident and valued. Over-occupancy in Residential Houses Strategic Response: • Explore increasing capacity across the estate. • Use matching processes to support appropriate placements and reduce pressure. Rationale: Reducing over-occupancy ensures children receive care in a safe, nurturing environment with the attention they need. Communication and Coordination Gaps Strategic Response: • Develop a multi-disciplinary consultation forum to support transitions and complex cases. • Strengthen communication pathways across services. Rationale: Improved communication ensures all professionals are aligned, particularly during transitions or when needs change, reducing fragmentation and delays. Unclear Accountability Across Services Strategic Response: • Clarify accountability structures to support confident and timely responses. • Promote shared ownership of outcomes across teams. Rationale: Clear roles and responsibilities reduce delays and support effective decision- making, ensuring all services work towards shared goals. Embedding Trauma-Informed and Therapeutic Practice Strategic Response: • Support staff with time, training, and leadership to embed these approaches. 94
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NORTH AYRSHIRE Health and Social Care Partnership 41 Delivering care together • Ensure consistent and planned implementation across services. Rationale: Trauma-informed practice enables staff to respond sensitively to children’s needs, promoting healing and better outcomes. Supporting Transitions for Young People Strategic Response: • Plan transitions carefully and involve the right professionals. • Use reflective processes for disrupted placements to support learning. Rationale: Well-planned transitions reduce stress and uncertainty, supporting continuity and stability in care. Best Practice Models and Research – Outputs Summary: Identified Issue: Strategic Response: Rationale: • Complexity and Interconnectedness of Services. • Encourage collaborative approaches across services. • Recognise that meaningful change may require time and coordinated effort. The care system is made up of many interlinked services, and working together in a coordinated way helps ensure that support is consistent and effective. Acknowledging the complexity allows for more realistic planning and shared responsibility. • Limited Data Usage to Inform Planning. • Improve data collection and analysis to inform service development and strategic planning. • Make Data part of Management Meetings at all levels. • Reflections and learning when placements disrupt. Using data effectively helps services understand what is working well and where improvements are needed, supporting evidence-based planning and decision- making. • Staff Wellbeing and Support. • Provide regular opportunities for reflection, consultation, and training. • Recognise and respond to the emotional demands of care work. • Pilot of Supports to be implemented by Psychological Services. Supporting staff wellbeing helps maintain a stable and resilient workforce, which is essential for delivering high-quality care and support to children and young people. • Placement Stability and Matching. • Reinforce the use of matching protocols and plan transitions carefully. • Consider the impact of decisions on the wider group and home environment. Careful matching and planning help ensure placements are more stable and better suited to the needs of the young person and the wider group, reducing the risk of disruption. • Recruitment and Retention of Foster Carers. • Continue to invest in recruitment and support for foster carers. • Promote therapeutic approaches and training to build resilience. A strong fostering service helps ensure children can grow up in family settings. Supporting carers with training and development helps them feel confident and valued in their role. 95
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NORTH AYRSHIRE Health and Social Care Partnership 42 Delivering care together • Over-occupancy in Residential Houses. • Explore increasing capacity across the estate. • Use matching processes to support appropriate placements and reduce pressure. Reducing over- occupancy helps ensure that children and young people receive the care and attention they need in a safe and nurturing environment. • Communication and Coordination Gaps. • Consider developing a multi- disciplinary consultation team to support transitions and complex cases. • Strengthen communication pathways across services. Improving communication and coordination helps ensure that everyone involved is well-informed and aligned, particularly during transitions or when needs change. • Embedding Trauma-Informed and Therapeutic Practice. • Support staff with time, training, and leadership to embed these approaches. • Ensure consistent and planned implementation across services. Embedding trauma- informed practice helps staff respond to children’s needs in a sensitive and supportive way, improving outcomes and promoting healing. • Supporting Transitions for Young People. • Plan transitions carefully and involve the right professionals. • Consider reflective processes for disrupted placements to support learning and improvement. Well-planned transitions help reduce stress and uncertainty for young people and staff, supporting continuity and stability in care. Figure 15-Best Practice Models and Research – Outputs Summary 4. Financial Modelling & Sustainability Prior Years The prior financial years have continued to face pressure with the number of external residential placements; the table below highlights not only external placements but also the position over fostering, kinship etc for the three prior financial years. Additional Information: 22/23: as a result of the pandemic; covid monies were received; expenditure totalling £1,374,186 was removed from External Residential and Fostering and realigned accordingly. 23/24: as a result of Scottish Government increasing rates for fostering and kinship; additional monies were received of £486,072; this was used to increase our 16+ rates from £400 per week to £468.41 per week in Fostering and Kinship. 96
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NORTH AYRSHIRE Health and Social Care Partnership 43 Delivering care together External Placements 24/25 23/24 22/23 21/22 20/21 No of Placements at Year End (active) 28 37 32 20 17 97
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NORTH AYRSHIRE Health and Social Care Partnership 44 Delivering care together Current Position Table below indicates early projections (Sept 25) for the noted areas: External Placements As of 30 September 2025, there are: • 34 young people in external placements (average age: 15.27 years of age) • 12 young people in external placements (CFDIS) (average age: 16.55 years of age) • 2 ongoing respite placements (provide monthly support over one weekend per month and during school holidays and ensure the foster placement in particular remains as stable as possible) In terms of the projections for the financial year 25/26: * External placements were noted as a pressure and in 24/25 temporary funds of £4m were aligned; this has been reduced by £1m in the current financial year. Therefore, had the funding not been available for these placements the overspend be significantly higher. *Please note that providers rates have yet to be confirmed for the current financial year.* Note included within the calculations below; the service has provided details of possible 8 potential movements during the current financial year. This could result in the following savings being achieved: 98
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NORTH AYRSHIRE Health and Social Care Partnership 45 Delivering care together Medium Term Planning To address the challenges facing the service, alternative approaches have been considered, aiming for efficiency and sustainability. Of the current 34 placements; a number are noted with the legal reason “permanence order/continued care. Whilst some placements also have a commitment by Education of 50%/25%. The modelling below assumes: • 8 young people within external placements are likely to move during the current financial year 25/26 • Where an external placement has a commitment by Education an estimate of when this may cease and return in full to HSCP has been noted; this has broadly been assumed August following 16th birthday. • Recognising where young person will age out system automatically • Assuming a similar number of young people throughout Kinship etc whilst recognising where appropriate weekly rates change due to age • Assuming recruitment of new foster carers and an uplift in weekly rates • Reflecting the new supported accommodation model 99
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NORTH AYRSHIRE Health and Social Care Partnership 46 Delivering care together The service will continue to face challenges such as: • the capacity within children houses (over capacity currently) • recruitment/retention of carers • Uncertainty around current and future uplifts to providers rates • Risk of new external placements and/or breakdown of current placement; issues surrounding legal orders. Fostering The service has highlighted the pressures on the service along with the opportunity to review current payment rates to not only retain current carers but attract new. In terms of recruiting more carers, which is noted within this report via the CAN recruitment programme; the Current Year 1 Year 2 Year 3 Year 4 Year 5 2025/26 2026/27 2027/28 2028/29 2029/30 2030/31 Kinship Placements 326 326 326 326 326 326 Change 0 0 0 0 0 Financial Projected Cost £2,871,271 £2,804,568 £2,898,179 £3,131,225 £3,048,585 £3,120,965 Fostering Placements 135 138 141 144 147 150 Change 3 3 3 3 3 Financial Projected Cost £3,118,565 £3,478,008 £3,521,623 £3,548,352 £3,581,970 £3,624,251 Internal Residential Placements 35 32 32 32 32 32 Change -3 0 0 0 0 Financial Projected Cost £4,545,847 £4,378,810 £4,378,810 £4,378,810 £4,378,810 £4,378,810 External Residential Placements 34 25 22 15 9 7 Change -9 -3 -7 -6 -2 Financial Projected Cost £8,442,349 £6,706,621 £5,584,857 £2,990,130 £2,293,752 £1,208,142 Step Down - Boyle Street Placements 0 6 6 6 6 6 Change 6 0 0 0 0 Financial Projected Cost £0 £440,000 £440,000 £440,000 £440,000 £440,000 Other CE Projected Costs £1,866,568 £1,888,613 £1,905,034 £1,913,971 £1,918,264 £1,914,879 Adoption £407,862 £384,732 £398,909 £408,087 £414,383 £410,998 Private Fostering £771,821 £819,215 £821,459 £821,218 £819,215 £819,215 Continued Care £161,614 £225,000 £225,000 £225,000 £225,000 £225,000 Supported Accomodation £15,160 £50,000 £50,000 £50,000 £50,000 £50,000 Short Breaks £153,350 £154,666 £154,666 £154,666 £154,666 £154,666 Fostering Respite £219,070 £180,000 £180,000 £180,000 £180,000 £180,000 External Residential Respite £137,691 £75,000 £75,000 £75,000 £75,000 £75,000 Baseline Budget £18,911,307 Financial Cost £20,844,600 £19,696,620 £18,728,504 £16,402,488 £15,661,381 £14,687,047 Cost Reduction -£1,147,980 -£968,116 -£2,326,016 -£741,107 -£974,334 NET (OVERSPEND) / UNDERSPEND -£1,933,293 -£785,313 £182,803 £2,508,819 £3,249,926 £4,224,260 Impact/Forecasts 100
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NORTH AYRSHIRE Health and Social Care Partnership 47 Delivering care together service it is highly likely that any new carer would be helping to reduce the overcapacity across those currently in situ. Current Carers (all foster carers who have received payment in 25/26): Current Rates Effective from Apr 25: 16+ weekly increase by £4.56 per week a rise of 0.97% Rates are also applicable for fostering respite. The options are: Option 1: increase all fostering first by £50 per week Option 2: increase all fostering first by £100 per week Option 3: remain at current rates for all and provide additional weekly allowance as follows: 1wk x birthday; 1wk x Christmas and 2wks x summer Age Profile (Carer) Total 31-40 1 41-50 10 51-60 40 60+ 24 Total 75 Payment Type Weekly Rate Fostering First <16yo £400.00 Fostering First =>16yo £472.97 Fostering Xtra <16yo £550.00 Fostering Xtra =>16yo £622.97 101
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NORTH AYRSHIRE Health and Social Care Partnership 48 Delivering care together * Calculations are based on data as of 29 July 2025; for reference additional costs noted below: • Option 1 - £270k cost - if Foster Carers receive an additional £50 per week; resulting in overspend based on the current budget of £96k. • Option 2 - £541k cost - if carers receive an additional £100 per week; resulting in overspend based on the current budget of £367k. • Option 3 - £291k cost – if carers received an additional payment (at current rates) for birthday x 1wk, summer x 2wks and Xmas x 1wk; resulting in an overspend on current budget of £116k. o This could be lower if the additional payment was on only part of the payment. In addition to these options the assumption would be the rates would be increased for fostering respite, which at present is being used consistently and is currently projecting overspends. This can vary throughout the year dependant on need etc. A decision would need to be taken whether this was suitable. Either option would see the current overspend increasing. Kinship Expenditure incurred over the past three years has been reviewed to determine based on those placements and commencement within that particular year what a further payment of 6wks or 12wks would cost. It should be noted that an assessment is carried out to determine and if any deduction is required to the flat rate (tidy this up wording). With the Option 1 Budget Cost Fostering First 2,389,765 2,461,617 Fostering Xtra 931,034 955,141 Total 3,320,799 3,416,758 Variance 95,959 Overspend Option 2 Budget Cost Fostering First 2,389,765 2,732,310 Fostering Xtra 931,034 955,141 Total 3,320,799 3,687,451 Variance 366,652 Overspend Option 3 Budget Cost Fostering First 2,389,765 2,395,151 Fostering Xtra 931,034 1,041,660 Total 3,320,799 3,436,811 Variance 116,012 Overspend 102
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NORTH AYRSHIRE Health and Social Care Partnership 49 Delivering care together change in universal credit, we are starting to see that this assessment is resulting in a higher rate being paid. Additionally, effective from Apr 2025 we have implemented a new weekly rate of £250 for 18+ service users. Supported Accommodation Model One consideration is to review the development of a Supported Accommodation resource that will support 6 young people leaving care. Analysis has been done on this, and the favorable outcome would be to outsource. Below are the details and assumptions made. Based on information provided by external providers a staff structure was provided to which we have costed if we were to operate internally. Assuming implementation from April 2026 and the associated costs for building costs (requisites/food: based on average expenditure incurred across the four children’s houses in 24/25) and the average cost of an external placement at June 2025 being £247,737, per annum, there would need to be a reduction of three external placements per year in order to cover the operating costs of a supported model provision. Dependent upon single or double cover arrangements cost analysis; details of which are below; at present Option 1 is what has been recommended via the Supported Accommodation Business Case: 24/25 23/24 Additional 6wks at an estimated cost of 83,073.19£ 83,588.71£ Additional 12wks at an estimated cost of 92,190.46£ 97,716.37£ £ If NAC were to implement the structure - Staff Costs £412,971 Building Costs £140,000 Requisties £25,400 Food £28,500 Total Cost £606,871 Average Cost Per Placement £101,145.17 Average Cost Per External Placement 248,304.40£ Estimated Saving -£147,159.23 If NAC were to progress - placements to be brought back 3 103
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NORTH AYRSHIRE Health and Social Care Partnership 50 Delivering care together To some degree the external placements will continue to be a pressure point on the service given the children’s houses are over capacity; there is an expectation that in conjunction with a review of these placements and where viable those particular young people may be aligned to this accommodation whilst possibly allowing for an external placement to be brought back to a children’s house. 5. Strategic Recommendations & Implementation This section will detail both the strategic actions that has been implemented, and the larger future developments that will be implemented in the coming months Implemented Service Improvements: The following Strategic Actions have already been implemented during the lifespan of the Brighter Pathways Programme of works: Strategic Improvement Date Completed Revised Supported Care Scheme to enhance support for young people aged 16 and over. June 2025 Development of Practice Guidance and Welcome Booklets for Unaccompanied Asylum-Seeking Children. June 2025 Establishment of a Moving on Forum and Tracker to support planning and review of transitions from care settings. June 2025 Revised Housing Protocol to ensure a co-ordinated response to the accommodation and support needs of care leavers. June 2025 Implementation of a new referral template for intensive support referrals to Rosemount for children in family-based care. June 2025 Pilot initiative with Children’s House to provide psychological consultation for children and young people. June 2025 Establish a Placement Assurance Forum to provide scrutiny across all internal and external residential resources. September 2025 104
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NORTH AYRSHIRE Health and Social Care Partnership 51 Delivering care together Area to be progressed/Action Plan The table below highlights the current Strategic Actions that the Board wish to progress over the coming months: Strategic Action Target Completion Date Increase the number of foster carers in North Ayrshire through the transformation of digital recruitment strategies. November 2026 Develop a Standard Operating Procedure between Education and HSCP to promote shared understanding and transparency across services, enabling more consistent and equitable funding decisions. November 2025 Develop a revised model to provide intensive support to families and children who are at risk of accommodation. April 2026 Develop a Supported Accommodation resource to support six young people transitioning from care. April 2026 Implement a new fostering scheme with enhanced financial support to retain existing carers and attract new applicants. April 2026 Develop a service offering psychological interventions, support, and direct work for children on the edge of care and care experienced young people. November 2025 6. Conclusion The Brighter Pathways Programme has provided a valuable opportunity to reflect on the current pressures and future direction of North Ayrshire’s care and support system for children, young people, and families. It has brought into sharp focus the increasing complexity of need, the challenges facing our workforce, and the financial pressures that continue to shape service delivery. What has emerged is a clear and shared understanding that while much good practice exists, the system as a whole is under strain. Issues such as limited placement availability, an ageing foster carer demographic, and difficulties in recruitment and retention are not new — but they are becoming more acute. At the same time, our reliance on external placements continues to grow, placing further pressure on budgets and limiting our ability to deliver care close to home. The recommendations set out in this paper are designed to support a more sustainable, responsive, and child-centred system. They reflect the views of practitioners, partners, and are grounded in evidence and best practice. While some actions can be progressed within existing resources, others will require investment, innovation, and a willingness to work differently. This is not about wholesale system change overnight. It is about taking purposeful, strategic steps to strengthen local capacity, improve outcomes, and ensure that every child and young person receives the right support, at the right time, in the right place. Brighter Pathways offers a framework for doing just that — and with the continued support of the IJB and wider partners, we can move forward with confidence and shared purpose. 105
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NORTH AYRSHIRE Health and Social Care Partnership 52 Delivering care together Appendix1-Brighter Pathways TOR Brighter Pathways Re-modelling Children's Care Options Programme Board Terms of Reference February 2024 106
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NORTH AYRSHIRE Health and Social Care Partnership 53 Delivering care together 1.Introduction & Context Looked after children and young people are amongst the most vulnerable in society. The functions of local authorities in relation to children who are ‘looked after’ by them are set out in the Children (Scotland) Act 1995 and associated regulations and guidance. The principal regulations are in Care Planning, Placement and Case Review. These functions in North Ayrshire are delegated to the IJB and undertaken through the HSCP. The Children (Scotland) Act 1995 sets out that Local Authorities have a legal duty to: • Sets out the general duty of the local authority looking after a child to safeguard and promote the welfare of the child. This duty underpins all activity by the local authority in relation to looked after children. This duty is known as ‘corporate parenting.’ ‘Corporate parenting’ means the collective responsibility of the council, elected members, employees, and partner agencies, for providing the best possible care and safeguarding for the children who are looked after by the council. • Prepare young people for leaving care or ceasing to be looked after. • Provide advice and assistance to young people who have ceased to be looked after on or after their 16th birthday. Local authorities are legally required to provide aftercare support until the care leaver turns nineteen, and to assess any eligible needs for aftercare support until they turn 26 (or beyond in some cases). • The Children and Young People (Scotland) Act 2014 strengthened the approach to throughcare and aftercare for children and young people by putting into law Section 67 of The Children and Young People (Scotland) Act 2014. Section 67 of The Act (2014) inserted a new section and from April 2015, a young person born after 1 April 1999 who is looked after in foster, kinship or residential care is eligible to remain in their current care placement until they turn twenty-one. This is called Continuing Care, Further legislation that is of key interest to this work includes the Social Work Scotland (1968) Act and in particular the legislative requirement therein to promote welfare in the local authority area. Definition of Placements: • Kinship care – When children are in the care of friends/relatives that have been assessed as being of a good standard of care. May be Looked After, or as a preventative measure to child becoming Looked After. • Supported care – When older young people wish to leave foster care or residential care, they can reside with a supported carer. This is more informal care in the carer’s own home. • Short break service – This service offers families in kinship care and those ‘looked after at home’ the opportunity of a short break and to get time away from caring responsibilities. • Respite care – This is planned care for children with disabilities to Roslin House or other bespoke providers and offers both a break to the young person and their family. • Foster care - Fostering means that the local authority arranges for you to live with foster carers in their own home. It enables you to be cared for in a family environment. • Residential care – Local authority run children’s house. 107
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NORTH AYRSHIRE Health and Social Care Partnership 54 Delivering care together • External residential placement – usually a smaller, bespoke accommodation to meet the individual needs of young people who are very traumatised. Often these placements are highly specialised and offer single placements and two-one staffing ratios. • Care and Education placements - specialised schools who provide care and education for young people, located out with North Ayrshire. At present within North Ayrshire Health and Social Care Partnership there is a significant overspend associated with Children’s Residential Placements, over £5m across the HSCP and Education. The overspend predominately relates to costly External Residential Placements. We started 2023 with 32 external placements. These placements are costly and do not always deliver the best outcomes for children, young people, and their families. Overall, the number of Looked After Children has reduced over the last few years but the numbers in residential care have not followed the same trend, and the number of requests for Continuing Care has increased significantly, at present we have 49 Children & Young People in Continuing Care, it is predicted that the number of Children receiving Continuing Care will continue to rise, resulting in older children staying longer within Residential Care settings. There are a number of factors leading to this challenging position: • We have 32 places available in our internal children’s houses, due to demand these have been operating at 100%+ occupancy for some time, leading to increased use of external placements where residential care is required. • We have limited availability of alternative care provision including Foster Carers and other supported carer options in North Ayrshire. • 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. We currently have 28 YP living within North Ayrshire, across both our residential houses and semi-independent living who have come to us through these routes. • A number of young people in residential care have requested Continuing Care, whereby a young person can remain in their placement until age 21. • Where appropriate young people are placed to meet their educational needs, the cost of Residential School Placements in most cases is shared 50/50 with Education services. All organisations and services within North Ayrshire with corporate parenting responsibilities and the care experienced community are essential contributors to ensuring that care experienced infants, children and young people's outcomes are as good as those for any other children. Delivering positive outcomes for care experienced children and young people is a key priority for the Community Planning Partnership and its partners. We must now make sure that these priorities are put into practice and that the commitment to those who are Care Experienced is delivered through the implementation of this plan and tangible actions North Ayrshire has committed to #KeepThePromise which provides a benchmark for corporate parents, carers, practitioners, managers, care experienced community, and decision makers in fulfilling the 108
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NORTH AYRSHIRE Health and Social Care Partnership 55 Delivering care together goal to meet the collective and individual needs of all of our Care Experienced infants, children and young people. Children’s Services are continuing to work with other services including Education and Housing to address the ongoing challenges, however it is recognised that the incremental change approach is not keeping up with demand nor the pace of change required and therefore more transformational solutions are required to developed and progressed at pace. Given the nature of the current financial position and challenging circumstances around accommodation for our care experienced young people, it has been recognised there is a need to establish a project board of multi-agency partners to assist in proposing solutions, advice, and guidance across North Ayrshire to work collaboratively to ensure best outcomes for our young people and reduce associated costs. A focused change programme is required to respond to the pressures of residential care, to ensure all partners can contribute to the development of alternative pathways of care for children and young people and to radically reform the care options we have available for our children and young people. 2. Aims of the Programme Board The role of the Programme Board is to provide strategic leadership, support, challenge, and guidance on key issues to inform, engage and take collective action enabling a timely and co-ordinated set of agreed actions to be progressed. Providing strategic leadership and oversight the Programme Board will: • Inform, engage, and take collective action on key issues identified • Own and be accountable for the delivery of agreed actions • Resolve strategic issues and remove barriers • Ensure all members have a shared situational awareness • Support the work of the project groups and allocate resource where required, and as appropriate The HSCP and Education Services (Children’s Services) require working jointly to deliver a significant transformational change agenda with a focus on shifting the balance of care from high cost purchased residential accommodation to alternative family placements (foster / kinship care) and to providing support to families in need of intensive support, where they live. There is a substantial body of evidence to support the fact that additional tailored flexible support provided to children, young people and their families aimed at keeping young people engaged in their local communities and schools produces better outcomes regarding changed behaviour, active citizenship and keeping families together. The current use of high-cost external purchased services does not achieve the care and educational attainment outcomes required for North Ayrshire’s children looked after and accommodated away from home and does not facilitate the investment required in alternative care pathways. Whilst this is the case, it is expected that there will always be a cohort on Children & Young People who will require out of authority care in particular circumstances. It is acknowledged that in order to reduce this number there is a need to identify and fill any existing gaps in the provision of effective community-based intensive family 109
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NORTH AYRSHIRE Health and Social Care Partnership 56 Delivering care together support services and to develop alternative pathway of support for young people leaving care. The Board will work in partnership across NAHSCP, NHS Ayrshire and Arran, North Ayrshire Council, and wider partners, including the Community Planning Partnership. The Programme Board will work collaboratively and collegiately across the whole system to improve outcomes and pathways for care experienced young people and use all existing resource across various services. It is proposed this is delivered through establishing the formal focussed workstreams below: 1. Housing and Throughcare 2. Fostering and Kinship 3. Education including Residential School Placements 4. Internal Children’s Houses – Model of Care 5. Early Intervention and Crisis/Intensive Support Pathways 6. Strategic Needs Assessment/Data/Workforce 7. Best Practice Models and Research Each workstream will focus on data, funding, workforce, communication and engagement, and pathways in and out of services. A multi-disciplinary programme board, known as the Brighter Pathways: Remodelling Children’s Care Options Programme Board, will be established to support the work outlined above. 3. Programme Board Remit 3.1 The remit of the Programme Board is to: • Recognise that children, wherever possible, should remain in the care of their family. Any recommendations should meet legislative requirements and reflect the spirit of the Promise. Where family-based care is not possible, alternative care will be warm, loving and allow children the best possible chance to fulfil their potential. • Ensure early intervention services are closely aligned and coordinated to offer the earliest possible help and afford families the best chance to succeed. • Ensure a reduction in the overspend associated with children’s residential placements. • Develop, whenever possible, shared pathways, procedures, and policies within and across services to best meet the needs of care experienced young people. • Create a governance system that promotes good practice, safety, and quality in order to improve outcomes for care experienced individuals known to our services, especially at key transition points of moving on to shared living/independent living arrangements and adulthood, The governance systems should also include the development of a multi-agency group, chaired by the Head of Children, Families and Justice Services with the Head of Education as Vice Chair to access and monitor out of authority placements. • Report progress, issues, and risks to other members of the group. 110
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NORTH AYRSHIRE Health and Social Care Partnership 57 Delivering care together • Support and assist the service in determining key aspects of service transformation including: the development of a step-down accommodation within one of our existing children’s houses; a revised staffing model across residential services; revised contracts and working hours; providing resource to design and deliver a ‘wrap- around’ model of support for older young people residing in the proposed step-down accommodation. • Engage and communicate planned works and changes that may have an impact on individuals within North Ayrshire. • Identify any workforce requirements and HR/legal implications to deliver proposed changes, and ensure these are reflected in workforce planning, governance, and development mechanisms in North Ayrshire. 3.2 Accountability - The Programme Board will provide support, challenge, advice, professional expertise, and guidance to inform recommendations for future decision making to the Chief Officer, Head of Service Finance/Transformation, Head of Children, Families and Justice Services, Head of Adult Services and Head of Mental Health Services. 3.3 Governance Reporting - The Programme Board will provide reporting updates to the HSCP Transformation Board and final recommendations to the HSCP Partnership Senior Management team for approval/enforcement. In line with established practice, matters affecting the delivery of Social Work Services will be presented to the Social Work Governance Board for consideration of recommendations prior to submission for decision. Any policy decisions and progress updates will also be taken to the Integration Joint Board and North Ayrshire Council’s Cabinet as required. 4. Chair & Depute Chair The Chair of the Programme Board will be Scott Hunter, Chief Social Work Officer. The depute chair will be Elizabeth Stewart. A dedicated Programme Manager has been appointed for two years from January 2024 to lead and co-ordinate the work. 5. Membership The role of the Programme Board is to provide strategic leadership and guidance on key issues, to inform, engage and take collective action enabling a timely and co-ordinated set of actions to come forward. Members will ensure their respective stakeholders are engaged and their views represented, including: Name Organisation Role Scott Hunter NAHSCP Chief Social Worker (Chair) Elizabeth Stewart NAHSCP Head of Service: Children, Families & Justice/Depute CSWO (Depute Chair) Paul Doak NAHSCP Head of Service: Finance & Transformation Thelma Bowers NAHSCP Head of Service: Mental Health Services Mae Henderson NAHSCP Senior Manager, Children and Families Kevin McGinn & Arthur Coutts NAHSCP Planning Managers Cara Hainey NAC Legal Services 111
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NORTH AYRSHIRE Health and Social Care Partnership 58 Delivering care together Yvonne Baulk NAC Head of Service, Housing and Public Protection Andrew McClelland NAC Head of Service, Education Gail Nowek NAC Principal Psychologist, Education Wendy Van Riet NAHSCP Director of Psychology NAHSCP Andrea Elliott NAC Senior Manager Housing Services 6. Attendance 6.1 Regular and consistent attendance and representation at all meetings is essential. Members can nominate a deputy to attend meetings in their absence, providing the nominated deputy has relevant knowledge accountability and responsibility to take decisions to support the implementation of the Children and Families implementation plan. 6.2 Where a member cannot attend, they should notify the chair as soon as possible copying in their alternative proposed attendee. In order to ensure the meeting is quorate, members must be clear when no representation can be sent. 6.3 It is expected the Board will provide support & challenge, guidance & advice, and resource (where appropriate). Members will engage in open and honest discussion to support decision making. Decision making will be by majority where unanimous consensus is not achieved. 7.Administration of Meetings 7.1 Appropriate administrative support for the Children and Families Programme Board will be arranged by Elizabeth Stewart, Head of Service Children, Families and Justice Services. 7.2 A call for agenda items will be issued the week before the Board meeting with a deadline for items of 1700 one week before the agreed meeting time. Members are encouraged to put forward agenda items to inform the work plan and standing agenda items will reflect key topics. Minutes, including agreed points of action will be circulated amongst the group after every meeting. (week before etc) 7.3 The agenda and any supporting papers will be sent to members at least three working days before the date of the meeting. An action note, including key decisions, will be drafted by the secretariat, and issued together with the call for agenda items. 7.4 The meetings will alternate between MS Teams platform and face to face. 8. Frequency of Meetings The Programme Board will meet on a monthly basis and will be chaired by Scott Hunter, CSWO, or by the depute chair in the chair’s absence. 112
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NORTH AYRSHIRE Health and Social Care Partnership 59 Delivering care together The Chair may at any time convene additional meetings of the Project Board. 9. Quorum The meeting shall be quorate when the Chair, or deputy Chair, is present together with a third of the representatives of the membership. 10. Confidentiality Confidentiality with regard to discussion of sensitive information should be observed at all times. All papers will be confidential. Only papers which have been explicitly marked for wider distribution should be disseminated further. 11. Behaviours and Expectations The Board will at all times demonstrate behaviours in line with established Social Work values. Fundamental behaviours include: partnership working, openness and honesty, mutual respect, compassion, and recognition of individual contribution. All members are expected to contribute to achieving the purpose of the established Board, operating within the following expected standards of behaviour: • Contribute information and resource to achieving the goals of meetings and agenda items. • Promote open discussion by sharing information in a timely manner with due respect for others. • Recognise and respect the responsibilities that individuals have as representatives of their organisations. • Maintain confidentiality regarding sensitive information within the parameters set by the Board. • Strive for consensus as far as possible and where this is not possible to value difference. 12. Timescales & Lifespan of Board It is proposed the Programme Board will hold its first meeting in February 2024, Meetings will follow monthly thereafter. It is anticipated the Board will function for the duration of this year and into 2025 It is expected that regular updates will be provided to the HSCP PSMT, Transformation Board, IJB and Cabinet throughout the lifespan of the Programme Board at appropriate junctions. 113
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NORTH AYRSHIRE Health and Social Care Partnership 60 Delivering care together Appendix2- Strategic Needs/Data/Workforce Position Paper Authors Kevin Mcginn (Planning Manager / HSCP SP&TT ) Arthur Coutts (Programme Manager) Laura Doherty (Project Manager Public Health) Kevin McGinn (Planning Manager HSCP 114
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NORTH AYRSHIRE Health and Social Care Partnership 61 Delivering care together Strategic Direction - Identification of data sources which are relevant - Agreement and presentation on which measures evidence the current situation as being unsustainable - Agreement on which measures will be underpinning an evaluation and monitoring framework moving forward to evidence the situation is becoming more sustainable - List actions to address these issues in the short term - List actions to Addressing these issues over the long term with an approach underpinned by early intervention and prevention - How do we hear the voice of ICYP and families??? Introduction and Aims The Brighter Pathways transformation programme was implemented to address current challenges associated with resources and accommodation for looked after and care experienced young people. Aims of the transformation programme include consideration of a number of factors by the programme in the short-term including: • Children’s Houses over occupancy • Decline in foster care recruitment/retention • Increase in external high-cost residential resources • Pathways to support care leavers/care experienced young people • NTS scheme and model of support to UASC The purpose of Strategic Needs Report by the transformation programme is to take an evidence-based approach to assist understanding of the current and future demographics and experiences of and relating to looked after children, care leavers and children on edge of care. The report will be considered to identify any changes and improvements that require to be made in the planning and delivery of children’s services in the best interest of Infants, Children, Young People, and families. The approach adopted in the report being produced by the transformation programme involves three stages: 1. Assessing the level of need for children’s placements /resources 2. Describing the current pattern and level of supply of these services 3. Identifying the extent of the gap between need and supply This report is formed following a large degree of scoping of appropriate and available data by the data working group of the Brighter Pathways programme. It aims to collate, summarise and comment on the data available which impacts upon the lack of availability of suitable local placements outside the family home for looked after ICYP in North Ayrshire. The Strategic Needs workstream consisted of members from: ➢ Public Health, Project Manager for Infants Children and Young People ➢ Data Analyst HSCP 115
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NORTH AYRSHIRE Health and Social Care Partnership 62 Delivering care together ➢ Planning Manager HSCP ➢ Programme Manager HSCP ➢ Head of Service HSCP ➢ Education, Data and Research Manager Report Objectives: - Identify Contributing Factors and available data regarding these - Utilise data to tell the story of the current picture and situation - Identify wider contributory factors and available data regarding these - Present the available data succinctly and recommend their use as a means of monitoring improvement moving forward - Recommend a sustained focus on improvement in data and systems more generally across partner systems to allow for effective assessment, planning, and evaluation to shift to more preventative focussed care pathways and facilitate improved health and social outcomes for ICYP and families and furthermore to evidence best value. Background and context- Policy/legislation • The Promise – Plan 24-30 • The United Nations Convention on the Rights of the Child (UNCRC). • Getting it Right for Every Child (GIRFEC). • North Ayrshire Council’s Corporate Parenting Plan 2023-2026. • Council Plan 2023-28 Key Priority: Improving outcomes for care experienced young people including implementation of The Promise • Children’s Services Plan 2023 -26 • The Children and Young People (Scotland) Act 2014 The UNCRC The incorporation of the UNCRC into Scottish Law means that there will be a greater scrutiny of all public bodies with regard to ensuring compatibility with The UNCRC (Incorporation) (Scotland) Act 2024 as they fulfil their duties to all infants, children and young people and their families The Act provides an opportunity for corporate parents to consider closely groups of children who are more likely to have their rights transgressed due to their experiences. ICYP who experience the care system may require “scaffolding” to ensure equity of support in comparison to some of their peers who have not experienced care. The North Ayrshire Context The North Ayrshire Children’s Service Plan 2023-261 outlines some useful information which will help to set the scene for this paper. The population of North Ayrshire is shifting. A decreasing population size over time has been observed with higher number of older people and a decreasing working age and child population. 1 North Ayrshire Children's Services Plan 2023-26 116
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NORTH AYRSHIRE Health and Social Care Partnership 63 Delivering care together North Ayrshire also has high levels of poverty and deprivation. In the Scottish Index of Multiple Deprivation, of the 186 data-zones (very small areas with about 800 people living in them) across North Ayrshire, almost 40% are amongst the most deprived in Scotland. Mid 2023 Population Estimates2 show that, North Ayrshire has 25,602 people aged between 0 to 18 years. In addition, information published by the charity End Child Poverty3 in June 2023, suggests that 29.2% of infants, children and young people in North Ayrshire are living in poverty. This is an increase of 4.4 percentage points 2014/2015 to 2022/2023 and equates to more than 1 in 4 young people. This is the second highest rate of child poverty in Scotland, second only to Glasgow City. North Ayrshire has the 4th highest rate of looked after ICYP in Scotland, 18 per 1000 of the North Ayrshire 0-18 population, The national rate for children looked after is 12.3 per one thousand. CAMHS have provided minimal information and data to be able to fully understand the full picture within North Ayrshire. The analysis provided below details the high-level trends from 2021-24: Clinical Activity by age – Higher percentage of children aged 9–15-year-old. Clinical workload – Significant increase with spike in 2022-2024 New referrals – increase in referrals in 2023 Referral Category – highest referrals relate to mental health disorders with spike in 2021, Neurodevelopmental referrals have increased significantly from 2021 with significant spike in 2023. 2 Mid-2023 population estimates - National Records of Scotland (NRS) 3 Child Poverty Statistics 2024 - End Child Poverty 117
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NORTH AYRSHIRE Health and Social Care Partnership 64 Delivering care together Map of Data Zones within North Ayrshire coloured by SIMD quintiles. Inequalities, Stigma and Health Outcomes in the Care Experienced population Health problems increase with age. Research4 shows that in many cases this increasing trend is more pronounced among care experienced children and young people, widening the inequalities in health between care experienced individuals and non-care experienced individuals across the life course. It attributes some of this inequality to significant life events including at points of transition, therefore transitions into and out of placement, settings and systems of care require close and careful consideration by the corporate family, together. Quantitative data, although important, should not be viewed in isolation as statistics can be dehumanising. People with experiences of care have often faced disadvantage in childhood and, as a consequence, have poorer outcomes as a group at a population level.5 Research tends to view this through a lens of clinical disorder and repeatedly reporting deficit focussed data can result in the further stigmatisation of the group in consideration. Corporate Parents can and must advocate for our children’s right to health. Poor health and health inequalities are not an inevitability for care experienced infants, children, young people, or adults. With the right support, care experienced children and young people can attain excellent health and social outcomes that continues throughout their lives. 4 Allik, M., Brown, D., Gedeon, E., Leyland, A. H. and Henderson, M. (2022) Children’s Health in Care in Scotland (CHiCS): Main findings from population-wide research. University of Glasgow. (doi: 10.36399/gla.pubs.279347). 5 Allik, M. et al. Cohort profile: The ‘Children’s Health in Care in Scotland’ (CHiCS) study—a longitudinal dataset to compare health outcomes for care experienced children and general population children. BMJ Open 11, e054664 (2021) 118
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NORTH AYRSHIRE Health and Social Care Partnership 65 Delivering care together The Promise Scotland6 raises concerns with regard to the collection and use of data about children and their lives, is very critical about the quality and scope of available data and emphasises children’s ownership of their data and their stories. It is important that the data within this report is considered with equal weighting alongside the stories that CYP tell us about their experiences of the care system. We should understand the problems, the solutions and progress toward these solutions by the same token, and that should always involve how ICYP and families tell us they experience their journeys. The structures and groups exist within North Ayrshire to allow for this to happen. ICYP views and experiences are sought via the Champions Boards meetings, yearly Annual Promise Conference, one- off/special consultations e.g. Care Experienced Joint Youth Cabinet and engagement with our CE4U app and social media pages. Data Sources and associated Considerations and Limitations Data within this report has been sourced from education (Seemis system), Scottish Children’s Reporter’s Administration (SCRA), HSCP (Carefirst system), Scottish Public Health Network, CAMHS, comparative authorities. National data has been sourced from looked after children and child protection statistics 23/24, care inspectorate statistical bulletin 2023/24, and the Promise Progress Framework (2024). There are challenges associated with telling a comprehensive story using the data available across sources, including that each system may report upon different populations of children, and upon different time frames. This is linked to each corporate parent’s individual and collective responsibility, for example, education and health partners have a responsibility for all children living within the North Ayrshire/ AA health board area whereas Social Care systems hold information only on those ICYP with a North Ayrshire social worker. Furthermore, each partner’s systems are not linked. Differences across Reporting Timelines are highlighted in the below: SCRA Data – Financial Year 2020-2024 Education August to June. 2020-2024 Comparative authority – August – June 2019-2023 HSCP – 2020-March 2025 Headline statistics - Children’s Social Work Statistics 2023-24 – Looked After Children Looked after children • On 31 July 2024, 11,844 children were looked after – down 2% since 31 July 2023 (12,084) and down 24% since 2013-14 (15,600). • The rate of children looked after per 1,000 children was 11.7 in 2024. This is the lowest rate since 2005. 6 The Promise 119
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NORTH AYRSHIRE Health and Social Care Partnership 66 Delivering care together • A total of 2,313 looked after children were looked after at home on 31 July 2024. This is down 5% on 31 July 2023 and down 44% on 2013-14. This accounts for 20% of looked after children. • On 31 July 2024, the most common placements away from home were kinship care (35%), foster care (32%), and residential accommodation (11%). • During 2023-24, 3,105 children started to be looked after – down 1% since 2022-23 (3,133) and down 28% since 2013-14 (4,295). • A total of 3,398 children ceased to be looked after during 2023-24 – down 3% since 2022- 23 (3,494) and down 28% since 2013-14 (4,696). • Just over half (54%) of looked after children have a home address in one of the 20% most deprived areas in Scotland, whereas 3% were from one of the 20% least deprived areas in Scotland. Care Leavers • During 2023-24, 967 young people aged 16 years or over ceased to be looked after and were eligible for continuing care. Of these, 33% (315) entered continuing care. • On 31 July 2024, 1,115 young people were in continuing care. This is 22% of those who were eligible for continuing care at the time of ceasing to be looked after (4,985). • On 31 July 2024, an estimated 9,369 young people were eligible for aftercare services. • 4,454 (48% of those eligible) were receiving aftercare services on 31 July 2024 – up 7% on 31 July 2023 (4,151). • 2,047 (55%) of those in aftercare were in education, training, or employment. The statistics show a decrease in the overall number of children in care in Scotland on 31st July 2024, continuing a trend over the last few years. The latest statistics also show that just over half of children experiencing the care system lived in Scotland’s most deprived areas, compared to just three per cent from the least deprived areas. This confirms what is already known – that to keep the promise is to end child poverty. When families lack financial resources, homes are cramped and putting food on the table is a struggle, meeting the needs of children can be challenging. 120
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NORTH AYRSHIRE Health and Social Care Partnership 67 Delivering care together Placement Types/Looked After Children The table above details, the occupancy levels of our children’s houses since 2023. Each of the houses hase cosistenlty been over numbers during time period. Data captured for each fiscal year 121
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NORTH AYRSHIRE Health and Social Care Partnership 68 Delivering care together Snapshot (Example: as of 1 December 2024)– the exact number of children on that specific date. 122
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NORTH AYRSHIRE Health and Social Care Partnership 70 Delivering care together Data Presentation – The Current Situation Care Settings – Trends over Time in North Ayrshire Over the last couple of years there have been notable decreases specifically in children and young people being looked after at home, with friends/relatives, and with foster carers. However, the number of formerly Looked After young people requesting to stay in their placement under Continuing Care is increasing. In March 2025, there were 39 young people in these placements. This will likely increase further as young people are choosing to remain in their care setting longer and up until aged twenty-one. Overall, the number of Looked After Children has steadily reduced over the last few years but the numbers in residential care have not followed the same trend, and the number of requests for Continuing Care has increased significantly. This reflects the decline in foster care provision and a reliance on residential care. Positively the number of Kinship placements has increased over the same period. The graph below illustrates the movement/trends from 2018 until September 2024. Unaccompanied Asylum-Seeking Children/Trafficked young people Over the last few years there has been an increase in young people coming to North Ayrshire through the National Transfer Scheme following its inception 2021.North Ayrshire is committed to support twenty-four young people. This cohort of young people are looked after children under section 25 and are accommodated or houses in children’s houses, private lets and one is placed with supported carers, the HSCP have statutory duties and responsibilities under the looked after regulations. This is a cohort of young people that have never been considered in any strategic needs assessment or impact on resources which has been a factor in the capacity issues within internal residential care since 2021. There is also a lack of ability to plan and have adequate resources due to the nature of the arrival of trafficked children who are under sixteen. 124
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NORTH AYRSHIRE Health and Social Care Partnership 71 Delivering care together At the time of writing, there are Thirty-Nine UASC/Trafficked Young People who are receiving support from North Ayrshire Council, with Six Children & Young People residing within our Residential Houses. The table below details the number of UASC/Trafficked YP per year since 2021, up to May 2025. Foster Care - - - 2 10 13 12 1 0 2 4 6 8 10 12 14 2021 2022 2023 2024 2025 UASC/Trafficked YP 125
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NORTH AYRSHIRE Health and Social Care Partnership 72 Delivering care together Foster Care Recruitment data – Can Digital as of 30th April 2025 Foster Care Analysis There is a vast reduction in the number of approved carers from 2020, down twenty-six approved carers. Reduction in number of children within external foster carer from 2020. 74 11 7 3 4 Enquires Calls Requested Home Visits Number at Prep Stage Assesements Taking Place Council Advertising Network 126
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NORTH AYRSHIRE Health and Social Care Partnership 73 Delivering care together Significant decline in foster care enquiries from 2020 pre covid currently have the highest number of enquiries in five years. Service has been unable to meet target of six approved interim carers over last five years. Over the last five years there are a significant number of de-registrations of carers compared to approval numbers. The fostering service has reduced capacity due to changing role of carers, adoption, permanence, supported care and some children requiring single placements. The digital approaches to recruitment have led to the highest number of enquiries in the last five years. It is early in the process to analyse if the investment in digital approaches to foster care recruitment will lead to conversion of approved carers. Number of registered foster care households per 1,000 0–17-year-olds in Scotland, and relative to number of children in the ‘care system’. The number of registered foster care households has been decreasing each year since 2020, falling by 15.3% between 2020 and 2023 to 2,988 approved households. By comparison, the overall number of ‘looked after’ children fell by 1.9% over the same period. • The number of registered foster care households has been falling each year in Scotland, at a faster rate than the fall in the number of overall children experiencing care in the same period. 405 foster carer households de-registered in 2023, an increase of 16% from 349 in 2020. • More foster carers in Scotland are de-registering each year. • In 2023, the number of new foster care households (178) was less than half of the number of foster care households that de-registered (405) • It is projected that the Fostering Service will require thirty newly approved interim foster carers to meet needs and demand of children in North Ayrshire over the next five years. this is based on data on children requiring alternative care, age and demographic of current carers and de-registration information. 127
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NORTH AYRSHIRE Health and Social Care Partnership 74 Delivering care together Kinship Care The data above only relates to total number of children in kinship care and there are approximately 328 children in kinship care placements with only 92 with a looked after status. The Growing up in Kinship Care Report (2024) highlighted that North Ayrshire had less than 20% of looked after children in kinship care and were the third lowest in Scotland. This reflects the current and good practice of achieving permanence for children in kinship care in North Ayrshire and the increasing number of children on kinship care orders who are not looked after. The proportion of children starting to live with kinship carers under Section 25 arrangements has increased substantially (from 19% in 2009 to 40% in 2019), and children in kinship care were more likely to be in care under Section 25 arrangements than children in the wider population of ‘looked after’ children. The Growing up in Kinship Care Report (2024) North Ayrshire has a kinship first culture and when any child requires alternative care kinship options should be fully explored in the first instance and kinship considered throughout a child’s care journey and before permanence agreed. Given the increase in kinship care numbers there is significant support needs for children and kinship carers due to increased complexity of children in kinship care due to children’s previous experienced and adversity. The Growing up in Kinship Care Report (2024) highlighted the need for increased support for kinship care families. Rosemount – Edge of Care Referrals Year: No. of Males: No. of Females: Total: 01/04/2019 to 31/03/2020 54 (55.1%) 44 (44.9%) 98 128
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NORTH AYRSHIRE Health and Social Care Partnership 75 Delivering care together 01/04/2020 to 31/03/2021 33 (42.9%) 44 (57.1%) 77 01/04/2021 to 31/03/2022 58 (49.2%) 60 (50.8%) 118 01/04/2022 to 31/03/2023 39 (41.5%) 55 (58.5%) 94 01/04/2023 to 31/03/2024 40 (37.7%) 66 (62.3%) 106 01/04/2024 to 31/03/2025 55 (56.1%) 43 (43.9%) 98 Total: 279 (47.2%) 312 (52.8%) 591 Rosemount Referrals have been relatively consistent numbers apart from 2021 which is during covid period. The average age of young person being referred to the service was 13.8 The average length of time that each case was involved with the service in the past five years and the year to date (2024/25) is 12.9 months. There has been 5 of the 98 children involved with the service in the past year who have become looked after and accommodated in residential care. That is 6.1% of the children supported by the team and 93.9% living in a family setting. The trend has been that more females (53.5%) than males (46.5%) are referred to the service Again, in terms of the age range of children who become looked after (including looked after at home), the Scottish Government's Children's Social Work Statistics for 2023-24, provides the distribution of children starting to be looked after by age group: • Under 1 year: 448 children (14% of the total) • 1-4 years: 560 children (18%) • 5-11 years: 896 children (29%) • 12-15 years: 857 children (28%) • 16-17 years: 340 children (11%) This data indicates that most children are aged 5 to 15 years when they become looked after, with those in the age range of 5-11 having the highest numbers 129
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NORTH AYRSHIRE Health and Social Care Partnership 76 Delivering care together Child Protection The table above details a steady decline in the number of Children & Young People on the Child Protection Register. The Child Protection Minimum Data Report 2024/25 is within the appendix which provides structured data to follow a child’s journey through the child protection process. 130
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NORTH AYRSHIRE Health and Social Care Partnership 77 Delivering care together Continuing Care Note: Young People under 16 were included up to 30/03/2024. From 01/04/2024 only Young People at age from 18 are included 131
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NORTH AYRSHIRE Health and Social Care Partnership 78 Delivering care together The data above relates to all young people from CareFirst who are in Continuing Care during that financial period, this was including young people aged sixteen from 2021-23. There has been a steady increase in young people in continuing care from 2020. Reduction in overall numbers if young people in continuing care form 2023 – 2024. Continuing Care provision has created significant challenges within residential care, kinship, and foster care, it has led to capacity issues in foster care and residential care and there is a financial commitment to pay an allowance to foster and kinship carers until a young person is aged twenty-one. Education data for Care Experienced learners The identification of a pupil as Care experienced is done by putting the following information on a dedicated area of the pupil record: 1. Looked after status – which is blank for non-Care Experienced (CE) learners or can be selected as: • Looked After at Home • Looked After Away from Home • Previously Looked After The Scottish Government collects only the first two categories – “previously looked after” being considered the same status as “never been looked after.” Our recording requirement for school users is that – when a supervision order stops – the entry is not deleted, but the status added is “Previously Looked after” From the total number of pupils we report on as Care Experienced – every year – about 15- 16% are educated in North Ayrshire schools but are looked after by other authorities (most frequently from Glasgow City, East Ayrshire, or Renfrewshire). The data provided refers to children of school age. Although our management information system also allows the recording of pupil details from the time, they join any local authority or partner private provider of Early Years Education in North Ayrshire – the quality of data and 132
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NORTH AYRSHIRE Health and Social Care Partnership 79 Delivering care together the consistency of recording CE learner characteristics is not as good as in schools. Attendance is also not compulsory for pre-school education. As a general comment on the performance statistics presented, we acknowledge that there continues to be a considerable gap between CE learners and non-CE learners in academic performance, attendance, and exclusions in North Ayrshire schools. Although our CE/Looked after pupils (when available statistics allow it) compare positively to the national performance of Looked after pupils in Scotland – there is considerable room for improvements. Care Experienced Pupils – All Schools It is also worth noting that the deepest performance gap appears in the case of Looked after at home pupils, while looked after away from home pupils perform much better and – in the case of % attendance – outperform even the general (non-CE) learners’ group. Please consider that time trends in performance are strongly affected by the disruptions caused by the pandemic/lockdowns – and therefore the 2019/20, 2020/21 and even 2021/22 are atypical years – particularly for SQA/Senior Phase performance of school leavers. On the other hand - the long-term effects of the changes in learning and social interactions introduced by the pandemic are just starting to reveal themselves through new behaviours, experiences and performance of children and young people. Finally, all these statistics are subject to high random variations, as, in many cases, they refer to small numbers of pupils. (For example, school leavers – with around 100 CE individuals each year or Looked After at the time of leaving school – where numbers are even lower - around 50 every years 133
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NORTH AYRSHIRE Health and Social Care Partnership 80 Delivering care together Comparative Authorities Number of looked after children per council Analysis North Ayrshire looked after figures are similar to the comparative authorities, there is significant variation in the types of placements. Scottish Children’s Reporter Administration (SCRA) Data from 2019 to 2024 key themes: Yearly Breakdown • 2019-2020: 496 children were referred with 679 referrals. • 2020-2021: 372 children were referred with 532 referrals. • 2021-2022: 405 children were referred with 536 referrals. • 2022-2023: 370 children were referred with 457 referrals. • 2023-2024: 427 children were referred with 616 referrals. Sum of Value Column Labels Row Labels 2019 2020 2021 2022 2023 Glasgow City 2523 2544 2328 2094 1909 North Lanarkshire 850 832 734 692 730 North Ayrshire 550 575 489 431 409 West Dunbartonshire 505 506 466 465 479 Dundee City 463 493 437 434 421 East Ayrshire 375 382 402 354 393 Inverclyde 205 223 206 190 186 Na h-Eileanan Siar 39 50 39 44 31 134
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NORTH AYRSHIRE Health and Social Care Partnership 81 Delivering care together Sources of Referrals • Police: The highest number of referrals came from the police, with a total of 1182 referrals over the years. • Social Work: 565 referrals. • Education: 257 referrals. • Multiagency: 142 referrals. • Court: 36 referrals. • Other sources: Including relatives, health, reporter, PF, and others. Grounds for Referrals • Lack of Parental Care: The most common ground for referral, with 712 cases over the years. • Close Connection with Person Who Has Carried Out Domestic Abuse: 356 cases. • Offence: 316 cases. • Victim of Schedule 1 Offence: 229 cases. • Failure to Attend School Without Reasonable Excuse: 225 cases Sum of Total Year Ground 2019- 2020 2020- 2021 2021- 2022 2022- 2023 2023- 2024 Grand Total Lack of parental care 182 171 138 107 114 712 Close connection with person who has carried out domestic abuse 104 59 65 69 59 356 Offence 65 44 58 61 88 316 Victim of Schedule 1 offence 73 44 40 43 29 229 Failure to attend school without reasonable excuse 39 23 31 55 77 225 Close connection with Schedule 1 offender 19 25 41 30 12 127 Exposure to persons whose conduct likely to be harmful to child 33 11 14 10 28 96 No Ground 17 29 8 29 83 Child's conduct harmful to self or others 27 13 11 16 12 79 Same household as child victim of Schedule 1 offender 28 16 5 8 5 62 Beyond control of a relevant person 17 7 8 5 8 45 Close connection with Sexual Offences Act offender - Parts 1, 4 and 5 5 5 5 5 5 25 Accommodated and special measures needed 6 5 0 5 0 16 Misuse of alcohol 0 5 5 5 0 15 Permanence order and special measures needed 5 0 0 0 0 5 Misuse of a drug 0 0 0 0 0 0 Grand Total 603 445 450 427 466 2391 135
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NORTH AYRSHIRE Health and Social Care Partnership 82 Delivering care together Yearly Trends • Fluctuations in Referrals: The number of referrals and the specific grounds for these referrals vary year by year, reflecting changing social dynamics and possibly the impact of different policies or interventions. • Increase in Referrals: There is a noticeable increase in the number of referrals in the most recent year (2023-2024) from 457 to 616 Key Age Groups Sum of Total Column Labels Age 2019- 2020 2020- 2021 2021 - 2022 2022 - 2023 2023 - 2024 Gran d Total 0 43 34 21 23 28 149 1 26 24 26 19 19 114 2 34 28 13 10 26 111 3 35 23 15 21 16 110 4 37 24 29 17 16 123 5 32 23 19 24 20 118 6 32 31 18 16 20 117 7 25 24 26 17 18 110 8 19 22 30 25 26 122 9 21 20 16 12 25 94 10 20 14 17 16 18 85 11 26 16 28 14 14 98 12 30 24 29 33 30 146 13 34 21 45 40 67 207 14 40 22 39 53 62 216 15 56 25 40 40 42 203 16+ 16 15 10 6 7 54 Grand Total 526 390 421 386 454 2177 0-4 Years: This age group consistently shows a significant number of referrals, indicating early childhood concerns. • 5-10 Years: A substantial number of referrals are also seen in this age group, reflecting issues that arise during early school years. • 11-15 Years: This age group often has the highest number of referrals, highlighting challenges faced during adolescence. • 16+ Years: Fewer referrals in this age group, but still notable, especially for older teenagers. Compulsory Supervision Orders (CSO) • 2019-2020: 141 CSOs made, 145 CSOs terminated. • 2020-2021: 86 CSOs made, 114 CSOs terminated. • 2021-2022: 103 CSOs made, 120 CSOs terminated. • 2022-2023: 89 CSOs made, 119 CSOs terminated. • 2023-2024: 107 CSOs made, 125 CSOs terminated. 136
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NORTH AYRSHIRE Health and Social Care Partnership 83 Delivering care together Interim Compulsory Supervision Orders (ICSO) Yearly Breakdown • 2019-2020: 558 children under ICSO. • 2020-2021: 419 children under ICSO. • 2021-2022: 462 children under ICSO. • 2022-2023: 489 children under ICSO. • 2023-2024: 377 children under ICSO. Referrals to SCRA Locality Area Sum of Count Column Labels Row Labels 2019-2020 2020-2021 2021-2022 2022-2023 2023-2024 Grand Total Irvine 206 147 199 146 219 917 Dreghorn 4 2 2 8 Irvine 201 144 199 146 217 907 Springside 1 1 2 Three Towns 170 172 151 163 208 864 Ardrossan 35 38 28 32 50 183 137
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NORTH AYRSHIRE Health and Social Care Partnership 84 Delivering care together Saltcoats 89 80 54 70 66 359 Stevenston 46 54 69 61 92 322 Kilwinning 74 70 67 64 94 369 Kilwinning 74 70 67 64 94 369 Garnock Valley 49 38 54 43 59 243 Beith 14 12 11 9 10 56 Dalry 13 9 19 17 38 96 Kilbirnie 22 17 24 17 11 91 N/A 127 61 34 6 228 N/A 127 61 34 6 228 North Coast 47 37 30 33 36 183 Fairlie 1 1 Largs 22 23 18 22 27 112 Skelmorlie 4 1 4 9 West Kilbride 20 14 12 10 5 61 Arran 5 7 1 2 15 Isle of Arran 5 7 1 2 15 Grand Total 678 532 536 457 616 2819 A Public Health Approach to Data – Wider contributing factors The Requirement for a Preventative, Public Health Approach to understanding and monitoring Data Solutions in the short term are required to address lack of suitable accommodation however these will not address the wider preventative focus and spend required to target the many contributing factors which contribute to current problems. The current situation is a symptom of a wider context, one which is not specific only to North Ayrshire. The factors which interact and contribute to the current lack of availability of suitable local placements are extremely complex, therefore identifying and accessing all relevant and applicable data is challenging. The interplay of multiple factors requires to considered through a public health lens and therefore the primary aim of corporate parents in North Ayrshire, is to prevent situations which lead to infants, children, and young people to be accommodated away from their family home altogether, where this is possible. This can only be successfully achieved by addressing the wider determinants of health and the structural barriers to good health and social outcomes which exist. Poverty is a key area which requires to be addressed. Scotland has a number of laudable policies aimed at tackling poverty and inequality; however, too many children are still experiencing the effects of poverty and policies have been severely undermined by the crippling cost of living crisis. 138
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NORTH AYRSHIRE Health and Social Care Partnership 85 Delivering care together Add to this the ongoing rippling impact of the COVID-19 pandemic on health and wellbeing and there is no doubt that the level of need for support is high. This unprecedented level of need places a huge demand on resources. Defining Complexity There is a recognised increasing complexity in the lives of children and families and society in general Moreover, there are suggestions that complexity for the role of child protection7 in family’s lives is growing over time. Changes in levels of social inequality, drug and alcohol use, family fragmentation, professional practice, thresholds for entering care, and legislation are contributors. As mentioned briefly in the introduction, the current situation with regards to utilisation of out of area residential placements is symptomatic of a number of converging issues which contribute toward the situations faced by ICYP and families who experience the care system. Further data and analysis to fully understand the demographic of children and families that require statutory services, SCRA involvement and who become looked after is required. - Identification of key issues (That contribute to “complexity”) - Identification of proxy measures e.g. - Families where there are health /developmental concerns for ICYP - Rising poverty level - Rising levels of poor MH - North Ayrshire profiles 7 Complexity-in-the-lives-of-looked-after-children-and-their-families.pdf 139
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NORTH AYRSHIRE Health and Social Care Partnership 86 Delivering care together Appendix One References Growing Up in Kinship Care (2024) CELCIS, the Centre for Excellence for Children’s Care and Protection, for SCADR, the Scottish Centre for Administrative Data Research. Growing Up In Kinship Care Report - CELCIS-SCADR 8 October 2024.pdf Children’s Social Work Statistics 2023-24 – Looked After Children Supporting documents - Children’s Social Work Statistics: Looked After Children 2023/24 - gov.scot prm004_progress_report_plan24-30_s2_v2.pdf Can statistics tell a story? https://www.careinspectorate.com/index.php/news/7741-fostering-and-adoption-statistical- bulletin-2023-24 Child Protection Statistics: 2023-24 - gov.scot 140
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NORTH AYRSHIRE Health and Social Care Partnership 87 Delivering care together Appendix3-Housing & Throughcare Workstream Position Paper Housing & Throughcare Position Paper Authors- Kevin McGinn/Arthur Coutts/Claire McAlpine 141
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NORTH AYRSHIRE Health and Social Care Partnership 88 Delivering care together Introduction The Aim of this Paper is to give the Board an update on the ongoing work within the Housing & Throughcare Workstream Some of the topics covered are as follows: • Increasing Numbers of Young People within the service. • Pressures on Services. • Housing Crisis (National Picture). • Integrated Service Working. • Social Work Position. • Housing Position. • Strategic direction/next steps. Please note that this paper does not cover all the issues being faced by services, further exploration can be carried out on request. 142
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NORTH AYRSHIRE Health and Social Care Partnership 89 Delivering care together Legislation /Policy Context The Children and Young People (Scotland) Act 2014 was implemented to ensure Local Authorities would have a legal duty to prepare young people of leaving care or ceasing to be looked after and provide aftercare and follow on support for those eligible, potentially up to the age of twenty-six. An amendment to the Children (Scotland) Act from 2015 provided that a young person born after 1 April 1999 who is looked after in foster, kinship or residential care is eligible to remain in their current care placement until they turn twenty-one. This is called Continuing Care. Any young people who are accommodated post sixteen will also be eligible for continuing care. Scotland holds an ambition that all children will grow up safe, loved, and respected so that they will meet their full potential. The Independent Care Review concluded that this ambition was harder to meet for those children who have grown up in care. Supporting young people when they wish to transition to independence from care was a key feature of The Promise. The Promise notes the challenges care experienced young people face when going through the transition from leaving care and into adult life and living independently of the care of services. The Promise spoke of the need to support both care leavers and those with experience of care to move on from care in a planned way, with care leavers fully informed in decisions. “Parenting does not stop at 18. Throughout The Plan, Scotland must continue to consider how to create greater equity and opportunity for care experienced young adults. That consideration must include how to increase opportunity for care experienced people to access employment, training, stable housing, and support.” — (pg93, The Promise, 2020) The ‘Moving On’ Change Programme’s third phase will contribute to the production of a shared set of standards and principles that will inform a national ‘Moving On’ strategy for Scotland. 143
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NORTH AYRSHIRE Health and Social Care Partnership 90 Delivering care together Current Position The biggest challenges facing both the Housing & Throughcare Teams is the growing number of Children & Young people requiring Throughcare and Aftercare services and accommodation pressures vs the lack of suitable accommodation and alternative options for young people moving on from care settings. With Regards to our Children’s Residential Houses, over a prolonged period of time, demand for placement has consistently been higher than what we have available: at the time of writing, within North Ayrshire we have Thirty- Six Children & Young People residing within our Children’s Residential Houses. It is important to note that Our Children’s Houses are registered for Thirty-Two placements, Over the last few years there have been significant policy and legislative changes which have had a direct impact on both our Housing & Throughcare services. In addition, Services have noted that there has been an increase in the complexity of issues that the Children & Young People who require support from or Throughcare Service are experiencing. Further pressures are being placed upon on services as a result of continuing care legislation and the inception of the National Transfer Scheme, in addition to this the service has also seen an increase in the numbers of Children & Young People who are seeking Asylum. The workstream set out to explore alternative options to support young people to move on from their care settings which would provide a stepping stone and gradual process to independence. It is important to note that given the changes Continuing Care Legislation brings, it must be acknowledged that more young people will remain in care settings until the age of Twenty- One, this will place a significant increase on our resources. At the time of writing, North Ayrshire have Thirty-Nine young people in Continuing Care. 144
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NORTH AYRSHIRE Health and Social Care Partnership 91 Delivering care together Social Work Position The workstream set out to explore alternative options to support young people to move on from their care settings which would provide a stepping stone and gradual process to independence. Given the importance of ensuring that Young People are allocated suitable housing when leaving care, it was acknowledged that significant improvements were required to improve the processes and integrated working between our Housing & Throughcare Services. Throughcare Support Since the launch of Continuing Care in April 2016 there has been an increase in number of Young People who are eligible for Throughcare Support. In addition to this there has been a rise in the number of Young People who are eligible for Priority 2 housing, this includes those in Foster Care, Kinship & Residential Care. In addition, the service also supports all Unaccompanied Asylum-Seeking Children and Trafficked young people over the age of Sixteen. The Throughcare Service has experienced significant challenges in securing accommodation for UASC and have had to rely on private rental properties for this cohort of young people who are over sixteen. Unaccompanied Asylum-Seeking Children/ Trafficked Young People Over the last few years there has been an increase in young people coming to North Ayrshire through the mandate of National Transfer Scheme in 2021. North Ayrshire is mandated to support twenty-four young people which is calculated as a proportion of unaccompanied children in care of any local authority against their general children population. The calculation encompasses UASC child population until their 18th birthday and does not include care leavers. Unaccompanied children count towards the threshold, regardless of the route of arrival into the local authority care (whether NTS, spontaneous presentation, (Trafficked) or presentation from adult asylum dispersal) or immigration status. Unaccompanied asylum-seeking children (UASC) and separated migrant children under the age of eighteen who have been trafficked to Scotland, are looked after, and accommodated by local authorities as children in need under Section 25 of the Children (Scotland) Act 1995. Section 25 of the Children (Scotland) Act 1995 establishes the duty of local authorities to accommodate ‘children in need’ in their local area. Local authorities are obliged to offer aftercare duties to children who were formerly accommodated by them, under Sections 29 and 30 of the Children (Scotland) Act 1995 and the Children and Young People (Scotland) Act 2014. It is acknowledged that supporting UASC children is a developing area of practice and as such there was a need for practice guidance for services who have a role in the initial presentation and for those who have case management responsibility. 145
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NORTH AYRSHIRE Health and Social Care Partnership 92 Delivering care together The Practice guidance sets out the statutory framework and process of referral process for young people who are support via the NTS scheme and the process and practice in supporting trafficked young people who are under eighteen and to ensure any young people over eighteen are also supported to appropriate accommodation via the Home Office. The practice guidance provides clarity on the support young people will require when they initially arrive in North Ayrshire and to ensure there is a consistent approach in the ongoing support as looked after children and care leavers. The aim of the guidance was to ensure consistency of practice and increase knowledge and awareness of the appropriate legislation and links to other services to support UASC in North Ayrshire. At the time of writing there are Forty Unaccompanied Individuals, with Nine residing within our Children’s Houses and Thirty-One in the Community. Housing Protocol It was acknowledged that the current Housing Protocol was outdated and required updated and refreshed to ensure it reflected the changes with continuing care and eligible young people who should be supported via the protocol. To ensure the updated Housing protocol had a clear process for housing allocation for care leavers and care experienced young people and an escalation process when there was a delay in an offer of housing for young people who were moving on from a care setting. There were case examples of young people who were approaching twenty-one and there was no offer of suitable housing and concerns that care leavers were being offered tenancies in unsuitable areas. Service Meetings Within the Workstream it was noted that there had previously been joined up meetings between the Housing & Throughcare services to review applications etc, but they had fallen away and hadn’t taken place in some time, the purpose of the meeting was to review Housing Applications that had been made for young people and discuss their needs and circumstances. h As an action these meetings have been re-established, the have been scheduled into the diary and will take place on a monthly basis, in addition to this a tracker has been developed that will allow for the process to be tracked, and for the applications to be highlighted based on the date the Young Person will turn Twenty-One. The Tracker also includes individuals who are over Twenty-One, as throughcare can work with Young People up until they are Twenty-Six. Supported Care Scheme There has been developments and an update to the supported care scheme as an alternative option for UASC and young people moving on from residential care, or an alternative to residential care for young people over sixteen. The programme board and PSMT have agreed an increased allowance for supported carers 146
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NORTH AYRSHIRE Health and Social Care Partnership 93 Delivering care together Supported Accommodation Development Initial scoping of a supported accommodation model is being explored. this is with a view of having a service for Young People who require additional support and who are not ready for independent living, this would be a facility where Young People could stay until age of Twenty-One. A supported accommodation would provide an alternative to young people remaining in internal and external residential care and provide a stepping stone to independent living within a supportive environment. The landscape and demographic of young people in residential care have shifted with an increase in young people aged sixteen and above with a high number requesting continuing care which supports them to remain in residential houses until they are aged twenty-one. This changing landscape is a result of Continuing Care legislation and Staying Put Guidance for Local Authorities and other Corporate Parents which promotes supporting looked after children and young people to remain in care, as part of a staged transition towards adulthood and greater independence. Tenancy Skills Programme It was highlighted in the Transitions for care experienced young people A thematic review November 2024 that Stirling Council had set up SQA Accredited Tenancy Skills to support care experienced young people transition into their own tenancy and supported by weekly group sessions from the Champions Board. This is a collaboration between the council’s housing service, the champions board, children and families’ social work, and education. The materials from the programme have been shared with North Ayrshire and there is scope to develop a tenancy skills programme for young people. The Throughcare service have liaised with employability who are keen to support an accredited tenancy programme, and work has commenced looking at the programme content and plan to role this out when the accreditation has been finalised. To promote the and ensure buy in from young people House Managers will be made aware of the tenancy programme which will also involve housing colleagues. Satellite Flats There have been discussions with housing on the possibility of the HSCP having local authority tenancies in close proximity to children’s houses that can be utilised to support young people transitioning from residential care to support capacity for independent living before they move into their own accommodation. The young person would be able to receive outreach support from children’s house staff. 147
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NORTH AYRSHIRE Health and Social Care Partnership 94 Delivering care together Housing Position We are committed to reviewing throughcare cases for all young people regularly to ensure that applications are updated and reviewed with the support of our Senior Housing Officer (Promise Champion). This process maximises young people’s choices and ensures a positive rehousing outcome. We are committed to reviewing and updating our Housing Protocol to ensure that this reflects the changes with continuing care and eligible young people who are supported by the protocol. • One Hundred & Forty-Four Throughcare applicants have been rehoused in the last five years. • There are currently Sixteen Throughcare applicants in Group two waiting to be rehoused. 148
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NORTH AYRSHIRE Health and Social Care Partnership 95 Delivering care together 100 Days of Listening Report 2024 (Staff & The Promise Scotland) Key Themes 100daysoflisteningfinal17.6.24digitalrgb.pdf These are four themes that were heard across all the wellbeing indicators and felt to fundamentally impact on a care experienced person’s ability to have a move on from care that was safe, loving, and respectful. The ‘What Matters’ points reflect what ‘moving on’ experts believe Scotland needs to keep The Promise for people moving on from care Systems and Services There was a perception from ‘moving on’ experts that there is a lack of future planning for all key transition stages. This was felt to have a profoundly negative impact. Care experienced young people regularly felt disconnected and unrepresented in the limited planning processes that are taking place. What Matters? • Planning at both an individual and system level needs to be reviewed. Comprehensive planning processes that account for individuals’ needs at various ages and stages must be implemented. • All young people moving on from care should have access to pathways planning to support a planned move that recognises their needs as an individual, so support is provided on a needs-led basis. • A needs-led approach should be expected, which places less emphasis on chronological age. Scotland needs to remove the cliff edges of care that are caused by criteria based on age. • The establishment of agreed pathways from children services to adult services to ease access of support for care experienced young people who have ongoing or lifelong care needs. Housing The issues surrounding housing fell into the broad categories of availability, sustainability, and quality. Like other groups, care experienced people found it difficult to access housing in a timely manner. In a general sense, care experienced people spoke of not being taught the skills to sustain a tenancy and manage a household. Finally, there was a clear message that the housing that care experienced people were offered was often in a poor state. The workforce echoed all these issues, and they noted frustration at the lack of money and resources available to support young people into housing in the way they wanted. What Matters? • No young person should be expected to hold a tenancy autonomously at 16/17 years of age. • Young people should not be moved into a tenancy in a crisis, moving a person into their first home of their own should always be managed in a planned and respectful way. • The need for Scottish Government to address the housing in crisis in Scotland is already well documented elsewhere and this is echoed by the 100 Days of Listening. 149
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NORTH AYRSHIRE Health and Social Care Partnership 96 Delivering care together • Consideration given to extend the housing protocol in areas to children who have grown up in an out of authority placement. Finance Issues within finance were about how much money care experienced people had, how they managed their money and the financial constraints in providing high-quality care. There was a general perception that care experienced young people do not have a sufficient income to ensure their own wellbeing. This point was raised by both the workforce and care experienced people, but care experienced people also stressed that they do not have sufficient skills to manage their money well. Care experienced people in further and higher education spoke highly of the care experienced bursary, but some still experienced poverty due to using the bursary to pay for their rent. The workforce presented as frustrated at the lack of resources to ensure they could provide adequate care and support for young people. What Matters? • To ensure financial security for care experienced young people it may be helpful to consider a guaranteed income approach for care experienced young people who have moved on from care. • Consider extending the right for continuing care for young people in further/higher education so that their care matches their length of study. • Higher priority is given to the ‘moving on’ phase of a young person’s life by all relevant parts of the ‘care system.’ Better planning on an individual and systemic basis is required to ensure resources are secured to best meet need. • The workforce must have the capacity to ensure that they are able to provide a high level of care for young people and that relationships are supported to continue through and beyond care. Practical Support and Life Skills There was a recognition across both care experienced people and the workforce of the need for young people to have practical support and life skills to manage their life comfortably and safely. It was understood that children and young people who grow up in a stable family environment will be taught a variety of simple DIY, cooking, and budgeting skills by their family members. Those with lived experience often felt this was missing from their lives. What Matters? • Opportunities for developing a variety of life skills should be planned and be as naturally occurring as possible. • When a care experienced person moves into their tenancy, they should have access to a trusted person or team to support them with everyday practicalities. The ‘Moving On’ Change Programme’s third phase, blueprinting, will use the information collected through the one hundred Days of Listening to inform the creation of tests of change. The tests of change will be small in nature and will gauge whether the change opportunities identified can support the delivery of The Promise. This will all contribute to the 150
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NORTH AYRSHIRE Health and Social Care Partnership 97 Delivering care together production of a shared set of standards and principles that will inform a national ‘Moving On’ strategy for Scotland. Moving On’ from Care into Adulthood Consultation 2025 Scottish Government Respondents were asked to provide insight, suggestions and examples of practice which might help the Scottish Government understand how support for young people, and those who care for them as they transition out of care, can be improved. Respondents emphasised the importance of including the young person and the adults who care for them more in the planning around the transition from care and creating a plan that best meets the individual needs of each young person. Respondents also suggested that better guidance and training be provided to staff members involved in assisting young people leaving care. Suggestions included training in trauma-informed approaches, a broader understanding of support and services available and a clearer understanding of statutory responsibilities. Respondents also felt there should be greater collaboration between services, including better information sharing, earlier planning and preparation for transitions, and that support should be person-centred, meeting the unique needs of each individual. There was a clear consensus from respondents that a lack of resources and workforce capacity at a local level are barriers to implementing the suggestions recommended above. This was seen to impact how effectively staff engage with young people and create a lack of continuity and stability among the teams assisting them. Other respondents highlighted structural issues, particularly interactions between different systems and processes that could be a barrier to starting the process of planning and preparing young people to leave care at a suitably early stage. 151
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NORTH AYRSHIRE Health and Social Care Partnership 98 Delivering care together Strategic Direction and Next Steps The workstream has provided the current position, pressures and challenges relating to resources to support care leavers/care experienced young people. Within the workstream there has been improved collaboration and joint working between Throughcare and Housing and the following areas which are being developed or progressed. • Integrated Service meetings have been re-established. • UASC Guidance for services has been developed. • Housing Allocation Tracker has been developed. • Supported Carers Scheme has been Approved. • Revised Housing Protocol • Accredited Tenancy Skills Programme being developed The workstream findings from quantitative and qualitative data would indicate that there is an increased number of young people that need to be supported by the Throughcare Service under our statutory obligation. There are also numerous case examples where young people transitioning from care have been unbale to sustain their tenancy and resulted in failed tenancies, multiple failed tenancies which has questioned the preparatory work and capacity for independent living skills. • The workstream would provide the recommendation and strategic direction for the Board to consider the development of a supported accommodation model which would support young people aged 16-21 with potential for young people staying longer should they require further support. Extensive research, together with the collective experience of workstream members has demonstrated that young people leaving care/leaving home to take up their own tenancy find it difficult to cope. Therefore, most young people leaving a children’s house, residential school, etc. benefit from supported accommodation to enable a gradual move towards their own tenancy with on-going support being provided throughout. The development of a 6-bed supported accommodation service for young people would be an alternative to young people remaining in internal and external residential resources under continuing care which would provide a resource for increasing capacity for independence and for a gradual transition from care. The length of stay of a young person will vary, again, depending on follow on support and housing availability and readiness for independent living. The proposal is a solution that bridges the gap of current service provision, meeting local and national outcomes, of empowering the lives of our young people. It is the recommendation of the workstream that the integrated working continues between our Housing & Throughcare services, continuing to share information & review young people’s Housing application needs. 152
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NORTH AYRSHIRE Health and Social Care Partnership 99 Delivering care together Appendix One Commissioned Service One The service provides new purpose-built accommodation for young people from age 16 who are care leavers, the model is cluster homes with intensive support from two staff members 24/7 who have a separate house that offers young people consistent practical and emotional support. The aim of the service is to provide accommodation to young people for up to two years and prepare them to move to independent living in the community. The service is offering support to young people who require a stepping stone from residential care to living independently in the community and to prepare them for independence and prevent homelessness and future tenancy failures. The service can support young people with additional needs and mother and baby placement and within the staff house they also have a crisis bed to support young people. The arrangement with young people is via an occupancy agreement and they are supported to claim housing benefit. The Local Authority and Commissioned Service One work in partnership to identify land in the area that the local authority gift or sell for a small fee and the commissioned service via funders backing build the new homes. Local authorities have commissioned the service and agreed to a block contract. The service has ongoing projects and has no scope to consider partnership with other local authorities for the next three years. Commissioned Service Two Supports eight young people Core and cluster supported accommodation with six one-bedroom flats to support young people moving on from residential care to support gradual transition to independent living. The resource has staff on the resource 24/7 to offer support to young people and they provide ongoing outreach support to young people who move on from the resource to live in the community independently. The service also has semi-detached house that also supports two young people who require less support. 1. The IJB cannot own property, so any service the HSCP develops/commissions would either need to be rented or owned by the council, or the provider. 2. For a housing type service, housing benefit can/needs to be claimed and needs to be CI Registered. (or similar) Commissioned Service three Housing Support Service 16-25 The resource is a partnership between social work and housing; Commissioned Service Three lease the flats from The Local Authority and Social Work commission the service to support six young people transition from foster care or internal or external residential care. The resource is made up of six independent flats and a communal area for staff and young people to use. The service has seven support workers (trained to level 3 SVQ 3) 3-night shift workers and 4- day time workers. A Service Manager and an assistant Service Manager oversee the service. 153
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NORTH AYRSHIRE Health and Social Care Partnership 100 Delivering care together Service supports young people’s capacity for independence and has had positive outcomes with young people sustaining tenancies in the community and equipping young people with the soft skills, being part of their community and support with practical skills and emotional capacity to live independently. National House Project The Promise Oversight Board highlighted the National House Project as positive example of change and good practice to support care experience young people. There are currently House Projects in Fife, East Dunbartonshire, and Midlothian. The aim of the National House Project is to enable young care experienced people to develop a peer community with others who are also leaving care, and to live together in a home that supports them to develop the skills needed to live interdependently and provide one another with practical and emotional supports and skills, The National House Project (NHP) provides a psychologically informed practice framework to support young people in care to move into their own homes and live connected and successful lives. It enables them to achieve their potential and whilst improving outcomes for individual young people it also realises financial savings to Local Authority budgets. The attached financial modelling paper considers the costs to set up and run a Local House Project and the potential savings that can be made by the HSCP. Reports Transitions for care experienced young people A thematic review November 2024 Transitions_for_cyp_thematic_review_final.pdf 100 Days of Listening Report 2024 (Staff & The Promise Scotland) 100daysoflisteningfinal17.6.24digitalrgb.pdf Moving On’ from Care into Adulthood Consultation 2025 Scottish Government 154
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NORTH AYRSHIRE Health and Social Care Partnership 101 Delivering care together Appendix4- Moving on Forum- Terms of Reference Moving on Forum – Terms of Reference Authors – Kevin McGinn/ Arthur Coutts 155
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NORTH AYRSHIRE Health and Social Care Partnership 102 Delivering care together Introduction The Moving on Forum 1. The Moving on Forum was developed from the Housing and Throughcare workstream that was part of the Brighter Pathways transformation work. It was agreed that there would be a monthly forum with Housing and Throughcare services to discuss all young people with live housing applications and to project young people who would require future priority two housing applications. The forum would be called the Moving on Forum. 1.1. Looked after children and young people are amongst the most vulnerable in society. The functions of local authorities in relation to children who are ‘looked after’ by them are set out in the Children (Scotland) Act 1995 and associated regulations and guidance. The principal regulations are in Care Planning, Placement and Case Review. These functions in North Ayrshire are delegated to the IJB and undertaken through the HSCP. The Children (Scotland) Act 1995 1.2. sets out that Local Authorities have a legal duty to: 1.3. Sets out the general duty of the local authority looking after a child to safeguard and promote the welfare of the child. This duty underpins all activity by the local authority in relation to looked after children. This duty is known as ‘corporate parenting.’ ‘Corporate parenting’ means the collective responsibility of the council, elected members, employees, and partner agencies, for providing the best possible care and safeguarding for the children who are looked after by the council. 1.4. Prepare young people for leaving care or ceasing to be looked after. 1.5. Provide advice and assistance to young people who have ceased to be looked after on or after their 16th birthday. Local authorities are legally required to provide aftercare support until the care leaver turns nineteen, and to assess any eligible needs for aftercare support until they turn 26 (or beyond in some cases). 1.6. The Children and Young People (Scotland) Act 2014 strengthened the approach to throughcare and aftercare for children and young people by putting into law Section 67 of The Children and Young People (Scotland) Act 2014. Section 67 of The Act (2014) inserted a new section and from April 2015, a young person born after 1 April 1999 who is looked after in foster, kinship or residential care is eligible to remain in their current care placement until they turn twenty-one. This is called Continuing Care, Further legislation that is of key interest to this work includes the Social Work Scotland (1968) Act and in particular the legislative requirement therein to promote welfare in the local authority area. Remit of the Moving on Forum: 2. To ensure a coordinated response to the accommodation and support needs of care leavers. 2.1. To plan and review young people's transition from care to their own tenancy. 2.2. To maintain a record of all young people and actions required to ensure. there is no delay in the offer of appropriate housing /support. 2.3. To ensure all young people who need to transition have a live housing application. 156
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NORTH AYRSHIRE Health and Social Care Partnership 103 Delivering care together 2.4. Develop whenever possible, shared pathways, procedures, and policy within services. 2.5. To review housing application status and young people housing options and area selected. 2.6. Forum to ensure adequate visibility of young people entering the transition phase to allow other service to strategically plan their resources. 2.7. Create a governance system that promotes good practice, safety, and quality, in order to improve outcomes for care leavers/care experienced young people. 2.8. To ensure any young people who have made a new housing application are added to the tracker and reviewed. 2.9. To ensure the principles of the Care Leavers Housing protocol are adhered to. Care Leavers Housing Protocol 3. Key Areas that have been strengthened in the revised Care Leavers Housing Protocol: 3.1. All care leavers will be in Group 2 housing allocation which is the second highest priority group. 3.2. The protocol reflects the commitment of each party to strengthen existing services and joint working arrangements, detailing the duties and responsibilities of each department. 3.3. A range of accommodation and support solutions will be made available to young care leavers on discharge from care and until their 21st birthday, with advice and guidance available until their 26th birthday. 3.4. Improved information sharing, earlier planning and preparation for transitions, and that support should be person-centred, meeting the unique needs of each individual. 3.5. Access to an appeals and resolution service, which is described and understood by young people. Chair 4. The Moving on Forum will be chaired by the Throughcare Team Manager 4.1. In the absence of the chair, a nominated deputy from the Throughcare Team deputise and assume responsibility for chairing the meeting. Membership Name Organisation Role Contact Claire McAlpine HSCP Throughcare Team Manager clairemcalpine@north-ayrshire.gov.uk Liz Brown Housing Team Leader lizbrown@north-ayrshire.gov.uk Stacey Hume Housing Team Manager staceyhume@north-ayrshire.gov.uk Deputy HSCP Throughcare TBC Kevin McGinn NAHSCP Planning Manager kevinmcginn@north-ayrshire.gov.uk 5. Planning Support will be provided in the interim; it is expected that this resource will cease after a period of three months from the date of the first meeting. Attendance 6. Members can nominate a deputy to attend meetings in their absence. Providing the nominated deputy has relevant knowledge or an update on young people on the tracker that will be discussed the forum. 157
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NORTH AYRSHIRE Health and Social Care Partnership 104 Delivering care together 6.1. Where a member cannot attend, they should notify the chair as soon as possible, copying in their alternative proposed attendee. In order to ensure quorate, members must be clear when no representation can be sent. Administration of Meetings 7. The tracker document will be update at the meeting and will be a live record of the discussion and actions that will be reviewed at the next meeting. 7.1. The updated tracker including action points will be shared with forum members. Quorum 8. The forum will require Housing and Throughcare representation to enable the meeting to take place. 158
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NORTH AYRSHIRE Health and Social Care Partnership 105 Delivering care together Appendix5- Care Leavers Housing Protocol North Ayrshire Care Leavers Housing Protocol Kevin Mcginn (Planning Manager / HSCP SP&TT ) Abstract This Paper provides a Strategic Update to the IJB. 159
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NORTH AYRSHIRE Health and Social Care Partnership 106 Delivering care together Management Information Responsible Manager Mae Henderson Author(s) Arthur Coutts & Liz Brown Date Agreed at Governance Implementation Date Review Date Version Control Version Date Author (s) Comment 1.0 27/10/2025 Arthur Coutts & Liz Brown 160
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NORTH AYRSHIRE Health and Social Care Partnership 107 Delivering care together 1.Introduction Housing & Social Services Care Leavers Protocol and Procedure North Ayrshire Health and Social Care Partnership place the health, welfare and development of children and young people, at the centre of the planning and delivery of services. Research indicates that care leavers are particularly vulnerable when making the transition to adulthood and are frequently over-represented in statistics relating to homelessness. Their need for a continuation and a spectrum of support is recognised within this Protocol. North Ayrshire Health and Social Care Partnership will offer an integrated and co- ordinated service which aims to ensure that no care leaver will become homeless, on leaving care, residential, foster or kinship care and will provide the necessary support to ensure a care leaver can achieve independence and stability within the community. The Protocol promotes the principle that care leavers will be provided with the securest form of tenancy available to them, dependant on support needs and independent living skills. This Protocol is an inter-agency departmental agreement between Housing and the Heath & Social Care Partnership, detailing the joint response to the support and accommodation needs of care leavers and young people, who have been looked after and accommodated by North Ayrshire aged 16-25. The protocol only applies to looked after young people who are the responsibility of North Ayrshire Council and will not be applicable to any young people placed in North Ayrshire by other local authorities, if these young people require accommodation they will be supported under the general housing application process. This Protocol supports the following outcomes: National Outcome • We live longer healthier lives. North Ayrshire Outcome • More vulnerable young people are supported within their own communities. National Outcome • We have tackled the significant inequalities in Scottish society. The overarching aim of this Protocol is to ensure a co-ordinated response to the accommodation needs of care leavers. It outlines the legal and operational frameworks agreed between the departments for providing assessment, planning and appropriate accommodation for young people leaving care. 161
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NORTH AYRSHIRE Health and Social Care Partnership 108 Delivering care together It also provides for care leavers who have found themselves unexpectedly homeless, or in significant housing difficulty. This will be achieved by ensuring: • No young person will become homeless on leaving care. • A range of accommodation and support solutions will be made available to young care leavers on discharge from care and until their 21st birthday, with advice and guidance available until their 26th birthday, if involved with the Throughcare team. • Provision will be based on the best interests of the young person, taking their views into account. Throughcare will support by enhancing independent living skills, identifying support needs, offering practical, financial and emotional support. Access to employability and counselling services is offered by Throughcare and based at Meadowcroft for young people to access • A joint approach involving all relevant partners will be adopted, to maximise tenancy sustainment. • The protocol reflects the commitment of each party to strengthen existing services and joint working arrangements, detailing the duties and responsibilities of each department. • Both parties are committed to working together to improve outcomes for young people, who have been looked after and accommodated. • Housing services will ensure the provision of appropriate advice and assistance to young people leaving care, to prevent homelessness and ensure transition to suitable accommodation. • A detailed Pathway plan has identified the young person’s individual needs in relation to Housing, Health, finances, friends/family and aspirations for future. The Pathways plan will identify the most appropriate route of housing for the young person as well as their identified support needs. • The young person’s needs will be reviewed through the Moving on Forum Outcomes Housing and the Health & Social Care Partnership will ensure that a care leaver receives: • A consistent integrated service. • Excellent information sharing, earlier planning and preparation for transitions, and that support should be person-centred, meeting the unique needs of each individual. • All young people moving on from care will have a completed pathways plan to support a planned move that recognises their views, needs as an individual, so support is provided on a needs-led basis. • Access to accommodation which considers the young person’s needs and choice. 162
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NORTH AYRSHIRE Health and Social Care Partnership 109 Delivering care together • Access to an appeals and resolution service, which is described and understood by them • Appropriate support during their transition to independence, within the community. 3. Legal Framework 3.2 UN Convention on the Rights of the Child 1989 This international framework outlines the rights of the child up to their 18th birthday. In relation to accommodation, it includes: A right to an adequate standard of living for their physical, mental, spiritual, moral and social development. Young people deprived of their family environment are entitled to special care and protection paying due regard to their cultural background. Decision making about accommodation must take contact with family, protection from abuse, neglect and exploitation, health, leisure and recreation activities into account. 3.2 Children (Scotland) Act 1995 This Act places a duty on Corporate Parents to ensure that their policies take account of the needs of care leavers. It also extends the age to which a care leaver can access support, to 26 years. The Act alters Section 29 of the Children (Scotland) Act 1995, to define those young people eligible for support to those ‘looked after’, beyond their 16th birthday. 3.3 Continuing Care Continuing Care Legislation is contained within the Children & Young People (Scotland) Act 2014 under Part 11 of the Act – Section 67. This section of the Act indicates that there is a duty placed on Local Authorities to provide young people, who’s final ‘looked after’ placement, on, or after their 16th birthday, was in foster, kinship, or residential care, with the same accommodation and other assistance, as was being provided by the local authority, immediately before the young person ceased to be ‘looked after’. Therefore, this enables a young person to remain in the same placement, they were in, when they were ‘looked after,’ beyond the age of 16 years, i.e. foster care, kinship care, or residential care. 3.4 The Housing (Scotland) Act 1987 Part 1 Section 20 as amended by Part 1 Section 10 of the Housing (Scotland) Act 2001 Local Authorities and Registered Social Landlords have a duty to give reasonable preference when selecting tenants to people who are: - 163
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NORTH AYRSHIRE Health and Social Care Partnership 110 Delivering care together • Are homeless or threatened with homelessness. 3.5 The Homelessness etc. (Scotland) Act 2003 This Act strengthens the rights of people affected by homelessness in Scotland. It amends details of the Housing Scotland Act 2001 and prioritises a coordinated national and local approach in the prevention of homelessness. 3.6 The Children and Young People (Scotland) Act 2014 This Act places a duty on Corporate Parents to ensure that their policies take account of the needs of care leavers. It also extends the age to which a care leaver can access aftercare support to 25 years. The Act alters section 29 of the Children (Scotland) Act 1995, to define those young people eligible for Aftercare to those looked after, beyond their 16th birthday, rather than school leaving age 3.7 The Promise Scotland holds ambition that all children will grow up safe, loved, and respected so that they will meet their full potential. The Independent Care Review concluded that this ambition was harder to meet for those children who have grown up in care. Supporting young people when they wish to transition to independence from care was a key feature of The Promise. The Promise notes the challenges care experienced young people face when going through the transition from leaving care and into adult life and living independently of the care of services. The Promise spoke of the need to support both care leavers and those with experience of care to move on from care in a planned way, with care leavers fully informed in decisions. “Parenting does not stop at 18. Throughout The Plan, Scotland must continue to consider how to create greater equity and opportunity for care experienced young adults. That consideration must include how to increase opportunity for care experienced people to access employment, training, stable housing, and support.” — (pg93, The Promise, 2020) 4 Definitions of a Care Leaver For the purpose of this Protocol, a care leaver will be defined as any young person who has been looked after and accommodated by North Ayrshire Health and Social Care Partnership who meets the criteria of the legislation above. It will also encompass those young people, who have been referred to North Ayrshire Health and Social Care Partnership by another authority, under the national Protocol on the Management of Leaving Care where young people move between local authorities in Scotland. (The regulations for supporting care leavers use the following terms to describe the categories of looked after young people, who are to be supported under these new arrangements.) Currently Looked After Person 164
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NORTH AYRSHIRE Health and Social Care Partnership 111 Delivering care together A young person who is over 16, but less than 21 and who is being ‘looked after’ or ‘looked after and accommodated’ by the local authority. The duty is to prepare a young person for when they are no longer ‘looked after.’ Compulsory Supported Person A young person who is subject to support and assistance under Section 29 of the Children (Scotland) Act 1995 (amended by Children and Young Person (Scotland) Act 2014) who is no longer looked after and is less than 19 years. Prospective Supported Person A young person applying for assistance under Section 29’ who is 19’ or 20 years of age and who left care over 16 years. Continuing Care raises this to age 26 years. 5. Transition from a care setting to temporary or mainstream housing. 5.1 Pathway Plan/Assessment Needs to be undertaken, before they leave care. This person-centred activity will enable the individual ambitions and support needs of the young person to be outlined and understood. The HSCP is committed to improving outcomes for care leavers, particularly with regards to accommodation, health and education. Consequently, support for a young person’s Pathway Plan is a Corporate Responsibility. Pathway planning has three components: Pathway Views, Pathway Assessment and Pathway Plan (appendix 2). The assessment is informed by the views of the young person. • Pathway Views – this is the hopes and aspiration of the young person for their future. • Pathway Assessment – identifies strengths and support needs of the young person • Pathway Plan – details support plan to able the young person to meet their aspirations. Only in extreme circumstances should young people be moved on from care, without a Pathway Plan, or against the recommendation of the plan. There will be direct links with the Looked After and Accommodated Children review process. The current care plan and the officers responsible for its review will have a position in the Pathway Planning process. As a service, we must be clear that the young person meets the Group 2 eligibility in the first instance. If there is no Child and Family assessment/Childs plan in place and housing needs arise unexpectedly then information sharing between Throughcare and Housing should take place so a detailed overview of needs can be captured. 165
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NORTH AYRSHIRE Health and Social Care Partnership 112 Delivering care together An internal review should be convened with Housing and Throughcare to reflect on situation, ensure improvements and ongoing learning are identified in order to support a young person to sustain their tenancy. Procedures Not every young person will require provision of housing on discharge from care. The following procedures will apply only where housing is required. If the young person is 16 – 18 years of age, the Locality Team Social Worker from the HSCP, who is the Lead Professional, will be responsible for convening a planning meeting, to which Housing will be invited. All relevant support plans should be available for discussion and should include any relevant risk assessments. If the young person does not have an active application this should be completed, and all relevant housing forms should be forwarded to the Senior Housing Officer and forwarded to the Senior Manager (Housing Operations) Housing & Public Protection for approval. This should include any application for accessible housing. If the young person is 18 years plus, this Planning Meeting, will be convened by a member of staff from the Throughcare Team. All relevant people required to attend, as identified by the young person, are notified. This meeting should be convened at the earliest stage possible, usually six months before the young person leaves care. As per above process for 16–18-year-olds this should apply to 18 years plus in relation to the completion of relevant housing paperwork. 5.2 Pre Determination A care leaver’s housing and support needs will be identified as part of the Pathway Planning Process. The Locality Social Work Team or the Throughcare Team will, in partnership with others including housing, provide a detailed assessment of the young person’s needs, in both the short and longer term, by way of accommodation. The Moving on Forum will capture discussion around suitability of proposed tenancy. An application for housing will require to be completed when the young person turns 16. This will be co-ordinated by a Senior Housing Officer and the Throughcare Worker. If the Young Person remains within a Continuing Care placement, it should be noted that Housing applications may be undertaken at any point between the ages of 16yrs -21yrs. All housing applications with be tracked and reviewed every four weeks by the Throughcare and Housing Service. As part of the Moving on Forum the throughcare tracker is reviewed and updated accordingly. If a young person has not secured mainstream accommodation 6 weeks prior to discharge a meeting will be held with the Team Leader (Housing Support & Temporary Accommodation) to discuss the requirement for temporary accommodation. 166
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NORTH AYRSHIRE Health and Social Care Partnership 113 Delivering care together • The Social Worker, or the worker from the Throughcare Team and Team Leader (Housing Support & Temporary Accommodation) will have weekly contact prior to discharge, to ensure the transition from care is seamless. • The Social Worker, or the Throughcare worker, will have responsibility for ensuring the identified support package is in place, before the young person leaves care. • The Senior Housing Officer should record summary information within the Housing Services system, which should be updated and maintained through to final resettlement. 5.3 The Transition Meeting (Discharge LAAC) ‘Looked After & Accommodated’ Review Representation • Social Work - representative of the Locality Area Team, or the Throughcare Team (Known under the Regulations as the Pathway Co-ordinator). • Throughcare Worker will complete housing application and send to Senior Housing Officer for processing. The Senior Housing Officer will liaise with the Local Area Housing Manager if required. • Any other person as determined by the young person. • All applications will be reviewed by The Team Manager (Neighbourhood Housing) and approved by The Senior Manager (Housing Operations) Housing and Public Protection. 6. Accommodation & Support Assessment Options Accommodation options for the young person leaving care will be determined by the housing needs assessment, as identified at the Planning Meeting/Discharge Looked After and Accommodated Review, which will consider: ▪ The level of competency and skill of the young person to move towards independence ▪ The level of preparation and support that will be required ▪ The time scales for moving on There are five assessment categories which will be considered for the young person, dependant on need: - 1. Able to sustain a tenancy with minimal support input. 2. Able to sustain a tenancy within the next 12 months with support provision. 3. Requires supported accommodation in preparation for independent living. 167
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NORTH AYRSHIRE Health and Social Care Partnership 114 Delivering care together 4. Requires intensive support but supported accommodation not appropriate. 5. Leaving Supported Care with no interim accommodation requirements. Dependant on which category the young person needs most closely match, the following accommodation options will be selected: 6.1 Assessment Criteria 1 In exceptional circumstances a young person may leave care and be equipped to move directly into mainstream accommodation. This would be determined at the planning meeting and would require mainstream accommodation to be available on discharge from care. 6.2 Assessment Criteria 2 Where a young person is either awaiting availability of a tenancy, or requires a short period of accommodation to confirm assessed ability to manage a tenancy, the following would apply: - • Young person placed in Temporary Furnished Accommodation to assess skills prior to allocation of permanent accommodation. • Throughcare Staff will provide resettlement and skill development. • Housing – Temporary Accommodation Officer will carry out weekly property inspection. • Housing, Throughcare staff and Young Person will have weekly contact. • Young Person will have access to Out of Hour’s Service telephone numbers as deemed appropriated by the Leaving Care Service, following Support Assessment. 6.3 Assessment Criteria 3 • Young person placed within interim accommodation. • Following Support Assessment, Throughcare Team will identify and deliver the support package to young person. • Support provision will be reviewed two weekly and increased, or decreased, as appropriate. • Housing Property Officer will carry out weekly property inspection. • Housing, Throughcare and Young Person will have two weekly contacts. • Throughcare will advise Temporary Accommodation Officer, Local Housing Manager and HAT Officer, when young person is ready for housing, four to six weeks prior to housing being required, at the housing review meeting. • Young Person will have access to Out of Hour’s Service telephone numbers as deemed appropriated by Throughcare, following Support Assessment. 6.4 Assessment Criteria 4 • Young person will be placed within temporary accommodation. 168
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NORTH AYRSHIRE Health and Social Care Partnership 115 Delivering care together • Throughcare service staff will have a weekly input to support provision. • Throughcare staff will advise when young person is ready for housing, following a Pathway Review meeting and will request, either furnished accommodation, or activation on the waiting list. • Furnished accommodation may be provided for a period of time to assess independent living skills, prior to allocation of housing, or where allocation of permanent let is likely to take an extensive period of time. • Throughcare staff will provide resettlement and skill development. • Housing, Throughcare and Young Person will have weekly contact. The young person will have access to Out of Hours Service telephone numbers. as deemed appropriate, by the Throughcare staff, following the Support Assessment. 6.5 Assessment Criteria 5 • When a young person is leaving Supported Care, Interim accommodation may not be required. • Each case will be reviewed on its own merit, via the Pathway process. The above is not intended to be a structured pathway. As support needs change, or if following assessment accommodation proves to be unsuitable, a young person can move between accommodation types. Interim accommodation can be furnished accommodation within any sector, hostel accommodation, or a private let. 7.Guidance 7.1 North Ayrshire Housing Allocation Policy Application for Housing Once the young person has been assessed as ready for a tenancy and if they are still seeking housing in the social rented sector, the Senior Housing Officer will convene a meeting inviting Throughcare team Staff and the Area Housing Officer. At the meeting the young person’s application will be discussed to ensure sufficient areas, landlords and house types have been selected to be offered a property in a reasonable time scale. The support package being provided to assist the young person to sustain the tenancy will also be discussed. A summary of this should be put on the application notes. The Housing Application form should be passed to the Area Housing Officer with a Group 2 referral Form (appendix 3) attached to the front, signed by the Throughcare Team Manager. The Area Housing Officer will seek approval and signature from the Senior Housing Operations Manager and allocate the form in order that it be pointed and made live on the NAHR immediately following the meeting. An alert should be placed on the application to contact Throughcare team prior to offer. 169
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NORTH AYRSHIRE Health and Social Care Partnership 116 Delivering care together The application will be placed on Group 2 - Strategic Housing Need, in accordance with the Allocation Policy. It is recognised that it may take a period of time before an appropriate offer of housing is made and temporary accommodation will continue to be provided as required. An email should be sent by the Area Housing Officer to the RSLs and the Area Manager within the areas of choice selected, to highlight the application in Group 2. Care Experienced young people, who were not previously looked after and accommodated, will have their homeless application completed at the point of homelessness and the application will be managed in line with the Allocation Policy for Group 1 applicants and input and managed on Arbitras by the Housing Advice Team. Offer of Housing When a care leaver is being made an offer of housing from Group 2, a copy of the Offer Letter should be sent to the Throughcare team. Where a care leaver, on Group 2 of the allocation policy, refuses an offer which does not suit their needs they will not be penalised for such however the Throughcare Team should contact the Senior Housing Officer and arrange a meeting to review the NAHR application. 7.2 Finance Rent costs for Care leavers under the age of 18, who meet the criteria of Children (Leaving Care) Act 2000, Section 6, will be provided by Throughcare Team. This is paid via Inter departmental transfer regardless of if the young person is in temporary accommodation or mainstream tenancy. Throughcare will advise appropriate personnel, within the Temporary Accommodation Team and Housing Finance, of those clients to whom this applies. For young people to which Throughcare have no statutory responsibility, assistance will be given by them to completing Universal Credit Applications. Young people 18-25yrs, if in higher education at a level of HNC or above can have rent costs paid by the Throughcare if in continual education. 7.3 Resettlement Support Resettlement support to mainstream housing will be provided by the Throughcare team to assist the young person set up their tenancy and develop their independent living skills. Any requirement for ongoing, or additional support identified, will be provided, or sourced by Throughcare. Where any issues arise within the tenancy, i.e. Neighbour complaints, poor property condition, rent arrears. Throughcare will liaise with the Local Housing Office, to try to resolve these issues. 7.4 General Housing 170
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NORTH AYRSHIRE Health and Social Care Partnership 117 Delivering care together • In the event that a previously care experienced young person, who has previously been rehoused as a Group 2 under the age of 25 who is at risk of homelessness, Housing Services will attempt to re-engage them within the above framework, in partnership with the Throughcare Service. • Housing Services will maintain regular contact with Throughcare, ensuring appropriate information is shared in relation to accommodation provision, in order to achieve the best outcomes for young people. This will be undertaken with the young person’s consent as required in terms of the Data Protection act 1998. • Housing Officers will forward a copy of the Offer of Permanent Accommodation Letter, to the appropriate personnel within the Throughcare Service. • Housing will endeavour to ensure that offers of accommodation are appropriate to the needs of the young person. • Housing Services will contact the Throughcare team with any concerns about a young person’s tenancy. • All services will ensure care leavers are not at risk of sleeping rough. • Housing will provide essential furnishings for temporary furnished flats. • Housing Temporary Accommodation Team will report any complaints or concerns raised, whilst a young person is in interim/temporary accommodation to the appropriate Throughcare staff. • Housing will ensure all repairs are carried out, to temporary furnished flats, and that all flats are decorated to a satisfactory standard. • Young people who return to North Ayrshire and are eligible for Group 2 assistance should be directed via Throughcare in the first instance. Support to complete Housing applications will be provided and names added to the Moving on Forum for oversight. 7.5 General Throughcare Services • The Throughcare Service will ensure they will provide appropriate levels of support to maximise tenancy sustainment. Where difficulties arise, Throughcare team will undertake to liaise with Housing Services. • The Throughcare team will respond to referrals made by Housing for young people, who may have been previously looked after and accommodated, checking for any previous contact information and offering assistance where appropriate. • The Throughcare team will work with the young person to help determine appropriate housing options and will liaise with appropriate housing staff to ensure the accommodation plan is implemented. • The Throughcare Team will ensure that the Senior Housing Officer, is invited to participate in Pathway Plans and reviews as appropriate. • The Throughcare Team will maintain regular contact with the Senior Housing Officer and Team Leader (Housing Support and Temporary Accommodation) in relation to accommodation provision, to ensure best outcomes are achieved for looked after young people, ensuring appropriate information is 171
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NORTH AYRSHIRE Health and Social Care Partnership 118 Delivering care together shared. This will be done with the young person’s consent as required in terms of GDPR and the Pathway Plan. • The Throughcare Team will instruct their finance section to make the necessary transaction arrangements, for rent payments with Housing Service’s finance Section, as agreed. • Financial responsibility is transferred to the young person at age 18. Support will be provided by the Throughcare Team, to ensure rental payment responsibilities are understood and make sure appropriate benefits are in place. • The Throughcare team will provide the appropriate levels of support to the young person throughout the duration of their stay within temporary accommodation (Short Scottish Secure Tenancy), ensuring the young person understands that ‘engagement with support’, is a condition of the Tenancy Agreement. • If a young person accrues rent arrears, or displays any anti-social behaviour, then they will be treated in accordance with the terms and conditions of their tenancy agreement. • Where an issue arises, which threatens the security of a tenancy, due to breach of tenancy agreement, the Throughcare worker will notify the Senior Housing Officer with immediate effect, to minimise the risk of homelessness. • If a young person abandons their mainstream tenancy, it is understood that a 28-day Abandonment Notice, will be served on the young person. During this period the Throughcare team will endeavour to locate and engage with the young person, to assess if it is appropriate for them to return to their tenancy and liaise with the appropriate Housing Officer and Senior Housing Officer to update. • Responsibility for housing support whether in temporary, or mainstream accommodation, remains the responsibility of the Throughcare team, whilst a young person is still within their Service. All Temporary Accommodation is managed as a Short Scottish Secure Tenancy. Mainstream Accommodation can be managed as a Scottish Secure Tenancy or as a Short Scottish Secure Tenancy. 7.6 Rental Charges Rental charges apply 52 weeks of the year, for both temporary accommodation and mainstream Social Rented tenancies. The Throughcare team will be responsible for accessing benefit, on behalf of the young person, or paying rent liability for a young person under 18, in line with legislation. When a tenancy has been identified, the Throughcare team will arrange for the young person to sign for the tenancy. H & SCP Leaving Care Service will advise the young person that rent is due from the day the young person signs up for the tenancy. 172
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NORTH AYRSHIRE Health and Social Care Partnership 119 Delivering care together 8. Monitoring & Evaluation Framework The protocol will be monitored on a 6 weekly basis involving representatives from the Senior Housing Officer, the Housing Promise Champions and the Throughcare team. The group will consider: • Progress of protocol. • Temporary Accommodation and support options outcomes. • Mainstream accommodation sustainability outcomes. • Review of Band 2. • NAHR active applications. 8.1 Membership of the Review Group Membership of the Review Group will include: • Throughcare Team Manager. • Team Leader (Housing Support & Temporary Accommodation). • Team Manager (Neighbourhood Housing) • Common Housing Register Manager 9. Crisis Intervention Framework 9.1 Emergency Case Conference Housing Services will undertake not to move any young person from their temporary accommodation or terminate temporary accommodation due to non-occupancy without prior discussion with the Throughcare team, unless in emergency circumstances. Any issues arising which could result in a young person being requested to vacate their temporary accommodation, will be discussed, at an emergency Case Conference, attended by the young person and appropriate personnel from Housing and H & SCP. The meeting will be arranged within two working days of concerns being raised. Housing Services will not serve an Abandonment Notice for non-occupancy of a mainstream tenancy without prior discussion with the Throughcare Team. A meeting will be arranged within 24 hours following notification of an unoccupied property as per abandonment procedures. Any other tenancy issues i.e. rent arrears, anti-social behaviour, estate management, tenancy conditions should be discussed at a Case Conference attended by the young person appropriate personnel from Housing and H & SCP. The meeting should be arranged within 7 days of concerns being raised. 9.2 Repeat Applications Care Leavers who are faced with having to terminate their tenancy must do so by alerting Throughcare and Housing at the earliest convenience. Repeat applications for Housing will be discussed by Team Manager (Neighbourhood/Housing) and Senior Housing Officers and Throughcare team 173
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NORTH AYRSHIRE Health and Social Care Partnership 120 Delivering care together Manager and supports identified if required, to ensure a young person is able to sustain a tenancy successfully. All repeat applications will be discussed on an individual basis. Housing and Throughcare service reserve the right to refuse future applications if there is sustained failure to adhere to tenancy agreements. 9.3 Out of Hours Contact Where a young person is deemed to require support, out with usual working hours, Throughcare service will endeavour to provide this, as agreed with the young person. The young person will be provided with both the Ayrshire Out of Hours Service and Emergency Accommodation telephone numbers. 10.Dispute Escalation Policy Should Throughcare and Housing staff fail to agree on either the assessment outcome, of a young person’s needs, or any other aspect of this protocol, the following procedure should be followed. • All paperwork should initially be passed to the Throughcare Service Team Manager, if no resolution. • All paperwork and reports should be passed to Senior Manager (Housing Operations) and Senior Manager (Children and Families), if no resolution, all info passed to Head of Service Housing and Public Protection and Head of Service (Children, Families and Justice). 11. Appeals Process Any young person can appeal by accessing the existing appeal process. 174
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NORTH AYRSHIRE Health and Social Care Partnership 121 Delivering care together Group 2 Referral Form – Appendix 1 North Ayrshire Housing Register Referral for applicant to be placed in Group 2: Strategic Housing Needs This form should be attached to the front of the NAHR application for housing which should be fully completed and signed by the applicant in the usual way Applicant Name Applicant Address Please indicate under which criteria the applicant qualifies for Group 2 Reason Please tick one The applicant’s home is due to be demolished by one of the partner landlords The applicant has been temporarily accommodated, to allow regeneration, or demolition by one of the partner landlords The applicant is a young person, who has been looked after and accommodated by North Ayrshire Council, at school leaving age The applicant is currently in long-term hospital care, or another institution (not prison) and requires to be resettled in the community The applicant has been approved as a foster carer and requires a property with an additional bedroom, in order to foster The applicant is in supported accommodation but is now ready to move on to a general need’s tenancy (does not include supported accommodation for homeless applicants). The applicant has extreme circumstances and an urgent housing need, which is not recognised by the existing policy Please provide any additional information about the case in this box, or continue on a separate page if necessary Name of Officer referring the case Designation of Officer Organisation/Service Contact Telephone Number Date of Referral Signature of Referring Officer Name of Approving Manager Signature of Approving Manager Name of Senior Manager Signature of Senior Manager Please return this form to any of the NAHR landlord offices detailed in the Housing Application Guide. To discuss the case please contact the housing manager at any of the following organisations/offices:- North Ayrshire Council Housing Offices Irvine 01294 324870, Kilwinning 01294 552261, Ardrossan 01294 605258, Saltcoats 01294 602611, Stevenston 01294 605281, Largs 01475 687590, Kilbirnie 01505 685177, Dalry 01294 835355. ANCHO 01294 313121. Cunninghame Housing Association 01294 468360. Irvine Housing Association 01294 271128. 175
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NORTH AYRSHIRE Health and Social Care Partnership 122 Delivering care together Appendix6- Supported Accommodation Business Case Project Name: Supported Accommodation Service Authors: Kevin McGinn/Arthur Coutts Date: 12-6-25 Service Area: Children, Families & Justice Executive Sponsor: Caroline Cameron Senior Responsible Officer: Elizabeth Stewart Planning Manager: Kevin McGinn Service Lead: Arthur Coutts Other (Finance, Data, etc. as apt): Lee Thomson Programme Board: Transformation Board Planned Start Date: TBC Planned Completion date: TBC Version Control Detail Version Date Changes Initial Draft 0.1 26-6-25 Business Case Development 176
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NORTH AYRSHIRE Health and Social Care Partnership 123 Delivering care together 1. Executive Summary 1.1 The Brighter Pathways Transformation Programme was commissioned to address the current challenges associated with resources and accommodation options for looked after and care experienced children and young people. Another main driver was to improve outcomes for care experienced young people which is in line with the aspirations of The Promise to ensure high quality models of alternative care and to ensure young people were supported appropriately when leaving care. The supported accommodation service would provide tailored support to young people to increased capacity for independence. Within the Workstreams it was highlighted that there are significant pressures and demands currently being placed on our internal children’s houses, all of them have been consistently over their registered numbers for a prolonged period of time. As a result of this North Ayrshire HSCP have utilised a high number of high-cost External Residential Placements. Across our Children’s Residential Estate we have Four Houses, each of them being registered to care for Eight Children & Young People, in total our houses are registered to look after Thirty-Two Children & Young People. At the time of writing, we have Thirty-Three Children & Young People residing within our Houses, as a result we are currently One Placement above our registered numbers, the houses have consistently been over numbers with an average cumulative occupancy percentage of 109% across our residential estate since 2023. External Placements As a result of our Children’s Houses being over occupancy North Ayrshire HSCP have had to utilise high-cost External Residential Placements, at the time of writing there are Twenty-Nine Children & Young People in External Placements, with a further two attending regular respite, the average cost for each type of placement is detailed below: • Average Internal Placement Cost-£125,000 • Average External Placement Cost-£ 247,219 Proposal The HSCP have been presented with the option of developing a six bedded building that is currently un-occupied into a Supported Accommodation Service for Young People aged 16-21 as an alternative to Continuing Care. 177
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NORTH AYRSHIRE Health and Social Care Partnership 124 Delivering care together This Business Case proposes to both utilise the opportunity to increase capacity across our Residential Estate and improve transitions into Independent Living for care leavers. It is expected that the proposed service would provide more tailored and focused support to prepare young people who were ready to move on from their care setting into supported care accommodation. In addition, it is also predicted that this resource would reduce the demand for high-cost External Placements in the future, it will also allow more Young People from North Ayrshire to live within their own community. 2. Problem Statement 2.1 In Scotland, local authorities have a clear statutory duty to provide care and accommodation for children and young people who are unable to live safely at home. Where family-based care such as fostering or kinship care is not suitable or available, the local authority must ensure that appropriate residential care is provided. This duty is set out in the Children (Scotland) Act 1995, which requires councils to safeguard and promote the welfare of children in need within their area, including offering accommodation when necessary. Residential care plays a vital role in the care system, particularly for children and young people with complex needs, trauma histories, or those for whom other placements have not been successful. The Looked After Children (Scotland) Regulations 2009 provide further guidance on how local authorities must assess and plan for children in their care, ensuring that placements—whether family- based or residential—are made in the best interests of the child. Public bodies, including local authorities, are required to give due regard to the United Nations Convention on the Rights of the Child (UNCRC) in all decisions affecting children. This means that residential care must not only meet a child’s basic needs but must also uphold their rights to safety, participation, stability, and development. Local authorities, acting as corporate parents, are expected to ensure that every child in their care is treated with dignity, compassion, and respect, and that their voices are central to the planning and delivery of their care. This duty is underpinned by a rights-based approach, as reinforced by the Children and Young People (Scotland) Act 20148 and Article 12 of the UNCRC which promotes giving children a voice and having a right to express their views freely in decisions that impact on them, and their views should be given due weight according to their age and maturity. This applies to children and young people 8 https://www.gov.scot/publications/children-young-people-scotland-act-2014-national-guidance-part-12/pages/3/ 178
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NORTH AYRSHIRE Health and Social Care Partnership 125 Delivering care together with regards to continuing care and options for moving on from their care setting young people’s views will be obtained within their Pathways Assessment & Plan and review process; these will be the avenues to promote and discuss the supported accommodation resource with young people and allow for early planning and transitions from their care setting. 2.2 Strategic Case Staying Put Scotland was published by the Scottish Government in 2013 to provide guidance for local authorities and other corporate parents on supporting looked after children and young people to remain in care, as part of a staged transition towards adulthood and greater independence. The Children and Young People (Scotland) Act 2014 was implemented to ensure Local Authorities would have a legal duty to prepare young people for leaving care or ceasing to be looked after and provide aftercare and follow on support for those eligible, potentially up to the age of twenty-six. An amendment to the Children (Scotland) Act from 2015 provided that a young person born after 1 April 1999 who is looked after in foster, kinship or residential care is eligible to remain in their current care placement until they turn twenty-one under continuing care legislation. The Children and Young People (Scotland) Act 2014 intention is to improve outcomes for all children and young people in Scotland by ensuring that local planning and delivery of services is integrated, focused on securing quality and value through preventative approaches, and dedicated to safeguarding, supporting, and promoting child wellbeing. The aims are about creating and maintaining a local environment which facilitates Getting it Right for Every Child Practice (GIRFEC) for individual children and young people. Guidance and regulation state that whilst there is no one model of accommodation provision, supported lodgings, shared accommodation, and independent tenancies should be available for young people. Accommodation and support services should be flexible and focus on the individual needs of the young person. The National Transfer Scheme (NTS) is a UK government programme that allows the safe transfer of unaccompanied asylum-seeking children (UASC) between local authorities. Children can arrive spontaneously and are eligible for the scheme aged 17 years + 9 months and younger. On entry the local authority is obliged to provide temporary accommodation and complete the transfer request. Part 9 of the Children and Young People (Scotland) Act 2014 outlines a range of duties for corporate parents across Scotland. These duties extend to all looked after children, which include all UASC and Trafficked young people, there is a collective responsibility on the council and partner agencies. Supporting young people when they wish to transition to independence from care was a key feature of The Promise. The Promise notes the challenges care 179
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NORTH AYRSHIRE Health and Social Care Partnership 126 Delivering care together experienced young people face when going through the transition from leaving care and into adult life and living independently of the care of services. The Promise spoke of the need to support both care leavers and those with experience of care to move on from care in a planned way, with care leavers fully informed in decisions. “Parenting does not stop at 18. Throughout The Plan, Scotland must continue to consider how to create greater equity and opportunity for care experienced young adults. That consideration must include how to increase opportunity for care experienced people to access employment, training, stable housing, and support.” — (pg93, The Promise, 2020) In Summary, there is a lack of alternative accommodation for young people to move on from care settings, this is evidenced with lack of suitable tenancies within North Ayrshire due to increased demand and increase in homelessness applications to allow care leavers to live in their own community. As stated in the 100 Days of Listening Report9 The issues surrounding housing fell into the broad categories of availability, sustainability, and quality. Like other groups, care experienced people found it difficult to access housing in a timely manner. The report also highlighted that care experienced people spoke of not being taught the skills to sustain a tenancy and manage a household. Finally, there was a clear message that the housing that care experienced people were offered was often in a poor state. The workforce echoed all these issues, and they noted frustration at the lack of money and resources available to support young people into housing in the way they wanted. Staying put Scotland: providing care leavers with connectedness and belonging - gov.scot Continuing Care Guidance Update - June 2024 2.3 Opportunity To Create Capacity & Improve Transitions Existing Service Arrangements & Service Need The current position is that other than our Throughcare Service the HSCP does not have a resource to support young people to transition from residential care, and there a are high number of young people are requesting to remain in residential care under continuing care, until twenty-one and then move to their own tenancy. 9 100daysoflisteningfinal17.6.24digitalrgb.pdf 180
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NORTH AYRSHIRE Health and Social Care Partnership 127 Delivering care together The HSCP have a supported care scheme which offers a supportive family environment, although, there is limited scope due to the service only having three approved carers. There are significant pressures relating to accommodation and resources for looked after children. Over the last few years, the internal children’s houses have been operating over occupancy based on their registered numbers, the table below details the average occupancy levels of each of our Children’s Houses since 2023: There has been positive progress with the numbers in external residential care reducing slightly over the last year, from Thirty-Six, down to Twenty-Eight at the lowest point. There will be ongoing oversight and scrutiny relating to external high-cost residential provision. There is an acceptance that some care experienced young people will require care and support up until twenty-one which aligns with the national policy and legislative drivers and the HSCP need to plan and have adequate provision to meet this need. A supported accommodation resource would be part of the continuum of support and would assist in some young people transitioning from internal and external residential care. 111% 107% 107% 110% 109% 105% 106% 107% 108% 109% 110% 111% 112% Abbeycroft Achnamarra Canmore The Meadows Cumulative Total Average Occupancy Levels Since 2023 181
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NORTH AYRSHIRE Health and Social Care Partnership 128 Delivering care together This would provide a gradual stepping stone to independent living and create capacity within internal houses, allowing for savings if we could support some young people from external provision to transition to the supported accommodation service. In terms of deficiencies in current provisions, the key issues are as follows • At present there is no in-house or commissioned service which provides supported accommodation to care experienced young people in North Ayrshire. • Due to no alternative provision young people are choosing to remain in their care setting. • External Placements are costly and do not necessarily provide best value and support young people to develop independent living skills. • Young People can return and be supported in their local community • The NTS scheme, continuing care and age young people are accommodated in residential care, this indicates the need for additional resource to support the older age group. The rationale for this resource is based on having an alternative option to continuing care for six young people. The service would provide a more tailored and focused support to prepare young people for independent living, when they are ready to move on from their care setting. A supported accommodation resource would also allow for more capacity in the system, with reduced costs as some young people would transition from internal and external residential care, it is predicted that we could prevent the use of high- cost external resources if we had more capacity internally. There have been several key policy and legislative changes that have contributed to the pressure on placement capacity and the increasing demand on internal and external residential resources. The increase in residential care is due to a number of factors which include the inception of the National Transfer Scheme in 2002 and commitment to support Unaccompanied Asylum-Seeking Children who are under sixteen in residential care. There continues to be challenges with the recruitment and retention of foster carers in North Ayrshire for children of all ages. Furthermore, Continuing Care legislation promotes and supports young people to remain in their care setting until the age of twenty-one which has created capacity issues within internal residential care with limited alternative options to support young people to transition from residential care. 182
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NORTH AYRSHIRE Health and Social Care Partnership 129 Delivering care together Continuing Care came into force in April 2016; there has been a significant impact on resources and finances associated with supporting continuing care. Service planning and commissioning processes should anticipate, expect, and plan for an increase in continuing care due to young people choosing to remain in positive care placements. The HSCP do not currently have a resource to support young people transitioning from care settings that offers tailored support with independent living skills. Benchmarking has been undertaken with other local authorities who have supported accommodation resources that are commissioned services or in house provision. The Chart below shows figures internal and external residential care. Continuing Care At the time of writing there are Eight Young People (out of Thirty-Three) residing within our Children’s Houses, this equates to 24.24 % of the available placements across our internal residential, within the next three years (based on the current internal residents) it is predicted there will be a further Eight young people eligible for continuing care, given this figure, it could mean that there is a situation where circa 50% of available placements within our residential houses are utilised by young people in continuing care. The Continuing Care position in our External Placements is that, at the time of writing we have Six Young People who wish to stay in their current placement, this equates to 20.68% of the current commitment to external placements, within the 183
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NORTH AYRSHIRE Health and Social Care Partnership 130 Delivering care together next two years (based on the age of the current young people in external placements) it is predicted there will be a further Eleven young people eligible for continuing care, given this figure it could mean that there is a situation where circa 58% of external placements are young people in continuing care. 3. Objectives 3.1 The aim of this proposal is to establish a six-bed supported accommodation service for young people aged 16 to 21. This service would provide an alternative to remaining in internal or external residential placements under continuing care and would support a more gradual and supported transition towards independent living, in addition to this it will allow more Young People to live within their own community as they age out of care. The key objectives we hope to achieve through this development are as follows: • Create capacity within internal residential services by enabling young people who are ready to move on to do so in a planned and supported way. • Provide a tailored, rights-based alternative to continuing care, offering young people a stepping stone between residential care and full independence. • Support young people to develop independent living skills in a safe, structured environment, with support that reflects their individual needs and readiness. • Reduce reliance on high-cost external placements, contributing to a more sustainable and cost-effective model of care. • Address a clear gap in local provision, as there is currently no in-house or commissioned supported accommodation service available in North Ayrshire. • Enable young people to remain in their local communities, maintaining important relationships and connections as they transition to adulthood. • Align with national policy and legislative expectations, including the Children and Young People (Scotland) Act 2014, Continuing Care legislation, and the ambitions set out in The Promise. • Support a spend-to-save approach, by reducing pressure on internal residential houses and avoiding unnecessary external placements. This proposal is designed to meet both local need and national priorities, ensuring that care-experienced young people are supported to move on from care in a way that is planned, empowering, and rooted in their rights. 184
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NORTH AYRSHIRE Health and Social Care Partnership 131 Delivering care together 4. Options Considered 4.1 Option Description Pros Cons 4.2 Maintain Status Quo Continue with the current arrangement of over-occupancy and reliance on high-cost external placements. No immediate changes required; existing processes remain in place. Continued pressure on internal services; excessive costs associated with external placements; potential negative impact on young people. 4.3 In-house Supported Accommodation Service Develop and manage supported accommodation internally within the organisation. Greater control over service quality; tailored support for young people. Requires significant initial investment; increased staffing costs; potential delays in implementation. 4.4 Provider-Run Supported Accommodation Service Commission external provider to deliver supported accommodation services. Utilises provider expertise; potentially quicker implementation; flexible service delivery: 24/7 Cover. Value for money/reduced costs than inhouse provision. Risk of provider failure; less control over service quality; ongoing contract management required. 5. Recommended Solution 5.1 A provider-run supported accommodation service is considered the most suitable and sustainable option for meeting the needs of care-experienced young people in North Ayrshire. 185
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NORTH AYRSHIRE Health and Social Care Partnership 132 Delivering care together By commissioning an experienced provider, we can ensure the service is up and running quickly, with the right infrastructure, staffing, and systems already in place. This reduces the pressure on internal teams and avoids the delays and risks associated with developing a new in-house model from scratch. A provider-led approach also offers greater flexibility. The service can be tailored to meet the individual needs of young people and adapted over time as demand changes. This is particularly important given the increasing number of young people choosing to remain in care under Continuing Care legislation, and the current lack of supported accommodation options locally. Financially, this model supports a spend-to-save approach. It offers a more cost- effective alternative to high-cost external placements, while still delivering high- quality, rights-based support. Providers are also better placed to manage fluctuations in occupancy and staffing, which can be more difficult to absorb within internal services. Any commissioned service would be expected to align with national policy and legislation, including The Promise, GIRFEC, and the Children and Young People (Scotland) Act 2014. The focus would be on supporting young people to move on from care in a planned, supported, and empowering way. In short, a provider-run model offers the right balance of quality, flexibility, and value for money, while helping us respond to current pressures and plan effectively for the future. Scope of the Project The proposal and business case are to acquire accommodation to develop it as a supported accommodation resource for care experienced young people who are transitioning from residential care. The accommodation in mind has had significant capital investment to refurbish the bedrooms and ensuite bathrooms. The property has five ensuite bathrooms, and a bedroom with a bathroom adjoining, there is two communal areas, dining room, staff office and two kitchens for young people to prepare meals. The accommodation is located in the centre of Irvine and is not situated in a housing estate, the accommodation is in close proximity to the town centre, transport links to training/education and a short walk to Meadowcroft where young people can access the Throughcare Team. The location of the accommodation has many benefits for young people and easy access to local amenities, support staff and transport links. There will be some expenditure to furnish and decorate the property with no structural work on the property required. The table below projects current young people in internal and external who could transition and be supported in the resource, at the time of writing, the number of 186
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NORTH AYRSHIRE Health and Social Care Partnership 133 Delivering care together Young People who would be age appropriate for a Supported Accommodation Service. Location Number of Age Appropriate YP for Supported Accommodation Internal 8 External 12 Care Inspectorate – Pre Registration Advice Pre-registration advice has been sought from the Care Inspectorate who have advised that the resource can be registered as a housing support service. The registration process can take up to six months and would be the responsibility of the service provider to register the service with the Care Inspectorate. HOUSING SUPPORT A “Housing Support Service” is a service which provides support, assistance, advice, or counselling to a person who has particular needs, with a view to enabling that person to occupy residential accommodation as a sole or main residence. The Care Inspectorate have advised that due to all young people being over the age of sixteen years and the service would be providing assistance to enable young people to maintain their place in the accommodation which is detailed in the housing support tasks and includes things like - help to budget, help to make links with GP, dentists etc, help to learn to cook etc) and NO personal care or support will be provided which allows the service to be registered as a housing support service. It would be expected that each young person has some sort of tenancy or occupancy agreement, but this does not need to be a formal/ official tenancy of their own. Registered housing support services are regulated by the Care Inspectorate using the 2009 National Care Standards for Housing Support Service. Introduction - National Care Standards: Housing Support Services - gov.scot 6. Financial Breakdown 6.1 187
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NORTH AYRSHIRE Health and Social Care Partnership 134 Delivering care together The financial modelling is based on the resource being registered for six young people, the projected set up costs and potential savings are based on the proposed staffing model and young people returning from external resources. The creation of a supported accommodation resource will require an initial financial outlay to set up and the costs would depend on the service model delivery. The potential savings will be realised through young people who will either return to their local communities from external providers to benefit from the bespoke support they will receive from the supported accommodation service, or by young people transitioning from internal children’s houses to the new service, thereby creating capacity within our internal children’s houses, allowing us to support care experienced young children back to their local communities from external placement, that may not be meeting their needs. Consideration has been given to how this model will be delivered. There are two options: • Deliver through an in-house model, • Commission a service provider to deliver on our behalf, The costs of an in-house and commissioned service will be considered in relation to best value. The Council procurement process will be followed by publishing a Prior Information Notice on Public Contracts Scotland. If the service is delivered in-house, there are a number of key considerations: • A draft Project Plan has been developed, the workstreams will explore all related matters involving, staff recruitment/retention, operating costs, registration requirements etc. • If a service is commissioned, then the provider would be responsible for the details around staffing, registration etc. In addition, final determinations are required to be made surrounding the service delivery model – i.e. a 24-hr model of support versus a model more reflective of the age and stage of development of the young people who are entering the next stage of their journey to adulthood. Indicative Building Costs The breakdown of estimated building costs has been provided by our colleagues in PMI; detail of these indicative costs is detailed below: 188
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NORTH AYRSHIRE Health and Social Care Partnership 135 Delivering care together In-House Service- Indicative Costs The indicative costs associated with an in-house model are detailed below: In-House Model – Staffing Costs £439,405 Building Costs £140,000 Total Per Year Given the costs detailed in the table above, it is expected that there would be significant cost avoidance between placing a young person in a supported accommodation services compared to a high-cost external residential placement, this is detailed below: Cost Per Placement In- House Model: £96,567.50 Average Cost of External Placement: £247,219.00 Estimated Saving Per Placement £150,651.50 *It is important to note that an in-house proposal has yet to be fully scoped in terms of feasibility & suitability * 189
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NORTH AYRSHIRE Health and Social Care Partnership 136 Delivering care together Detail of the estimated cost avoidance based on young people returning from External Placement is detailed in the chart below: Initial Projected costs of an internal model £579,405.00 Average Cost of an External Placement £247,219.00 Saving Per Placement (If Yp moves back from External) 1 -£332,186.00 2 -£84,967.00 3 £162,252.00 4 £409,471.00 5 £656,690.00 6 £903,909.00 *It is important to note that the financials detailed in this paper are an initial guide, further financial modelling will be required should the project be approved* Based on the average cost of an external placement being in the region of £247,219, per annum, there would need to be a reduction of three external placements per year in order to cover the operating costs of a supported model provision, initially, the more children & young people we bring back to North Ayrshire from high-cost external placements, the greater the saving. Provider Run Service – Indicative Cost There are a number of providers who deliver supported care to care leavers on behalf of local authorities. All resources deliver 24hour seven day per week support. 190
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NORTH AYRSHIRE Health and Social Care Partnership 137 Delivering care together The indicative costs associated with an in-house model are detailed below: Provider Run – Staffing Costs £270,000 Building Costs £140,000 Total £410,000 Given the costs detailed in the Table above, it is expected that there would be significant cost avoidance between this model, and high-cost external placements, details are shown below: Cost Per Placement – Provider Run Model: £68,333.33 Average Cost of External Placement: £247,219.00 Estimated Saving Per Placement: £178,885.67 Detail of the estimated cost avoidance based on young people returning from External Placement to a provider run supported accommodation service shown in the chart below: Initial Projected costs of a provider run model: £410,000.00 Average Cost of an External Placement: £247,219.00 Saving Per Placement (If Yp moves back from External) 1 -£162,781.00 2 £84,438.00 3 £331,657.00 4 £578,876.00 191
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NORTH AYRSHIRE Health and Social Care Partnership 138 Delivering care together 5 £826,095.00 6 £1,073,314.00 *It is important to note that the financials detailed in this paper are an initial guide, further financial modelling will be required should the project be approved* Based on the average cost of an external placement being in the region of £247,219, per annum, there would need to be a reduction of two external placements per year in order to cover the operating costs of a supported model provision, initially, the more children & young people we bring back to North Ayrshire from high-cost external placements, the greater the saving. The resource at full capacity could provide care and support for six young people at any one time. Currently the service is working with lead professionals to identify young people who would benefit from the bespoke nature that this provision would provide them with. Savings will be achieved if more than two young people per year utilise this resource. Conclusion Based on the figures above it is predicted that a provider run model would be less expensive to deliver than an In-House model, the estimated savings would be in the region of £169,405 per year. 7. Cost-Benefit Analysis 7.1 This section outlines the anticipated initial investment required to make the building not only functional but also feel more homely and welcoming for young people who will be residing there. While the associated costs—covering furnishings, equipment, and connectivity— have not yet been fully scoped, each item has been identified based on its potential to enhance the living environment and support the wellbeing of young people. These enhancements are essential to meet the day-to-day needs of residents while enabling staff to deliver high-quality care and support. As the project progresses, more detailed costings will be developed to ensure value for money and alignment with service objectives. 192
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NORTH AYRSHIRE Health and Social Care Partnership 139 Delivering care together 7.2 Item Cost Benefit 7.3 Soft Furnishings TBC The young people would benefit from having appropriate soft furnishings within their room. White Goods TBC These will be required to allow for cooking, cleaning, and laundry requirements of the residents. Office Equipment TBC The staffing component will have adequate space to perform their daily duties. Corporate & Service User Wi-Fi TBC It is essential that both the staff group and the residents have adequate access to Wi-Fi. 8. Risk Assessment 8.1 Risk Likelihood Impact Mitigation 8.2 Continuing with the Status Quo. Medium/High High – Continued over-occupancy and reliance on high-cost external placements. Develop supported accommodation to create capacity and reduce pressure on internal services. 8.3 Provider Failure (e.g. financial instability, quality concerns). Low High – Disruption to service delivery and potential safeguarding concerns. Robust procurement process, due diligence checks, and strong contract management with clear performance indicators and 193
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NORTH AYRSHIRE Health and Social Care Partnership 140 Delivering care together contingency planning. 8.4 Insufficient uptake of the service (e.g. fewer young people transitioning than projected). Medium Medium – Reduced cost- effectiveness and underutilisation of resource. Ongoing engagement with Throughcare, Locality, Senior Officers & and Residential teams to identify suitable young people; phased implementation and regular review of referral pathways. 8.5 Delays in commissioning or procurement process. Medium Medium – Project timeline slippage and delayed cost savings. Early engagement with procurement colleagues; clear project plan with milestones and escalation routes for delays. 8.6 Staffing challenges (recruitment/retention if in-house model pursued). Low Medium – Service delivery may be impacted if staffing levels are not maintained. Workforce planning group in place; explore flexible staffing models and secondments from existing services, should they be required. 8.7 Regulatory or registration delays (Care Inspectorate). Low/Medium Medium – Delay in service go-live. Early engagement with Care Inspectorate to ensure compliance and 194
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NORTH AYRSHIRE Health and Social Care Partnership 141 Delivering care together timely registration 8.8 Reputational risk if service does not meet expectations. Medium Medium – Impact on public confidence and stakeholder relationships. Co-production with care- experienced young people; regular monitoring and evaluation; transparent communication with stakeholders. 8.9 Mismatch between service model and needs of young people. Low/Medium Medium – Risk of placement breakdown or poor outcomes. Flexible, trauma- informed model with regular review and adaptation based on young people’s feedback and outcomes. 9. Implementation Plan 9.1 This project will be managed in accordance with project management methodology. The project will be managed in stages, with one stage concluding before the following stage is planned in detail. At the end of each stage a report will be submitted to the Service Lead by the Project Manager. A Project Board will oversee the delivery of the project. The Board is accountable for the success of the project. Board members will: ▪ Authorise any deviation that exceeds or is forecast to exceed stage tolerances. ▪ Communicate with other stakeholders. 195
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NORTH AYRSHIRE Health and Social Care Partnership 142 Delivering care together ▪ Delegate, using the organisational structure and controls designed for this purpose. ▪ Facilitate integration of the project board with the functional units of the participating corporate, programme management or customer organisations ▪ Provide the resources and authorise the funds necessary (if applicable) for the successful completion of the project. ▪ Ensure effective decision-making. Once the Business Case is approved and a decision is made a Project Initiation Document will be created, this will set out the rationale, scope and intended outcomes for the proposed development. In addition to this, the PID will ensure alignment with strategic priorities and stakeholder expectations. It will the current challenges within the existing provision, identify opportunities for improvement, and further presents a clear case for change. The PID will serve as a reference point throughout the project lifecycle, supporting informed decision-making, effective governance, and robust risk management. The PID will reflect our commitment to delivering a high-quality, sustainable service that meets the needs of our children & young people, while ensuring value for money and operational resilience. 10. Conclusion & Recommendation 10.1 As stated in the report, it is felt that there is a gap in service provision and a need for both creating more capacity across our Residential Estate and to develop a service that would support young care leavers to transition into independent living, with this being the case the recommendation is: Preferred Option: Provider-Run Service It is recommended that a provider-run supported accommodation service is considered to be the most appropriate and practical solution for meeting the needs of care-experienced young people in North Ayrshire. Commissioning an experienced provider allows us to benefit from existing infrastructure, staffing, and operational expertise. This reduces the time and risk involved in setting up a new service and ensures that young people receive high-quality, trauma-informed support from the outset. It also avoids placing additional pressure on internal services, which are already stretched. 196
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NORTH AYRSHIRE Health and Social Care Partnership 143 Delivering care together This model offers flexibility and can be tailored to meet the individual needs of young people, with the ability to adapt as demand changes. Given the increasing number of young people choosing to remain in care under Continuing Care legislation, and the current lack of supported accommodation or other options locally, this approach provides a much-needed alternative. From a financial perspective, a provider-run service supports a spend-to-save approach. It offers a more cost-effective alternative to high-cost external placements, while still delivering a high standard of care. Providers are also better placed to manage fluctuations in occupancy and staffing, which can be more difficult to absorb within internal services. Any commissioned service would be expected to align with national policy and legislation, including The Promise, GIRFEC, and the Children and Young People (Scotland) Act 2014. The focus would be on supporting young people to move on from care in a planned, supported, and rights-based way. In summary, a provider-run model offers the right balance of quality, flexibility, and value for money, while enabling the HSCP to respond effectively to current pressures and plan for future demand, in addition to this, there would be an opportunity to realise savings based on the indicative costs versus the high-cost external placements. Authors: Kevin McGinn kevinmcginn@north-ayrshire.gov.uk Arthur Coutts - acoutts@north- ayrshire.gov.uk Sponsor/Responsible HOS/Principal Manager: Caroline Cameron – carolinecameron@north- ayrshire.gov.uk 197
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NORTH AYRSHIRE Health and Social Care Partnership 144 Delivering care together Appendix7- Fostering & Kinship Position Paper Brighter Pathways – Fostering & Kinship Workstream Kevin Mcginn (Planning Manager / HSCP SP&TT ) Abstract This Paper provides a Strategic Update to the IJB. 198
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NORTH AYRSHIRE Health and Social Care Partnership 145 Delivering care together Introduction The Aim of this Paper is to give a breakdown of the current position within our Foster Care Service Some of the topics covered are as follows: • Limited Placements available • Foster Carers in some cases are above recommended numbers • Ageing Carer Demographic • Lack of Funding within the Service • Concerns over the level of carers being recruited Please note that this list or the items covered are not exhaustive of all the services at present, it is hoped that this paper will allow for further discussion and each of these can be added to the Final Report. 199
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NORTH AYRSHIRE Health and Social Care Partnership 146 Delivering care together Current Position The biggest challenge facing the fostering sector today is the retention and recruitment of high-quality foster carers who can meet the needs of children in care. A lack of available foster carers in the right place at the right time means children are missing out on vital support. Children in need of care are at risk of being moved away from their communities, hobbies, siblings, and are having to change schools and leave behind what is important to them, which has a detrimental impact on their wellbeing, stability, and development. The acute crisis in foster care recruitment and retention has been widely documented, and the significant shortfall of foster carers is having an impact on Independent Fostering Agencies and Local Authorities across Scotland and the UK. Within North Ayrshire there has been more de-registrations than approvals of new carers which has created pressures resulting in fostering being a diminishing resource for children of all ages. The Fostering Service operates in a highly competitive marketplace. Ayrshire has for many years been considered a fertile area for fostering and adoption recruitment and not only Independent Fostering Agencies operate within the three local authorities, but also there are carers who foster for Glasgow and other local authorities. The table below highlights the payments of NAC as well as other Organisations. Service Payment Per Week Payment Per Year NAC Foster Care Standard £400.00 £20,800.00 NAC Enhanced Foster Carer £550.00 £28,600.00 External Provider A - Standard £471.15 £24,500.00 Provider A - Enhanced £673.08 £35,000.00 Provider B £572.65 £29,778.00 Provider C -Standard £540.00 £28,080.00 Provider C - Enhanced £710.00 £36,920.00 Provider D - Standard £495.00 £25,740.00 Provider D - Enhanced £630.00 £32,760.00 Recruitment of Foster Carers The number of fostering households in Scotland is continuing to fall, leaving a shortage of around four hundred households this year alone. 200
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NORTH AYRSHIRE Health and Social Care Partnership 147 Delivering care together We know from research that financial support is a critical part of both retaining and recruiting foster carers. The Fostering Network are campaigning for the Scottish Government to prioritise the SRA and commit to increasing it in line with inflation on an annual basis to ensure that foster carers can continue to look after Scotland’s children. At Present, North Ayrshire have set a recruitment target of six Foster Carers per year, this has proven difficult, the table below represents the recruitment position within North Ayrshire since 2019. Over the last five years North Ayrshire have been consistently unable to recruit to the agreed target of six Foster Carers, it has been highlighted by members of the Fostering & Kinship Workstream that the service is faced with continuing difficulties in the recruitment & retention of Foster Carers. At the present time NAC Seventy-Four Fostering Households that care for One Hundred and Thirty-Two children. This is a drop from 2021 where the position was One Hundred & Two Fostering Households caring for One Hundred & Seventy-Six Children. Retention of Foster Carers In addition to the difficulties in recruiting Foster Carers NAC are faced with a growing problem regarding the retention of existing Foster Carers. The table below details the Interim Placements lost within North Ayrshire over the last two years. 201
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NORTH AYRSHIRE Health and Social Care Partnership 148 Delivering care together Over the last two years there has been a significant decrease in the number of placements lost, with Fifty-Nine placements being lost in total External Foster Placements At present within North Ayrshire, given the difficulties faced in the recruitment & retention of foster carers, as well as the level of need of some of our Children & Young People, we are in a position where the purchase of External Foster Placements has been essential. These Placements come with higher associated financial costs for each placement, at the time of writing detail of these is presented in the table below. Provider Placement Cost Per Year Provider A 1 £73,346.75 Provider A 2 £58,367.15 Provider A 3 £55,089.45 Provider A 4 £55,089.45 Provider B 5 £79,825.25 Provider B 6 £35,118.04 Provider B 7 £24,275.70 Provider C 8 £40,409.15 Total Cost £421,520.94 202
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NORTH AYRSHIRE Health and Social Care Partnership 149 Delivering care together Age Demographic The Workstream Members have discussed their concerns around the Age Demographic of our Foster Carers, in particular their concern that a considerable number of our foster carers are over Sixty Years of Age . Detail of the current age demographic is detailed below. Summary The Members of the Fostering & Kinship Workstream wish to raise awareness of the current picture within our Foster Care Service. The group feel that, given the difficulties associated with the recruitment and retention of Foster carers it is appropriate to make the Transformation Board aware that in order to avoid further placement breakdown and the reliance on high tariff external placements, there may be a need to invest in a new Fostering Scheme that goes some way to addressing the financial gap in what we as an organisation pay our Foster Carers. The Workstream Members are seeking approval to progress with the further development of a new Fostering Scheme and are requesting to take a paper to the Brighter Pathways Programme Board for Approval. In addition to this, the Workstream would like to inform the Board of their existing plans to engage with our Foster Carers. An Engagement Survey has been sent out to existing foster carers; this will run until 30th September 2024. In addition to this, the workstream members are looking at Digital Solutions that will assist in the recruitment of new Foster Carers. 12 45 14 2 74 21-30 31-40 41-50 51-60 61-70 70 Plus Total Foster Carers Age Demographic 203
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NORTH AYRSHIRE Health and Social Care Partnership 150 Delivering care together Appendix8-Foster Carer Survey Report Brighter Pathways – Foster Carer Engagement Kevin Mcginn (Planning Manager / HSCP SP&TT ) Abstract This Paper provides a Strategic Update to the IJB. 204
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NORTH AYRSHIRE Health and Social Care Partnership 151 Delivering care together Introduction The Aim of this Paper is to give a breakdown of the information gathered within the Foster Carer Survey that was carried out in October 2024 as part of the Brighter Pathways work The report will detail the following: • A Breakdown of the type of careers who completed the survey • What motivates our Foster Carers • Happiness of our Foster Carers • Positives of being a Foster Carer • Challenges faced by our Foster Carers • Opinion on supports received by our Foster Carers • Areas of Additional support required • Long -Term views of our carers • Recommendations for retention of New Carers • Short Breaks • Societal Changes • Training • Peer Support • Recommendations for Service improvement Please note that this list or the items covered are not a full representation of the full complement of foster carers within North Ayrshire, due to resource implications an online survey was used to gather this information, the survey was sent digitally via email & QR Code to one hundred & two carers. • Forty-nine carers took part in the survey; this equates to 49.98% participation. The flyer is detailed below: 205
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NORTH AYRSHIRE Health and Social Care Partnership 152 Delivering care together Breakdown of Respondents • Long-Term/permanent Carers made up the highest volume of respondents with 55% • Short Break Carers made up the second highest volume of respondents with 25% • Interim/Emergency carers made up the third highest volume of respondents with 13% • Community Short Break Carers made up the fourth highest volume of respondents with 7% Community Short Break 7% Fostering Short Break 25% Interim/ Emergency 13% Long-term/ Permanent Carer 55% Breakdown of Carers Community Short Break Fostering Short Break Interim/ Emergency Long-term/ Permanent Carer 206
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NORTH AYRSHIRE Health and Social Care Partnership 153 Delivering care together What Was Your Motivation to Become a Foster Carer This Question allowed respondents to select any relevant responses from thirteen different responses, participants selected multiple answers. • Desire to Help Children & Young People in need was selected the highest number of times by our respondents with Forty -Two carers expressing a desire to help Children & Young people. • The Desire to provide a stable home was selected the second highest number of times by our respondents, with Thirty carers expressing a desire to provide a stable home. • Sixteen of our Respondents indicated a desire to give back to the community played a part in them becoming Foster Carers. • None of our respondents indicated that financial incentives were a motivation for them becoming Foster Carers. 4 42 1 16 2 5 11 7 10 30 Personal experience with foster care Desire to help children in need Expand my family Give back to the community Religious or spiritual beliefs Past challenges or experiences Professional background in social services or … Encouragement from family or friends Financial incentives Interest in child development and education Desire to provide a stable home What Was Your Motivation to Become a Foster Carer? 207
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NORTH AYRSHIRE Health and Social Care Partnership 154 Delivering care together Do You Enjoy being a Foster Carer Forty-Eight of our respondents indicated that they enjoy being a foster carer, a breakdown of this is detailed below: This Question allowed respondents to select any relevant responses from thirteen different responses, participants selected multiple answers. • Making a positive difference in a child’s life was selected the highest number of times by our respondents with all Forty-Nine carers expressing a desire to make a difference in a child’s life as a positive of being a foster carer. • Forty-Two of our respondents indicated that seeing children grow and thrive is a positive of being a foster carer. • Forty-One of our respondents that sharing love and providing a stable home is a positive of being a foster carer. 49 31 42 28 23 12 15 8 2 41 17 37 23 2 Making a positive difference in a child's life Building strong, meaningful relationships Seeing children grow and thrive Personal fulfilment and satisfaction Learning new skills / gaining experience Expanding my family and creating new bonds Contributing to the community Emotional / spiritual growth Receiving appreciation and recognition Sharing love and providing a stable home Being part of a supportive foster care … Experiencing joy and pride in children's … Developing patience, empathy, and … Other Positives of Being a Foster Carer 208
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NORTH AYRSHIRE Health and Social Care Partnership 155 Delivering care together What Are the Challenges? This Question allowed respondents to select any relevant responses from thirteen different responses, participants selected multiple answers. • Managing challenging behaviours was selected the highest number of times with Twenty-Seven of our carers indicating that challenging behaviours represent the highest challenge amongst our population of carers. • Twenty-Three of or respondents indicated that they face challenges balancing fostering with personal/family life. • Twenty-Two respondents indicated that navigating the bureaucracy within the foster care system causes them challenges. 27 19 23 22 12 16 9 17 1 9 6 9 8 6 Managing challenging behaviours Emotional strain and burnout Balancing fostering with personal/family … Navigating the foster care system and … Lack of support from social workers or … Dealing with trauma and attachment … Coordinating with birth families Financial strain Insufficient training or resources Impact on my own children or family … Coping with loss when children leave Time management and meeting needs … Maintaining consistent routines and … Stigma What Are the Chalenges? 209
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NORTH AYRSHIRE Health and Social Care Partnership 156 Delivering care together Do You Feel You Receive Adequate Support? Our respondents were asked if they feel that they receive adequate support in their role as a foster carer, the answers are detailed below: Respondents were asked to give comment on any specific areas that they feel they require support within their role, thirty-three respondents provided comment, some are detailed below: *Note further detail can be provided on request* Are There Any Reasons You Would No Longer Consider Being a Foster Carer? 39% 12% 49% DO YOU FEEL YOU RECIEVE ADEQUATE SUPPORT Yes No Sometimes "The training given is great for new carers however experienced carers should possibly have a shortened version like those offered after covid. Also maybe come away from PowerPoint presentation and do it more like modules and your personal training is updated real time. We should be able to access our training real time via a login and our supervisor worker can see electronically where their carers need to focus. This would also let managers, supervisors and auditors see real compliance if set up properly...also senior management would see compliance " "Help and support when helping to manage different children and their families also financial support also being listened too and respected as professionals, we know these children better than anyone we live with them " "I think it has been extremely difficult to continue fostering in recent years due to huge bill rises during the cost-of-living crisis while fostering payments have increased by o% over the last 14 years. Other public sector workers are given inflationary pay rises annually to help cope with the burden of this however this has not been taken into consideration for foster carers. In real terms our allowances have been cut by 50% over the last 14 years." 210
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NORTH AYRSHIRE Health and Social Care Partnership 157 Delivering care together Our respondents were asked if there were any specific reasons that they would no longer consider being a foster carer, there response is detailed below: Respondents were asked to give comment as to why they would consider leaving foster care, twenty-six responses we received, some are detailed below: 55% 45% Would you Consider Leaving Foster Care? Yes No "Very restricting, we are self-employed, yet we are told when we can and can't take holidays with our children, only 7 days respite a year, no pay rise for 15yrs. I think there should only be one scheme for all foster carers as we all have challenging children in various ways." "Balancing the cost of living, in the past 14 years there has been no change in the set allowance and yet our household cost has more than doubled." "Local Authority bureaucracy and risk averse approach causing detriment to child. Lack or trust in Foster Carers ability to make decisions benefiting the child all in order to protect Local Authorities reputation." "Financial. Struggles as ends do not meet. My outgoings are more than incomings day to day, month to month bills when everything has gone up in prices and my fortnightly allowance has remained the same for over a decade." "Lack of support. Not respected as having an active part in the children's lives and development. Expected to inherit issues from other carers who have not acted accordingly with the children whilst in their care to later find out that they have had them replaced almost immediately. No consideration given to the impact of the child seeing their former carer on a regular basis and effectively being ignored by them. " 211
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NORTH AYRSHIRE Health and Social Care Partnership 158 Delivering care together Are there any reasons you would not support or encourage people to consider fostering? Our respondents were asked if there were any specific reasons that they would not encourage people to consider being a foster carer, their responses are detailed below: Respondents were asked to give comment as to why they would not support or encourage people to become foster carers, sixteen responses we received, some are detailed below: 33% 67% Are there any reasons you would not support or encourage people to consider fostering? Yes No "Some people would be unable to work with certain behaviour issues we see. Some would find it difficult to deal with the bureaucracy. Insufficient respite, and also financial concerns. It is zero hours contract we work within." "The challenges in fostering are becoming more challenging. More children with complex needs, not always due to parents. Some children are being left at home under demanding situations. Lack of foster carers, reports taking too long. Changes in social workers, also funding constraints. Children being moved about within carers " "You really need to be prepared to fight for your children's and your own needs to be met with regards to support systems. " "Not enough foster carers to support holidays. This is going to create burn out with foster carers. " "Again, financial. Unless you have quite a few children it is difficult to meet requirements and pay bills in the current climate. " 212
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NORTH AYRSHIRE Health and Social Care Partnership 159 Delivering care together Do you have any comments relating to the current contractual short break arrangements you receive? Our respondents were asked if there was anything that they would like to mention relating to the current contractual short break arrangements they receive, thirty- seven the responses were received, some of them are detailed below: *Note further detail can be provided on request* "Short breaks are only 7 days out of 365 days if you are on fostering first. We have to have a break approved before we can book a holiday." “Availability of short break care can break down and be taken away at short notice. Short break care can sometimes only be given when it is available to families for children team and not when foster carers need it. " "Our short breaks are really helpful in re charging the batteries" "Would like to see two weeks paid respite especially for when your placement is very challenging. Understand that we have other things in place, but the rest is needed at times" “We are going through a period (for a while now) where not many people want to become foster carers coupled with an increase of the number of children and young people coming into care. This is having an impact on the availability of short break carers." "Yes, significant differences in Foster first holiday entitlement compared to Foster extra allocation. Also, would strongly oppose decision by management, should a foster carer take all children in their care on holiday throughout the year they should not lose their only paid week. This should be given due to extra financial cost of holidays" "The breaks we received is well needed and deserved." 213
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NORTH AYRSHIRE Health and Social Care Partnership 160 Delivering care together Societal Changes Our respondents were asked if there were any Societal Changes or personal challenges that they felt have impacted them in their role as foster carers, their responses are detailed below: Respondents were asked to give comment on the societal or personal challenges that have impacted them in their role, twenty- four responses we received, some are detailed below: 51%49% Societal Changes Yes No "Cost of living is a big worry. EG my car insurance rose by over £300 this year alone. Energy costs. " "Cost of living has gone up drastically with no increase in fostering allowance for over 10 years this has an impact on our household, no other job is like that " "The cost of living has risen sharply yet there has not been a pay raise for 14 years which has impacted every aspect of life as a foster carer. Relationships have changed some for the worse as fostering is all consuming and you don't have as much time or energy for friends and family.it can leave you feeling quite isolated. " "With caring for the children, attending meetings, paperwork and training, there can be (at times), little time for self-care and meeting with friends so you really need to commit to giving time for yourself." "Definitely the cost-of-living crisis. No discussion with carers how that or covid affected us. Family changes with family bereavement don't have same supports for carers to socialise as and when required at short notice." "Cost of living. Unable to spend time with my own children and grandchildren " 214
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NORTH AYRSHIRE Health and Social Care Partnership 161 Delivering care together Our respondents were asked if they feel that North Ayrshire HSCP provides them with appropriate training, their responses are detailed below: In addition to the above, respondents were asked to provide detail of any training or supports that they feel are missing, five responses were received, some are detailed below: 90% 10% Do You Feel NAC Provides Appropriate Training ? Yes No "The training is often. 12 hours long over to days this is difficult for me as I am happy to leave my foster child for short periods but not this length of time with relevant people . I find the training not to my needs as I have a post grad certificate in child protection and with regards first aid, I’m a qualified midwife and nurse and again does not meet my needs The NHS uses learn pro perhaps north Ayrshire council could utilise similar resources much more frequent as there is very limited child support and no crèche . Parents who do parenting groups get far superior support " "More varied training should be offered. These training sessions descend into a whining session from carers on why they do not have enough children or why their spare room is empty. I want to learn from these sessions and not listen to people's gripes." "I often hear Foster carers talk about struggling with using computers (probably just my generation). " · "Limited evening training" 215
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NORTH AYRSHIRE Health and Social Care Partnership 162 Delivering care together Our respondents were asked if there were asked if they feel that there are any barriers to them attending training events organised by North Ayrshire HSCP, their responses are detailed below: In addition to the above, respondents were asked to provide detail of any barriers that would prevent them from attending training, twenty-one responses were received, some are detailed below: 43% 57% Are There Any Barriers to You Attending Training? Yes No "Public transport if required" "No child care " "We live on the Isle of Arran, our ferry reliability is very poor, courses start at awkward times and there is no funding for overnight accommodation" "Commitment with travelling of young people in placement " "Distance from training and commitment to school times so do a lot of online" "Work commitments " 216
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NORTH AYRSHIRE Health and Social Care Partnership 163 Delivering care together Are there any barriers to you meeting your required training plan? Our respondents were asked if there were asked if they feel that there are any barriers to them meeting their required training plan, their responses are detailed below: In addition to the above, respondents were asked to provide detail of any barriers that would prevent them from delivering on their training plan, fifteen responses were received, some are detailed below: 31% 69% Barriers to Meeting Required training Plan Yes No "Transport links - Ferry's No funding for overnight accommodation " "No child care " "No child care and at times family times always coincided with the training days always Tuesdays Wednesdays and Thursdays " "Second carer so after working 7-10 hrs. Can't make training." "Distance and early starts" 217
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NORTH AYRSHIRE Health and Social Care Partnership 164 Delivering care together Are You Aware of Peer Support Opportunities? Our respondents were asked if there were asked if they are aware of any peer support opportunities, their responses are detailed below: The majority of respondents indicated that they are aware of peer support opportunities, some examples they gave were: Support Groups, coffee mornings, WhatsApp groups & training events. 84% 16% Are You Aware of Peer Support Opportunities? Yes No 218
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NORTH AYRSHIRE Health and Social Care Partnership 165 Delivering care together Suggested Areas for Improvement The Respondents were asked to give any further information that they felt was relevant to the service, or areas of improvement, their responses are detailed below: • "I think there could be better communication, all carers to be on the same scheme and treated equally." • "It is very easy to become isolated from friends and other foster carers" • "None for us " • "The biggest room in the world is the room for improvement. We feel well supported in what we do as foster carers" • "Being able for your birth children to contribute to the lives of these children in care. Barriers up all the time for overnight stays and my family are teachers!!!!" • "Some of your internal changes should be communicated that would help carers have a better understanding. CPT now keeping children for up to two years before moving to area team. If correct it used to be 6mths as an example " • "As a service they have said for years to set up a crèche service at training but nothing, so this is a big barrier Appreciate the experienced carers they have and not demotivate them help them " • "Consider the value of short break carers who provide support to long term carers is not always recognised. E.g., they may not be invited to relevant meeting regarding the young person which means their views are not considered or valued." • "Yearly or six-monthly AGM?" • "For what is worth there should be a Fostering committee giving Foster Carers the opportunity to contribute to any policy decision making and to endure the right balance of decision making. At the moment policies are forced upon carers with no consideration of the impact on the carers. There is a lot of experience out there being ignored." • "The fostering allowance needs looked at as cost of living and life in general has become so expensive trying to keep mortgage, car and children's activities for a single carer is difficult not to mention all the other things needed for the children " • "Na" • "While the incentive to foster is not a financial one for us, I feel the commitment expected from carer's is not reflected sufficiently in financial compensation. Fostering is more than a full-time job with work/life balance being impossible to achieve and this is not reflected in the salary. " 219
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NORTH AYRSHIRE Health and Social Care Partnership 166 Delivering care together • "Better communication between Childs social worker and carers" • "Increase in foster first annual paid time/allowance ( 2 weeks) " • "All foster carers should be treated the same whether they are fostering first or fostering extra, the same contract, same allowances, short break entitlement, especially when carrying out respite for other carers children & young people. There should not be different systems, fostering first or extra as all children come into the system with their own challenges. A lot of the younger children at present are more challenging than the older fostering extra children. We all do the same job, so treat every carer equally." • "To listen to foster carer views and not dismiss them as we know the children and it’s upsetting to be told or asked is it us maybe we are doing something wrong " • "We have been very well looked after by Staff Member A and Staff Member B. I have no idea how they cope with their clearly substantial workload and responsibility" • "I feel quite isolated and completely out the loop with other carers and have no network " • "The financial arrangements should be looked at as regardless of how fulfilling being a foster carer is, the payments need to progress in line with inflation and cost of living etc." • "They have to have one scheme only, not fostering extra, then fostering first, all children these days have challenges. Many fostering extra cares children do not meet the criteria for fostering extra, but the team needed a bed, so they children are placed. Why when respite is approved to fostering extra carers do the respite carers not receive the same allowance? As they are looking after the child deeded to be fostering extra. TRANSPARENCY is key. One scheme" • "I love doing the community short breaks. However, I do think the children are more challenging. As a short-term carer, it is extremely important to get respite, people want to go for meals, have nights out with friends, go to concerts, holidays festivals without having to look after children, most of whom have aces. Also, the financial strain on caters is real, the cost of living has risen but the finances have not. There is only so far, the money can stretch. When you take into consideration of all the costs it really isn’t enough to provide a good life for these children. " • "More respite carers required to alleviate the pressure of caring for a child with full time needs " • "More respite carers required to alleviate the pressure of caring for a child with full time needs " 220
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NORTH AYRSHIRE Health and Social Care Partnership 167 Delivering care together • "The one thing that has come up for me is the different support being given to families but when that ends so does the community care. Considering that for some children the introduction, initial day support and working towards overnight can take a few weeks, building the trust and relationship with the child can just be starting when cases might be closed and support potentially stopped. It has not happened yet but there are two children where it might. My concern is this is not just hard for the children.... but ultimately that respite could be what is keeping things manageable for the family.... so, situations at home would deteriorate again." Suggested Service Improvements Suggested Improvements 1. Review Financial Supports • Review allowances: Potentially adjust foster care allowances to reflect the rising cost of living and ensure they are reviewed regularly. • Transparent Payment Systems: Simplify and clarify our payment process, ensuring timely and consistent payments. 2. Improve Support and Respite Care • Increase Respite Opportunities: Provide more frequent and reliable respite care options to prevent burnout and emotional strain. • Flexible Respite Arrangements: Allow foster carers to have more control over when and how they take respite breaks. 3. Strengthen Communication and Support from Social Workers • Consistent Communication: Ensure regular and transparent communication between social workers and foster carers. • Dedicated Support Workers: Assign dedicated support workers to foster carers to provide consistent and personalized support. 4. Expand Training and Development Opportunities • Flexible Training Schedules: Offer training sessions at various times, including evenings and weekends, to accommodate different schedules. • Online Training Modules: Develop online training modules that carers can complete at their own pace. • Childcare Support: Provide childcare during training sessions to enable more carers to attend. 5. Enhance Networking and Peer Support • Regular Support Groups: Organise regular support group meetings, both in-person and online, to facilitate peer support and networking. 221
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NORTH AYRSHIRE Health and Social Care Partnership 168 Delivering care together • Mentorship Programs: Establish mentorship programs where experienced carers can support and guide new carers. 6. Address Bureaucratic Challenges • Simplify Processes: Streamline bureaucratic processes to reduce the administrative burden on foster carers. • Empower Carers: Trust and empower foster carers to make decisions in the best interest of the children in their care. 7. Recognise and Appreciate Foster Carers • Recognition Programs: Implement programs to recognize and appreciate the efforts and achievements of foster carers. • Feedback Mechanisms: Create channels for foster carers to provide feedback and suggestions, ensuring their voices are heard and valued. 8. Address Specific Challenges • Tailored Support: Provide tailored support for carers dealing with specific challenges, such as managing challenging behaviours or dealing with trauma and attachment issues. • Health and Well-being: Offer resources and support for the health and well-being of foster carers, including mental health services. 9. Improve Contractual Arrangements • Clear Contracts: Ensure that contractual arrangements are clear, fair, and transparent. • Equitable Treatment: Treat all foster carers equitably, regardless of the type of care they provide. 10. Advocate for Policy Changes • Policy Advocacy: Advocate for policy changes at the local and national levels to address systemic issues affecting foster carers. • Foster Carer Committees: Establish committees that include foster carers to contribute to policy decision-making and ensure their perspectives are considered. Implementing these recommendations can help create a more supportive and sustainable environment for foster carers, which would benefit the children in their care. 222
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NORTH AYRSHIRE Health and Social Care Partnership 169 Delivering care together Appendix9- Education – Including Residential Placements -Position Paper Education Including Residential Placements Strategic Vision Kevin Mcginn (Planning Manager / HSCP SP&TT ) (HSCP) Arthur Coutts- Programme Manager (HSCP) Gail Nowek -Principal Psychologist (Education) Joanne Crawford- Senior Manager (HSCP) Matt Close- Senior Officer (HSCP) 223
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NORTH AYRSHIRE Health and Social Care Partnership 170 Delivering care together Introduction The Aim of this Paper is to provide information on the Financial Position and decision-making processes relating to the allocation of Care & Education provision within North Ayrshire. It is hoped that this paper will provide clarity on the position re. funding from both a social work and education perspective and explore proposals going forward. Some of the topics covered are as follows: • Education Position. • Social Work Position. • Benchmarking of Other Local Authorities. • Workstream Options Appraisal. • Next steps for supporting the process going forward Should it be required, further information can be provided on request. 224
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NORTH AYRSHIRE Health and Social Care Partnership 171 Delivering care together Workstream The initial scope of this workstream was around: • Exploring our joint information sharing forums and processes around care and education placements • Looking at how we support children and young people on the edge of care to consider how we intervene early to ensure appropriate support • Latterly we were asked to consider our joint funding arrangements for care and education placements Some of the work around recommendations to intervene and support early is in the early stages. This paper will help to explore ways of: • improving processes to ensure we intervene as early as possible to prevent children being accommodated or being received into care and education placements. • utilising existing supports and services to keep children within their family setting and mainstream education where possible Education colleagues and social work staff have shared information on supports to children on the edge of care, as well as children who require additional support, or specialist educational resources in order to explore opportunities as to how we can better support children and families. We have also focused on improved joint working between social work and education and how we can more fully utilise internal resources to prevent children requiring external education and care placements. In addition to this, the Head of Service for Children, Families & Justice had asked that the workstream review the current funding agreement, the purpose of this paper is to provide this information & to suggest areas for improvement. Aims: • To clarify the current joint financial arrangements and propose a model to ensure joint ownership of this process (including developing a clear service level agreement) • To improve communication and collaboration between HSCP and Education regarding care and education placements to improve outcomes for CYP. Residential & Education Placements Current position The current arrangement is for joint education and residential placements to be decided and jointly funded by HSCP and Education. Funding arrangements are outlined below although no formal written agreement of these arrangements is available. • Where care and education provision are being accessed out with North Ayrshire, a funding agreement is in place of a 50/50 split between education and HSCP. • The funding split for secure provision is 75 (HSCP)/25 (Education). 225
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NORTH AYRSHIRE Health and Social Care Partnership 172 Delivering care together • There is also a current arrangement where after 16 years of age, full funding goes to HSCP. The current rationale around funding stopping at 16 has been due to many of the children no longer accessing a formal education provision. In the CFDIS Team education and care placements are more likely to continue beyond the age of 16. Generally, this would end at age 18 when children transfer to adult services. ASL legislation determines that there can be flexibility around entitlement to education dependent on how much education has previously been accessed. The current process for requesting an additional year in education beyond school leaving age is to make a request to the HoS for education. Associated Finances Education Budget / Expenditure (24/25 – 19/20) * Information is directly linked to cost centre / account code: 10-105012-0000/31023 During the financial year 24/25 there has been a commitment to a number of placements of 25% as they have been identified as secure placements, currently there continues to be further commitments that are linked to secure placements. The remaining placements are funded at 50%. The budget and expenditure for education are inclusive of commitments to care and education placements including disabilities placements (which are coded separately in HSCP) and education only funded placements. HSCP Budget / Expenditure (24/25 – 19/20) Education Position There is a complex legislative and policy landscape which local authorities are required to take account of to fulfil their duties in supporting the needs of children and young people. The Education (Additional Support for Learning) (Scotland) Act 2004 highlights that some children and young people will require additional support to benefit fully from their education. In North Ayrshire, over 40% of our children and young people have an identified additional need which are supported through a range of supports and provisions. The presumption of mainstream as outlined in Section 15 of the Standards in Scotland’s Schools Act (2000) means that we start from the premise of supporting children and young people’s needs within a mainstream context. However, to ensure that young people’s needs are met as effectively as possible, there is a range of provision, with mainstream education ASN Residential Placement Fee 24/25 23/24 22/23 21/22 20/21 19/20 Annual Budget 543,351£ 499,413£ 499,413£ 365,441£ 939,294£ 1,052,293£ Expenditure 1,859,416£ 1,551,578£ 1,022,733£ 825,932£ 1,151,223£ 1,400,723£ Variance 1,316,065£ 1,052,165£ 523,320£ 460,491£ 211,929£ 348,430£ Overspend Overspend Overspend Overspend Overspend Overspend 24/25 23/24 22/23 21/22 20/21 19/20 Childrens Care Homes Purchased 6,368,495£ 1,932,666£ 1,879,175£ 1,754,037£ 2,140,556£ 2,700,180£ Expenditure 7,799,178£ 7,299,921£ 4,105,755£ 2,982,642£ 3,044,821£ 4,319,629£ Variance 1,430,683£ 5,367,255£ 2,226,580£ 1,228,605£ 904,265£ 1,619,449£ Overspend Overspend Overspend Overspend Overspend Overspend Included Within Budget is Temp Funding of: 4,000,000£ HSCP identified expenditure linked to 6 placements would be covered by covid monies - excluded from £4.1m expenditure quoted 1,171,407£ 226
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NORTH AYRSHIRE Health and Social Care Partnership 173 Delivering care together being complemented by a continuum of supports including specialist provision where required. Within North Ayrshire, specialist supports include: • Lockhart Campus – significant, profound and complex needs including physical and medical needs • Elderbank Supported Learning – significant language and communication needs (including neurodiversity) • Dreghorn Education Support Resource - language and communication needs (including neurodiversity) • St. Bridget’s Education Nurture Resource – Social, emotional and behavioural needs • Hayocks Education Nurture Resource - Social, emotional and behavioural needs • Ardrossan Astra Base - language and communication needs (including neurodiversity) • Local authority Secondary support resources in Greenwood and Irvine Royal Academy – support learning, communication and some social and emotional needs. In addition, young people are supported through additional support resources in each of our secondary schools which are designed to be flexible to meet a range of social, emotional, learning and communication needs. Outreach services also support a range of support needs across the authority including • Early Years Inclusion Support Team • Deaf Education and Visual Impairment • Extended outreach • Home, hospital and tuition services • Outreach services to support language and communication needs • ESOL Team Additional funding has also been invested in pupil support hours which is prioritised to meet the needs of pupils with additional support needs. One of the most significant needs which has increased in recent years is around social, emotional and behavioural needs and communication needs. Education have continued to invest in supports for children with these needs, including Enhanced Nurture Resources in primary schools which support a range of social, emotional and communication needs. The Secondary Support resources and Extended Outreach services also support children with a range of social, emotional and communication needs. However, even with this level of provision and support there are still some young people for whom the complexity of their needs has resulted in North Ayrshire being unable to adequately support them within their 227
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NORTH AYRSHIRE Health and Social Care Partnership 174 Delivering care together own provision and we are then required to seek either external day placement provision or care and education provision. Factors which can increase the likelihood of education breakdown can include significant behavioural challenges within the school setting; complex learning profiles (including autism); attendance and engagement with education and mental health issues such as extreme anxiety. Education, both nationally and locally is currently dealing with a significant increase in identified additional support needs in all of these areas and has clear improvement priorities around supporting these. Increased need is also accompanied by a reduction in budgets and an increase in cost, resulting in stressed systems as evidenced by increases in staff absences and requests for additional supports. When education provision breaks down within the local authority, the first option would be to seek a day placement. The complex nature of young people’s needs who are placed out with the local authority and challenges in working with a variety of providers who have differing expectations, structures, etc can sometimes result in a trajectory which increases the likelihood of a care placement. This situation is both costly for the local authority and can also lead to greater risks for the young person who is placed out with the Local authority for their education provision. Currently we have 30 children and young people placed within external day provisions. These provisions include a number of external day providers. There are 13 confirmed care and education placements that are jointly funded by HSCP and education. Two of these are joint funded by Education and CFDIS teams, a smaller number are a joint agreement for a secure placement and a further 9 are a joint 50/50 funding arrangement by education and area teams. There is also one residential placement that is being fully funded by education at the current time. The reasons education and care placements are sought are often complex and multifaceted. Factors relating to both education and care often play a part in the breakdown of a local authority placement. One of the challenges for education is how quickly care placements can break down which can require an alternative placement to be sought quickly, limiting the extent to which collaborative discussion can take place. Similarly, the options around care placements are often limited and while the care aspect of the provision chosen may meet the care needs, it is sometimes the case that the education provision that is provided alongside this may not be the most appropriate provision to meet the educational needs of the young person. Often the placements are out with North Ayrshire and do not allow for children to attend their local mainstream or specialist provision even when it may be deemed appropriate to meet their needs. If education try to engage with mainstream establishments in other local authorities, they can be met with resistance due to the nature of the young person's needs. Both education and HSCP are often limited by the choices available. Joint decision making has improved with the introduction of the Care experienced forum, but it can still be challenging to carry out a robust assessment that allows identification of an appropriate education and care provision given the timescales. Strong relationships between HSCP and Education are key to getting this right. 228
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NORTH AYRSHIRE Health and Social Care Partnership 175 Delivering care together A further challenge which has been faced is that the original budget designated for care and education budgets within education was significantly reduced year on year since 2019/20. This was reduced over a number of years with savings dependent on the following rationale being provided. ‘Reduction in need for external residential school placements due to enhancing our community supports through the team which has been in place following the success of the Challenge Fund and the joint investment with Education services. There is an intention that the number of external placements will not increase in future years with the service using investment in other supports including fostering and kinship care and our own local in-house Children's Houses to ensure children are not placed out-with area. There are 18 placements projected to be in place at the end of 2019-20. This saving will reduce this to 10 during 2020- 21 and phasing down to 0 during 2021-22. The reduction to 0 assumes alternative services are developed by the partnership in conjunction with education and the saving is net of the estimated costs. The plan to remove the need for external placements will include creating residential school provision locally, including developing education outreach and using the capacity in our own children's houses and also developing an approach to supporting our kinship and foster carers appropriately to avoid carer breakdown. The move towards locality teams within schools will support the approach to early intervention and prevention of children going into care. The other key issue in terms of budget in this area is that costs have significantly increased due to inflationary aspects of the external providers. Social Work Position The Scottish Government note that – Residential care homes offer children and young people a safe place to live together with other children away from home. They provide care and support and, in some cases, education. Children and young people may reside in residential care in certain circumstances, including where the child: • is subject to a Compulsory Supervision Order under the Children’s Hearings (Scotland) Act 2011 with a residence requirement • is being provided with accommodation under Section 25 of the Children (Scotland) Act 1995 (a voluntary agreement) • is placed by a local authority which holds a permanence order made under Section 80 of the Adoption and Children (Scotland) Act 2007 In Scotland, care home services for children and young people are provided by local authorities, private firms, voluntary organisations and health boards. Children in a residential care home will have a plan for their care for the people looking after them to follow. Standards of Residential Care The Care Inspectorate inspects care home services against the Health and Social Care Standards which came into effect in April 2018. The standards set out what is expected when using health, social care or social work services in Scotland. They seek to provide better outcomes for everyone; to ensure that individuals 229
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NORTH AYRSHIRE Health and Social Care Partnership 176 Delivering care together are treated with respect and dignity, and that the basic human rights we are all entitled to are upheld. Improving Residential Care The Children (Care and Justice) (Scotland) Act 2024 will make changes to the law in relation to the care of children and young people and contains provisions to ensure we can improve their experiences of Scotland’s care and justice systems. Cross-border placements into Residential Care Cross-border placements into residential care occur when children and young people who are subject to a care order elsewhere in the UK are placed in a residential care setting in Scotland. It is vital that cross-border placements are only used in exceptional circumstances and where it is in the best interests of the individual child or young person. The Children (Care and Justice) (Scotland) Act 2024 received Royal Assent on 4 June 2024. The Act provides powers to further regulate cross-border placements of children and young people into residential care in Scotland from England, Wales and Northern Ireland to cater for the exceptional circumstances in which these placements are deemed necessary. The Scottish Government are working to develop a comprehensive set of regulations that will encompass all types of cross-border placements into residential care in Scotland. The regulations will help to ensure that the welfare of every child who has been placed into Scotland is safeguarded and promoted. Alongside new provisions to ensure children are kept out of prison - under 18s will no longer be sent to Young Offenders Institutions, with secure accommodation used for detention as an alternative. Previously the funding for secure care would be met by the Scottish Government if a young person under eighteen was remanded, with the implementation of the Children (Care and Justice) Scotland Act 2024 funding for secure care is primarily the responsibility of local authorities. Provisions in the Act which give “looked after” status to all children who detained in secure accommodation by virtue of section 51(1)(a), 205(2), 208(1) or, as the case may be, 216(7) of the Criminal Procedure (Scotland) Act 1995 (if they do not already have such status). Children and Young People who enter residential care in North Ayrshire Children and young people are placed in residential care for various reasons – due to care and protection issues which led them to being accommodated, being out with parental control, displaying a high level of need that requires a specialist group living environment rather than a foster placement. Although increasingly residential placements are being sought due to lack of foster placements as there is currently a national shortage of foster carers – a growing trend in recent years. Residential Childcare Placements Residential Care Placements Within North Ayrshire are provided internally through one of our 4 children’s houses that each can host 8 young people. The houses are based in Kilwinning, Irvine, Pennyburn and Saltcoats. The environment aims to model a large house with each young person having their own ensuite bedroom and communal living areas including living room, games room and kitchen. There is also a staff office for the residential childcare workers along with a housekeeper. Although registration is in place for 8 bedded children’s 230
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NORTH AYRSHIRE Health and Social Care Partnership 177 Delivering care together houses, the Care Inspectorate now has a preference for smaller-scale provision, typically 3–4 bedded children’s houses. In North Ayrshire the need for placements to accommodate children and young people outweighs the available resources, meaning external placements are sourced for both foster and residential care. External residential care is not a sustainable model and does not always offer value for money. Unfortunately, due to limited in-house resources HSCP have become reliant on an external residential model meaning we currently have 30 young people in external residential placements. The cost of the external placements for the financial year 2023/24 was £7.3 million pounds of which circa £1.4 million was 50 % joint funding (HSCP/Education) for care and education residential placements. At the time of writing, the 30 current external placements break down as follows - 18 residential care placements, 8 care and education, a small number respite residential care and a small number of secure care placements. The need to use external residential childcare provisions is not unique to North Ayrshire, nationally there is a shortage of childcare accommodation placements per se. Care and Education Placements Children and young people who enter such placements need a more specialist care and support package due to a high level of need, which is often complex and multifaceted, for various reasons such as innate conditions or trauma due to their previous experiences, caregiving or environmental factors. This demographic tends to cope better with group living rather than family living and smaller specialist education environments to allow much higher levels of support due to smaller ratios of pupils to staff. The care and education providers often offer additional health, wellbeing and holistic services that can provide tailored interventions to support reparative care, which aims to bridge gaps in the young person’s overall development and ultimate lead to improved future outcomes. Secure Care Placements Secure care Placements are a form of residential care that restricts the freedom of children under the age of 18. It is for the small number of children who may be a significant risk to themselves, or others in the community. Their needs and risks can only be managed in secure care’s-controlled settings. The funding of secure accommodation is a 75-25% split between HSCP and Education respectively. Continuing Care Children and Young People (Scotland) Act 2014 introduced the concept of Continuing Care. This part of the Act outlines the entitlement that eligible young people have in relation to wishing to stay in their care setting after they are sixteen years of age, up to their twenty- first birthday. Young people aged sixteen and over have the right to request to remain in their external residential placement under Continuing Care, where it is assessed as meeting their needs, until they reach the age of twenty-one. This legislation has had a positive impact, enabling young people to stay in care settings longer, either until they feel ready to transition to independent living or until they reach the upper age limit. Under Continuing Care duties, the Health and Social Care Partnership (HSCP) must continue to provide the same placement if the young person requests it, provided the placement remains suitable and is assessed to be in their best interests. 231
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NORTH AYRSHIRE Health and Social Care Partnership 178 Delivering care together Continuing Care can end if the placement is no longer appropriate or if the young person decides to leave. Continuing Care placements and young people’s needs will be regularly reviewed through the Pathway Plan & Assessment, and Continuing Care Reviews, ensuring ongoing support and planning tailored to their development and circumstances. Young People over the age of sixteen can request to remain in their external residential resource under continuing care until they are aged twenty-one years of age. The continuing care legislation has been positive to support young people to remain in care settings until twenty-one or until they are equipped to move to independent living. HSCP are required to pay full costs at the same rates for all young people over sixteen who request continuing care up until they reach twenty-one or move out of the resource. Consideration of the continuing care legislation and recognition that young people are choosing to remain in care settings until twenty-one. Continuing Care has presented a challenge in terms of the additional funding required to support young people to remain in external provision until twenty-one, prior to the 2014 Act young people would move on at eighteen. Local Authority Benchmarking Different Local authorities have different funding models in place for joint education/care placements including within the SWEIC. Some of these are outlined below Local Authority A • Local Authority A – The HSCP pay full costs for secure care; they view it as a social aspect and not an education issue. • Care & Education 50/50 up to sixteen then HSCP will pay full amount (day care resources 50/50 for transport) Local Authority B • Local Authority B has one budget that is delegated and sits within the IJB and overseen in the one place. Local Authority C • Local Authority C have a 60/40 split, the forty being education. However, that is currently being reviewed due to some challenges in education being involved in identifying placements, and about 20% of the young people being in the 16-18y old bracket and accessing local college options or working with Employability. • It is becoming increasingly difficult to source joint care/education packages, and we have had several cases where SW have placed a YP with a private care provider (with 40% cost being met by us) and then education has had to source and fund a separate education package. Local Authority D • Local Authority D has a joint residential/education budget that funds these placements. Funding Options 232
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NORTH AYRSHIRE Health and Social Care Partnership 179 Delivering care together Option A – Current arrangements continue as stated above. Pros: easier to continue with status quo, no change required, Cons- not enough clarity on 16 plus Option B – Funding arrangement of 50/50 to continue with a change to funding beyond 16. Split funding to continue up to 18 for education where education is provided through a school setting, where college is provided this is taken up by HSCP. Education will provide the funding up until the end of the school year (generally June of the academic year) when yp has been in education until at least Easter of that session. Where there is a more bespoke situation – this would need to be agreed by both education and HSCP at Care Experienced forum. 25/75 continues for secure due to the specialist nature of this placement. The decisions around this should be agreed at the Care Experienced forum. Pros: Provides clarity on post 16 arrangements, continues status quo in other areas Cons: Potential disparity exists in decision making processes which can impact on this joint accountability Option C – a separate fund is designated for care and education placements which takes funding from both HSCP and education budgets but is a budget for this area only (models exist in Renfrewshire and elsewhere which do this) Pros: Accountability sits within one budget and allows for more streamlined processes. Education would require continuing to be part of the wider discussions around decisions. Cons: Education and HSCP don’t work together as well to make decisions if accountability no longer sit between the two Option D – a separate split is negotiated. Other models include 40/60 - this could be considered and either include or exclude secure in this arrangement. Pros: If funding arrangement is same for care and education and secure – this allows for further streamlining. It also potentially encourages greater joint accountability Given the legal responsibility for placing out with LA sits within HSCP – this may seem a fairer division of costing Cons: Education have very little locus in decision making around secure so may not be deemed as a joint responsibility Recommendation The workstream recommends that given the pressures on both services, the current arrangement is not sustainable. The recommendation of the workstream at this stage is to proceed with Option C as a funding option with HSCP retaining overall responsibility for this budget. Education would continue to have sight of the children and young people and be part of the decision-making process. If board don’t go with Option C, a service level agreement should be developed between HSCP and Education to ensure clarity and transparency within the current processes. All of these options are dependent on there being effective collaborative processes and decision making. The section below explores this in further detail. 233
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NORTH AYRSHIRE Health and Social Care Partnership 180 Delivering care together Improving Joint working One of the key structures that has supported some of the decision making around care and education placements or children on the edge of care. Care Experienced Forum Rationale • Different decision-making processes existed in both HSCP and education. Neither of these forums provided a full opportunity to discuss the details of the case with the other, e.g. LA Inclusion Group – many cases were discussed with limited time available for full discussion. • Challenges around joint accountability for decision making – as reasons for breakdown of care and education placements are often multifaceted – need both partnerships to jointly discuss and tackle the challenges involved to ensure that all preventative measures had been considered and tried • Lack of understanding of each other’s roles and processes sometimes meant the need for building better more collaborative working • Information was not always shared in a timely and proportionate way • Education Psychologist required to have oversight of any potential changes to placements – while this took place, it wasn’t always consistent across the LA Process HSCP and Education have their own processes around allocating care and education placements but as stated previously, communication around decision making is crucial, particularly in the early stages of consideration of placement. The process around considering a placement is complex (see Appendix. Flowchart) The Care Experienced forum was set up specifically to allow for early discussion around: 1. Consideration of a care and education placement including exploration of alternative within authority options where applicable 2. Breakdown or changes to a current care and education placement, e.g. change to secure 3. Longer term planning around care and education placements 4. Children who are at risk of care or care and education placements Currently the attendees of the Care Experienced forum are: • Principal Educational Psychologist • QIO Education – Care Experienced remit • HSCP SM for locality areas • SM for Care Experienced children • Admin support • Senior Officer for Residential 234
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NORTH AYRSHIRE Health and Social Care Partnership 181 Delivering care together Currently each of the members of the group can nominate a young person for discussion if they fulfil any of the 4 criteria above. The care experienced forum takes place online 6 weekly. Cases are nominated by the members of the forum 2 weeks prior to the discussion. A spreadsheet is completed with details around child/yp name/DOB/ current establishment/care placement and rationale for discussion. Education brings information from Seemis and Psychological Service case work and HSCP bring information from CareFirst or from locality team feedback. Currently there are no reports submitted, and information is shared verbally. A minute is taken and actions agreed. Further Enhancements to This Process • Clearer criteria about who is discussed at the forum, e.g. where additional support is recommended in a placement – discussion to take place here • Locality Teams and Educational Psychologists submitting children and young people for discussion • Using Signs of Safety as a framework to support discussion • Clarifying paperwork to be completed to ensure a full picture of young people • Sharing of process and criteria more widely • Use of Options appraisals format when care and education is being considered (see Appendix as an example that is currently used for Day Placement) • Consideration of where Disability Team sits within this forum. Recommendation Short-term working group is established to agree enhanced process. Group should include care experienced forum reps alongside members of this workstream. A disability team rep should also be considered. The working group is also open to any further suggestions by the board. Recommendations to enhance Care & Education Placement Decision Making During the discussions at this workstream a number of suggestions have been raised that would further enhance the decision-making process and ensure better outcomes for children and young people. These include: • IPAs are currently used as a contract for financial arrangements – a process should ensure that both education and HSCP have access to these. • Service Level Agreements can be further developed with providers to clarify the expectations for providers and LA. • Options appraisal for all care and education placements – education currently piloting this for day placements • A role in education is created with increased capacity to monitor the efficacy and robustness of these placements, e.g. virtual head 235
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NORTH AYRSHIRE Health and Social Care Partnership 182 Delivering care together • Further scoping of data provided to other LAs from providers. • Setting a LA standard about data/information that should be provided on young people, e.g. attendance in education, risk assessments information, HWB updates. • Create a list of Scotland Excel carers- scores, processes etc, data to back up selection choices, communication. Please see details of the Care Experienced Flowchart in the link below: Care Experienced Young People Placement Flowchart - 151123.pptx Virtual Head Teacher Role Education – have a appointed an Outreach Head Teacher who will adopt the role of Virtual Head Teacher who will promote and advocate for care experienced learners, this will hopefully lead to improved educational experiences and outcomes for care experienced learners relating to attendance, attainment, school exclusions, reduced timetables and reduction in care and education resources and care experienced learners being supported within mainstream provision. Overview: The role of Virtual School Head Teacher (VSHT) is a strategic position focused on improving the educational outcomes of care experienced learners. This position is critical in ensuring care experienced children and young people go to, enjoy and succeed in their education. It contributes towards fulfilling the commitments to meeting the aspirations of The Promise and ensuring equity and a consistency of experience for all children locally and nationally. The VSHT Network has a vision and informed by the incorporation of the UN Convention of the Rights of the Child into Scots law, is contributing towards ensuring all care experienced learners are supported to access their right to education and ensure that Scotland keeps The Promise of the Independent Care Review. The VHT role is to: • Improve educational outcomes for care-experienced children. • Coordinate support across schools, social work, health, and third-sector partners. • Advocate for inclusion, attainment, and wellbeing. • Monitor progress and challenge barriers to learning. • Quality assurance of care & education providers – work alongside principle educational psychologist to contribute to the assessment of the suitability specialist educational provision. 236
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NORTH AYRSHIRE Health and Social Care Partnership 183 Delivering care together Appendix10- Internal Children’s Houses – Model of Care – Position Paper Introduction The Brighter Pathways programme aligns with a number of key priorities and strategic plans. The Council Plan 2023-28 strategic aim to transition to a wellbeing economy, delivering prosperity, wellbeing and resilience for local people. One of the key priorities in Council Plan: Improving outcomes for care experienced young people including implementation of The Promise. The Brighter Pathways transformation programme was implemented to address current challenges associated with resources and accommodation for looked after and care experienced young people. • Children’s Houses over occupancy. • Decline in foster care recruitment/retention. • Increase in external high-cost residential resources. • Pathways to support care leavers/care experienced young people. • NTS scheme and model of support to UASC. The Aim of this Paper is to give a breakdown of the current position within our Residential Houses and provide strategic direction on the future model of residential care in North Ayrshire. Please note that this list or the items covered are not exhaustive of all the services at present, it is hoped that this paper will allow for further discussion ad each of these can be added to the Final Report. Staffing Model The guiding principles of the Health and Care (Staffing) (Scotland) Act 2019, (HCSA) state that staffing arrangements must provide safe and high-quality services to ensure the best health care and care outcomes for people experiencing care. The HCSA places a statutory duty on care service providers to ensure that, at all times, suitable qualified and competent individuals are working in such numbers as are appropriate for the health, wellbeing and safety of people using the service, and the provision of safe and high-quality care, and in so far as it affects those matters, the wellbeing of staff. Providers also must ensure that staff receive appropriate training for the work they are to perform and receive suitable assistance, including time off work, for the purpose of obtaining further qualifications appropriate to their work. You must keep records to demonstrate how you are meeting your duties as detailed in The Act and how you have ensured safe and effective staffing arrangements are in place. There is a Care Inspectorate expectation there is a person equally as qualified as the registered manager to run the service in event of the manager either leaving or off long-term sick (more than 4 weeks) At the time of writing, within North Ayrshire we have Four Residential Houses, each being registered to have eight placements for Children & Young People, the houses are detailed below: • Abbeycroft • Achnamara • Canmore 237
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NORTH AYRSHIRE Health and Social Care Partnership 184 Delivering care together • The Meadows Each of the Houses have the same staffing structure consisting of 18.73 FTE, this is broken down for each establishment below: House Manager Assistant Manager Snr Residential Worker Residential Worker Total FTE Abbeycroft 1.00 1.00 5.36 11.36 18.73 Achnamara 1.00 1.00 5.36 11.36 18.73 Canmore 1.00 1.00 5.36 11.36 18.73 The Meadows 1.00 1.00 5.36 11.36 18.73 Total 4.00 4.00 21.46 45.44 74.92 Cumulatively, our Children’s Houses are registered to care for Thirty-Two individuals. Demographic of Young People Who Require Residential Care Children may become looked after because they experience some form of abuse or neglect, require specialist care because they have additional needs, are illegally trafficked or are unaccompanied minors, or as a result of being involved in offending behaviours. While there is no national study of Adverse Childhood Experiences in Scotland, in a study of children within secure care, Gibson [6,7] found that 68% of children ‘looked after and accommodated’ within this form of residential care, came from families who experienced relative poverty and the children’s exposure to adverse childhood experiences was reflected in heightened levels of ACEs scores. On moving to residential care, the adversity and trauma previously experienced may be further exacerbated, as children may experience placement instability, breakdown, and loss. Changing Landscape Residential Services within North Ayrshire has evolved, with the most significant development was the decision to close larger residential establishments that at times cared for up to twelve children. Due to emerging practice at the time, the service then invested in four purpose-built Children’s Houses that would be registered to care for six children. As a result, the budget and the staffing ratios, was calculated for six children. This new model of residential care was in line with good childcare practice which promoted smaller houses, less children and increased staff ratios to children, which promoted overall higher quality of care, nurturing and trauma informed care and environment. Continuing Care legislation came in to force in April 2016 which stipulated that young people, from the age of 16 years, could choose to remain in their care setting. This has been positive for young people, who can remain in the Houses; however, this has resulted in the demographic of an older age range of young people, who remain within the Houses and do not transition from residential care until twenty-one. While the age ranges of children and young people, within the Houses does fluctuate. it is predicted that the number of children receiving Continuing Care will continue to rise, resulting in older children staying longer within Residential Care settings. The Residential Houses have been required to provide care to any young people under sixteen who are trafficked or supported via NTS scheme, there is currently three young people accommodated via the NTS Scheme and five trafficked young people who reside within the houses. This is a cohort of young people that’s never been considered within strategic needs and has put significant pressure on residential care capacity. The "Promise" was published by the Independent Care Review on February 5, 2020, and the Scottish Government signed up to the actions set out within it, with The Promise Scotland established in March 2021 to oversee its implementation. Ther are a number of key themes and a commitment to improve the lives and quality of care children experience within the care system. 238
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NORTH AYRSHIRE Health and Social Care Partnership 185 Delivering care together "The Promise" in Scotland aims to transform the care system, including residential care, to ensure that children and young people grow up loved, safe, and respected. Here are some key aspects related to residential care: Quality of Relationships: Residential homes and schools must prioritize the quality of relationships that children experience. Staff should be recruited based on their values and ability to form meaningful connections with children1. Non-Stigmatizing Environment: Efforts must be made to eliminate any rules or practices that stigmatize children in residential care. The goal is to create a nurturing and supportive environment1. Trauma-Informed Care: The workforce must be trained to provide a caring, relational, and trauma- informed response to challenging behaviours. This approach helps in addressing the underlying issues rather than just the symptoms. Children's Involvement: Decision-making processes must involve children and prioritize their rights and needs. This ensures that their voices are heard and respected in all aspects of their care1. Supportive System: The system must be responsive and ready to provide the necessary support to children, families, and the workforce. This includes ensuring that children can stay with their siblings and belong to a loving home for as long as needed. The introduction of Signs of Safety in North Ayrshire in 2023 set out to change practice and culture, the framework involves comprehensive risk assessment, which includes evaluating dangers, strengths, and periods of safety. It aims to stabilise and strengthen a child's and family's situation by building on existing strengths and periods of good care. This also aligns with the principles of The Promise which emphasised the need to provide the necessary support and scaffolding to families to prevent children from entering care and to assist families to stay together where possible, this also involved wider family network as a support mechanises or alternative care option which supported the kinship first culture within North Ayrshire for any child who required alternative care. Signs of Safety promotes a shift away from risk-oriented practice, deficit based and centred on crisis management. The model fully supports participation form children and young people and their families in decisions and planning that affect their lives. The implementation of Signs of Safety was a significant change on a number of levels, including practice, culture, systems and services which continues to be a complex and prolonged process. The main principles of Signs of Safety were to support families in their community and those only at-risk significant harm would be accommodated. Meeting these ambitions is a complex and prolonged process which requires significant change on a number of levels, including to practice, culture, systems and services. Brothers & Sisters Legislation Part 13 of the Children (Scotland) Act 2020 and the Looked After Children (Scotland) Amendment Regulations 2021, came into effect on July 26, 2021, local authorities now have a duty to ensure siblings are supported to stay together. Within North Ayrshire there has been significant challenges in keeping siblings together due to lack of capacity within foster care provision and within residential houses. As alluded to in another section of the report there has been overoccupancy in the houses and lack of capacity to accommodate sibling groups. If spaces are created these are generally only one at a time. Sibling groups can be across a large age range, which would mean children under 12 being in care – but again they do not have the capacity to keep sibling groups of 3/4 children together, which again results in adverse Inspection reports. This is also relevant to fostering provision and due to the decline in the number of approved foster carers and current carers being at capacity and the requirement to adhere to placement limits which specifies that foster carers can’t care for more than three unrelated children and carers do not have accommodation to care for large sibling groups. 239
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NORTH AYRSHIRE Health and Social Care Partnership 186 Delivering care together The chart below details the average age of the Children & Young people currently residing within our Children’s Houses: At the present time there are thirteen young people in the four NAC houses who wish to remain in their house through continuing care. Within external childcare houses we have five young people who wish to stay in the Houses via Continuing Care but, as before, it is hoped that some of these young people will leave before age of 21 if appropriate housing can be accessed. The inception of the National Transfer Scheme has required North Ayrshire Council to support twenty-four young people, who are under 18. Due to lack of alternative provision for these young people, all young people under sixteen have been received into the Children’s Houses. There are currently nine UASC young people within the residential houses. This has created additional pressure on the sector. The levels of trauma experienced by many children and young people are high. Throughout the course of the workstream, staff have detailed that the demographic of the Young People residing within our houses is becoming more complex, this is detailed in the table below: As detailed above, the staff within the Children’s Houses are supporting a diverse population of young people who require additional support, with the vast majority of residents (Thirty-Two) living with trauma. This has an effect on the staffing ratios, in that young people with additional needs can, at times, require 1:1 staffing. This position would be difficult, if caring for six children, however, this has been exacerbated, as the Houses have all now gone up to eight children and also have been at ten children, on occasion. This can present significant challenges for the staff, given the diverse nature of the need, it is crucial that the matching process is adhered to in order to mitigate any risks that are presented by the needs of the Young People. Fostering Service 14.8 15.0 15.1 14.2 14.8 13.5 14.0 14.5 15.0 15.5 Average Age in Houses Abbeycroft Achnamara Canmore The Meadows Average Age In Children's Houses 6 5 1 1 1 1 2 1 1 1 4 32 4 0 5 10 15 20 25 30 35 DEMOGRAPHIC OF YP 240
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NORTH AYRSHIRE Health and Social Care Partnership 187 Delivering care together Over the last few years there has been a national and local crisis relating to recruitment and retention of foster carers. The Fostering services, due to capacity issues and lack of recruitment of carers willing to care for children over the age of twelve, has become a resource mainly for children under twelve and any enquiries/alerts for older children, from the community, requiring a fostering placement cannot be resourced, with a reliance on them being accommodated in residential care. The service is also reporting challenges when attempting to resource external fostering provision, due to the independent sector also facing significant challenges with recruitment. Due to the pressures on the fostering service, they are not recruiting or approving carers for children over the age of twelve and the service is currently under significant pressure to source a placement for any child. As a result of the pressures on the fostering service, this has led to six children under twelve and one as young as eight, being placed in residential care. Placement Matching Process/Emergency Placements As required in the “Matching Looked After Children and Young People: Admissions Guidance for Residential Services: Care Inspectorate 2024), residential services, other professionals, and service providers must work together to share information and make sound decisions about the suitability of potential places for young people to live. In addition, service providers (local authorities for NAC Children's Houses and external providers) have a responsibility to consider how the introduction of a new young person might impact upon the safety and wellbeing of young people already living in the service. North Ayrshire Residential Childcare Services devised a comprehensive matching and admissions document, “To provide guidance to managers relating to how children’s needs will be matched to the experience, training and skills of the staff team in placement…….and…. To provide guidance to managers relating to North Ayrshire’s referral, matching and impact risk assessment and admissions procedures.” Unfortunately, the matching process and planned admissions process, is not always possible because most admissions to NAC residential care Houses occur on an emergency basis and any matching is based on the House that has a vacant room, or agreement to put them over their registered numbers and for a young person to sleep in a communal area. There are concerns that the lack of matching and preplacement consideration. prior to children being received into residential childcare provision, presents a higher risk of placement sustainability and can have a significant impact on staff and other young people. There are also concerns that the lack of matching, as well as being frequently over the registered numbers and the lack of planned moves, is resulting in the Care Inspectorate down grading the 4 NAC Children’s Houses, post inspection. Scottish Journal of Residential Child Care: article by (Morris, 2023). Reasons to be cheerful: Factors making a positive difference to Children in Residential Care in Scotland. The article has analysed some of the key factors that contribute to the Care Inspectorate evaluations of high performing services. These services are making a positive difference to the children and young people living in them. The key factors of the high performing services: • Relationships • Knowledge and understanding of trauma • Considered and careful matching of children to residential services • Leadership Morris (2023) highlights the need for considered and careful matching of children to residential services and the importance of analysis of risks and how these can be reduced and managed, need to be factored in. Deliberation about how well a child, or young person, will fit in with other children and young people, needs to be part of the process. Can the service safely meet the needs of all children and young 241
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NORTH AYRSHIRE Health and Social Care Partnership 188 Delivering care together people? Are there enough staff with appropriate qualifications and experience to meet all the needs of the children and young people? Having a rigorous well considered matching process, as outlined in the Care Inspectorate Guidance, is an essential component of delivering high quality care. Within this context, sometimes it will be the right decision for the service to assess that, at a particular point in time, they are not well placed to respond to an individual child, or young person’s needs. Children and young people entering residential care have experienced significant trauma. Leaders and teams in North Ayrshire Children’s Houses work to be nurturing and trauma informed, so that children and young people living there can feel secure and be supported with transitions and associated challenges. Approaches to support are based on Nurture principles, founded on attachment and brain development theories, and values of safety, trust, choice, collaboration, and empowerment (Fallot et al, 2008). The Nurture Principle ‘Environment offers a Safe Base’ refers not only to the physical environment, but also to the social environment – children in residential settings require attuned regulated adults to care for them. Because children are often coming from environments where they have been deprived of their basic needs, the physical environment of a children’s home represents a powerful symbol of ‘home’, in which they can develop the trust that their needs will be met (Barton et al., 2012). Alongside the importance of nurturing and trauma informed care, the Care Inspectorate highlights that for care to be compassionately delivered, carefully considered matching of children to the right House is essential (Morris, 2023). When this happens, the specific individualised needs of children and young people are more likely to be effectively supported by the team around them. In North Ayrshire between 2021 and 2024, all four children’s houses have had unplanned placements and levels of over-occupancy. Some houses have been more affected by unplanned placements than others. The table below details the over occupancy rates within our Children’s Houses since June 2023 until the present time: Over several years all of our Children’s Houses have consistently been over numbers. Staff within the workstream have indicated that this, along with the demographics of the Young People residing there, is becoming more difficult to manage. A second Nurture Principle highlights the importance of transitions in the lives of children. When transition into residential care is unplanned, this can cause further distress to the child. Children who need to sleep on sofas, until a bed can be found, or have no space, or access to quiet areas, may be in danger of being re-traumatised by the House environment. Traumatic experiences tend to heighten an individual’s awareness of their surroundings as a means of protecting and preparing them to respond with a specific action (e.g. the fight-or-flight-or-freeze response), and features of the environment may become powerfully associated with a traumatic event, for example, loud noises, or door slamming (Robinson & Brown, 2016). It can be problematic when there is no private area to rest in, nor space away from peers when needed. Children need environments that promote healing by eliminating stressful environmental 111% 107% 107% 110% 109% 105% 106% 107% 108% 109% 110% 111% 112% Abbeycroft Achnamarra Canmore The Meadows Cumulative Total Average Occupancy Levels 242
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NORTH AYRSHIRE Health and Social Care Partnership 189 Delivering care together features and providing spaces that alleviate stress and strengthen coping resources e.g. access to nature and communal spaces that promote social support (Ulrich, 2001). Adults also need space to regulate and support, when children are distressed. Through a planned matching process, aspects of the environment that may be re-traumatising can be addressed and work planned to help the child develop strategies to cope with the transition into residential care. In terms of overoccupancy, whilst CELCIS (the Centre for Excellence for Children’s Care and Protection) has not published specific statements on the impact of over-occupancy in children’s homes, related research and guidelines highlight concerns about resource limitations and their effects on care quality. In summary, unplanned placements and over-occupancy in children’s homes can adversely affect the delivery of nurturing and trauma-informed care, overwhelm teams and reduce the quality of individualised care. Evidence suggests the way forward requires implementing trauma-informed design principles alongside provision of skilled support from teams with expertise in relational, nurturing and trauma skilled approaches, considered and careful matching of children to residential services and effective leadership (Morris, 2023.) Key Indicators from the Care Inspectorate The Promise highlighted that if children are not able to live with their families, then the focus of their care must be on building childhoods that are underpinned by loving relationships, fun, play, education, and opportunity. The Care Inspectorate has tried to capture these messages in their current inspection methodology with key quality indicators 7.1 and 7.2 focusing on the extent to which children and young people are safe, feel loved and get the most out of life, and on leaders and staff having the capacity and resources to meet and champion children and young people’s needs and rights. The Care Inspectorate use the following quality indicators when assessing residential child care. Key question 7 is comprised of a single key question with two quality indicators. The key question is ‘How well do we support children and young people’s rights and wellbeing?’ and the quality indicators are: 7.1 Children and young people are safe, feel loved and get the most out of life. 7.2 Leaders and staff have the capacity and resources to meet and champion children and young people’s needs and rights. 7.1 The physical environment: The service is clean, tidy, welcoming and free from avoidable and intrusive noise and smells. The layout of the setting and quality of the furnishings and fixtures provides a nurturing environment that meets children and young people’s needs and outcomes. Overoccupancy and emergency admissions in houses impacts on adherence to 7.1 as young people are using communal areas as bedrooms and due to higher number of children this reflects of staff ratio to children this can impact on the quality and nurturing can children receive. 7.2 Management oversight and governance: Management oversight and governance There are governance and oversight systems in place to identify risks and ensure appropriate action is taken to improve outcomes for children and young people. These include leaders’ behaviours which create the right environment for safe quality care. A decision for a young person to move into the service has a positive impact on the young person and also considers other needs and rights. There are concerns that current practice relating to over occupancy and emergency admissions falls short of the care inspectorates' expectations in meeting the requirements of 7.2. Group Size of Provision Matter for Children Who Experience Residential Group Care More than 75 years ago, the Clyde Report (1946) stated that residential care homes should house less than eight children. The Care Inspectorate Design Guide [21] (p. 18), the body that regulates and inspects residential care establishments, recently produced a report that states their “scrutiny evidence and data suggest that people living in smaller care homes often experience better care”, with children reporting a desire to live in settings with no more than four beds, which is consistent with other findings. 243
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NORTH AYRSHIRE Health and Social Care Partnership 190 Delivering care together The Care Inspectorate deems smaller houses to be more supportive of relationship building (Care Inspectorate, 2021). Consistency and felt security, within a larger group setting, can be difficult to achieve, as staff may respond to the needs of children who require their immediate attention, meaning the needs of children with less overt externalising behaviours, are less supported. A small-scale Scottish study reported on the impact of group size on the quality of care received – findings showed that higher numbers can adversely affect children’s feelings of being emotionally and practically supported (Whitelaw, 2023). Anecdotally, House Managers point to the impact of overoccupancy and unplanned placements on staff morale and motivation. It can be difficult to support the children and young people, when adults are feeling overwhelmed trying to support important transitions without the necessary time to plan and learn about the needs of the new and potentially distressed children, in their care. The United Nations Convention on the Rights of the Child (UNCRC) articles 3, 9 and 20 and Scotland’s Independent Care Review state what children should expect from authorities and services responsible for providing alternative care. The ambition for Scotland’s children is that they “grow up loved, safe, and respected so that (they) realise their full potential”. For those who spend a period of their childhood growing up in residential care, they should experience a relational, trauma-informed and caring approach from staff. Care homes for children should offer a safe and loving environment that resembles that of a family home, in order to improve the experiences and outcomes of young people experiencing care. The Promise stresses the importance of the quality of relationships in residential settings. It states that the values for these settings should be therapeutic and recognise that children require thoughtful, supportive relationships, as a basis on which to heal and develop as young adults. The overall size of residential care services must meet the needs of the individuals who use them. Young people have told us that they prefer to stay in a care home with a maximum of four beds. This supports people to form positive, worthwhile relationships with staff and other young people. Young people told us: “I was in a smaller service – it felt more homely and right for the children living there.” “Smaller houses seem more settled. Too many dynamics in larger groups. Imagine having seven brothers and sisters all winding each other up.” “With less young people, there is more space to have time away if needed.” Source: Care Homes for Children and Young People – The Design Guide (Care Inspectorate) The Health and Social Care Standards set out what people should experience as a result of their care: Standard 5.5 states: “I experience a service that is the right size for me.” Standard 5.7 states: “If I live in a care home the premises are designed and organised so that I can experience small group living, including access to a kitchen, where possible.” Standard 5.11 states: “I can independently access the parts of the premises I use, and the environment has been designed to promote this.” Standard 5.20 states: “I have enough physical space to meet my needs and wishes.” The Health and Social Care Standards set out what people should experience as a result of their care: Standard 5.5 states: “I experience a service that is the right size for me.” Standard 5.7 states: “If I live in a care home the premises are designed and organised so that I can experience small group living, including access to a kitchen, where possible.” Standard 5.11 states: “I can independently access the parts of the premises I use, and the environment has been designed to promote this.” Standard 5.20 states: “I have enough physical space to meet my needs and wishes.” 244
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NORTH AYRSHIRE Health and Social Care Partnership 191 Delivering care together Nurture/Trauma Informed care Educational Psychology Service (EPS) have worked on a consultation basis with NAC children’s houses for many years. In Summer 2018, following a period of negotiation and exploration of readiness factors, EPS began formally training and coaching House teams in the area of Nurturing approaches. The offer began with an introduction to Nurture for every House worker, then House Managers and Assistant Managers participated in 8 monthly joint coaching sessions with EPs and a South Ayrshire House Manager. This coaching approach was proposed to ensure future training for wider staff teams could be effectively supported by leaders who understood and believed in this relational and attachment-based approach. Throughout the sessions, key implementation factors were considered e.g. creating collective House values, using data to analyse impact of practice. Over the next 4 years training and coaching was rolled out to Seniors and House teams over the next 5 years, including refresher sessions for all in 2023. During this time every available worker was trained in all 6 Nurture Principles. Feedback from children and young people, and team surveys and Quality Assurance visits (2018 – 2022), indicated the majority of workers understood the values underpinning nurture and felt able to apply nurturing approaches in their context. There was evidence of Houses creating systems that supported ongoing development of nurturing practices, although all Houses had different takes on what they needed for their contexts. Published NAC Restraint figures (2018 – 21) showed a decrease of approximately 84% (from 18 in 2018 to 2 in 2021). The arrival of Covid strengthened relationships in some houses. Covid also created barriers to implementation, as it interrupted the momentum of collaboration across the 4 Houses and plans for in- house training. In addition, Quality Assurance visits, carried out by the extended House team and EPS, enabled Houses to identify barriers to implementation through use of the ‘How Nurturing is Our Children’s House’ self-evaluation document. Some challenges, in terms of planning, procedures, and changes to management teams did appear to be out with the control of the Houses. Currently, it is evident that demands on House teams have further increased, and planned entry to Houses can be the exception rather than the norm. EPS continue to work in partnership with Houses, upon request, via consultation. These sessions are productive and impactful with cases discussed through a mutually understood nurture lens. Provision of Residential Care for Children Under Twelve Residential care has gained a reputation of being a ‘placement of last resort’ and in 1992 the report “Another Kind of Home: a review of residential childcare,” by Angus Skinner (Social Work Services Inspectorate for Scotland, 1992) recommended against the use of residential care placements for children under the age of 12. However, in 2009 the Scottish Government indicated that residential care placements could be considered for younger children with significant levels of need, for instance: substantial histories of neglect, serious attachment problems, complex physical and mental health needs, and increasingly challenging behaviours that prove difficult to manage within family-type placements. North Ayrshire Councils policy and restructure of residential child care in 2007 was to shift the balance of care from residential care, to foster care and where possible children under 12 would not be placed in within residential child care and family-based options would be preferable. Following this Review, the Council continued a commitment that children under twelve years should not be placed in a residential setting and foster care was viewed as a more appropriate option for younger children. The original policy was based on the report “Another Kind of Home: a review of residential childcare,” by Angus Skinner (Social Work Services Inspectorate for Scotland, 1992). 245
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NORTH AYRSHIRE Health and Social Care Partnership 192 Delivering care together North Ayrshire acknowledge that residential care is a positive option for some children, and we have several younger children who have required the provision of residential care settings. This has related to younger children with complex histories, high level of needs and behaviours, who are unable to be supported and sustained within a family-based setting. It is noted that when children/young people have to be admitted to the care of the local authority, there are many factors which have to be considered, in terms of the best placement for their needs. While age is one of them, there are other considerations, in terms of their trauma and emotional situation, health, or neurodiversity issues, if they have brothers and sisters to be placed with them, geography, (for example, do they require to be near their birth parents, or other extended family members, or school placements). In addition, the lack of resources within foster care, particularly since 2021, due to the national crisis, in terms of recruitment and retention, has resulted in limited placement availability, to enable younger children, under 12 years, to be placed within foster care. As a result, all matching considerations require to be considered when considering the best possible placement, to meet the needs of all children/young people, who require to be taken into care. At time of writing report there are currently six young people under twelve in residential care this is in the main due to lack of fostering provision, rather than children having high levels, or complexity of need. Absence Over a consistent period of time the staff absence within the Children’s Houses has been running at elevated levels. Across the fiscal year 2022/2023 the service lost 1370.42 shifts as a result of staff absence, resulting in an absence percentage of 8.92%. In the last fiscal year, the service lost 1312.22 shifts as a result of staff absence, a detailed breakdown of this is shown below: 235.81 319.53 361.11 395.76 1312.22 0.00 200.00 400.00 600.00 800.00 1000.00 1200.00 1400.00 Abbeycroft Achnamara Canmore The Meadows Total Total Days Lost 246
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NORTH AYRSHIRE Health and Social Care Partnership 193 Delivering care together Source= Wellbeing @ Work 12.59 17.06 19.28 21.13 17.52 0 5 10 15 20 25 Abbeycroft Achnamara Canmore The Meadows Total YTD Total Days Lost Per FTE 4.68 4.8 5.79 7.26 6.41 6.15 6.02 4.79 5.8 7.14 5.43 5.79 0 1 2 3 4 5 6 7 8 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24Dec-24 Jan-25 Feb-25 Mar-25 Monthly Breakdown of Days lost Per FTE 247
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NORTH AYRSHIRE Health and Social Care Partnership 194 Delivering care together 87.7 89.9 108.4 136.0 120.1 115.2 112.8 89.7 108.6 133.7 101.7 108.4 0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Total Days Lost Per Month 6.14 8.32 9.40 10.31 8.54 0.00 2.00 4.00 6.00 8.00 10.00 12.00 Abbeycroft Achnamara Canmore The Meadows Average Absence Percentage 248
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NORTH AYRSHIRE Health and Social Care Partnership 195 Delivering care together 6.85 7.02 8.47 10.63 9.38 9.00 8.81 7.01 8.48 10.45 8.48 8.47 0.00 2.00 4.00 6.00 8.00 10.00 12.00 Total Absence % Per Month 249
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NORTH AYRSHIRE Health and Social Care Partnership 196 Delivering care together Finance The Cumulative spend is detailed below: • Budget = £4,139,220.00 • Actuals = £4,248,633.15 • Variance = £109,413.15 (Over Budget) Further detail in available in Appendix two Recruitment It has been highlighted within the workstream that the service has faced challenges when recruiting new staff members, it is felt that given the complex nature the role of a residential child care worker and the current pay scale, is a barrier to recruitment of skilled and appropriate staff. The Service note that it is a competitive marketplace with external providers and other local authorities offering higher salaries than North Ayrshire. Facilities Staff within the Workstream have highlighted that the importance of keeping the facilities & general building up to a good standard. The staff wish to highlight the importance of timeously carrying out any repairs to damaged or unusable equipment, such as lock on the doors of the Young People’s bedrooms, which if not repaired can lead to security issues as well as present a risk to confidential information, money, or further damage to property. The houses should offer a clean and tidy, warm and welcoming environment where children and young people are free to live with pride in their house/home. The children and young people have a say in how the House looks in decoration and furnishings. The Houses should be decorated every two years, or when damage/repairs necessitate it. The gardens should be regularly maintained and the responsibility for this lies with the residential staff not part of the councils’ parks and recreation schedule. The gardens should be tidy, well-kept and able to be used year-round. The grass should not be too long that a ball cannot be kicked around. Abbeycroft Achnamara Canmore The Meadows Sum of 24/25 Budget 1,029,196.00 1,028,227.00 1,032,546.00 1,049,251.00 Sum of 24/25 Actuals 1,014,752.32 954,165.03 1,134,512.44 1,145,203.36 - 200,000.00 400,000.00 600,000.00 800,000.00 1,000,000.00 1,200,000.00 1,400,000.00 24/25 -Childrens Houses 250
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NORTH AYRSHIRE Health and Social Care Partnership 197 Delivering care together Catering/Cleaning At the time of writing Facilities Management have submitted a proposal of changing the cleaning and catering provision within the houses, this is due to difficulties in recruiting to these posts. Key Findings There is evidence that aspects of residential childcare in North Ayrshire are working well, staff are committed to ongoing improvement and development to ensure a high level of nurturing and trauma informed care is provided to children and young people and the environment is welcoming and homely. In light of The Promise, Signs of Safety and North Ayrshire’s Kinship Care Strategy and the intensive supports services. there will always be a cohort of children and young people who require residential care provision, this has increased as a result of the NTS/trafficked young people and a decline in foster care provision. There is a changing and diverse group of young people, who require residential care, increase in children/young people with diverse needs, cultural background, additional needs and neurodiversity. There is also an increase in young people staying until twenty-one and a requirement to care for more children under twelve, within residential settings. Only a small percentage of the young people under twelve, have high levels of need and are in residential care due to lack of fostering provision. There is a reliance on residential care for children in North Ayrshire at this current time, due to a shortage of foster carers and alternative resources for young people to move on. Most admissions to residential care are on an emergency basis, with a lack of appropriate matching or pre-placement considerations. This has been a feature in recent inspections which have highlighted lack of adherence to matching protocol, inappropriate placements and overoccupancy above registered numbers. The Care Inspectorate highlights that for care to be compassionately delivered, carefully considered matching of children to the right house is essential. There is high rate of staff absence within residential childcare, which is associated with high levels of stress and ‘burn out’. The care inspectorate design guide, which is based on research with young people, indicated that a Residential House, with the maximum of four beds, is more conducive for children experiencing a higher standard of care. There has been changes to managers, staffing and as a result of inspections, there has been low staff morale within the sector. This is compounded by ‘public humiliation’ of staff already ‘burnt out’ and going above and beyond....and further stigmatisation of young people, who see their home negatively plastered all over the media following publication of inspection reports. Research by SCRA on the Care Trajectories and Nature of Care Received by Children Aged 5-11, Who Need Therapeutic Care, highlighted that in the absence of community-based supports, therapeutic residential care, delivered in homely environments, can be beneficial for younger children (age 5-11). These placements allowed for a team to be built around the child and provided both the time and space required for children to recover from their experiences of trauma. It also provided children with access to therapeutic and mental health supports that could not be accessed within the community. This was either done through clinicians working directly with children, or through providing residential care staff with advice about how to manage the behaviours they were witnessing on a daily basis. Care Inspectorate reports, following inspections of Residential Houses in North Ayrshire have highlighted the statutory responsibilities of the Residential Houses, as a local authority resource, to provide emergency care to children, which has contributed to the absence of admission, or matching procedure and the Houses being overcapacity. This has resulted in houses receiving a weak score from the Care Inspectorate and a requirement to have an effective and appropriate admissions process. This overall 251
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NORTH AYRSHIRE Health and Social Care Partnership 198 Delivering care together has had a significant impact on the scoring and the care inspectorate's assessment of the quality-of- care children and young people receive. Although residential care is a significant part of the Scottish care continuum, it is often viewed as “a placement of last resort” There are two key reasons for this. First, proven episodes of historical child abuse have resulted in concerns about the safety of residential care, Second, outcomes-based research indicating that children living in residential care experience poorer outcomes than children living in family-based placements, which has created concerns about the efficacy of residential care. The research by SCRA challenges the view that residential care is a last resort, by demonstrating that therapeutic care, delivered in a relationship-based and trauma-informed manner, by well trained professionals, can provide a period of stability and healing for children, who have experienced significant trauma. It also highlights that there is a need to consider whether residential care should be used earlier within the care journeys of some children.” Strategic Direction “North Ayrshire has high levels of poverty and deprivation. In the Scottish Index of Multiple Deprivation, of the 186 data-zones (very small areas with about 800 people living in them) across North Ayrshire, almost 40% are amongst the most deprived in Scotland. As of 2021, North Ayrshire has 26,246 people aged between 0 to 18 years. Of those, over 45% live in those most deprived areas. As a result, it is likely that these young people are likely to face additional barriers and challenges in achieving positive outcomes.” “Looked After Children …at 18 per 1000 of the local 0 to 18 population, North Ayrshire still has one of the highest rates of children and young people looked after in Scotland, ranking 4th highest in in Scotland. The national rate for children looked after is 12.3 per 1000. Given the current demographic, contextual risks and levels of deprivation within North Ayrshire, combined with high rates of child protection registration and kinship placements, there will continue to be a significant number of children who will be at edge of care, with a smaller proportion who require to be accommodated. The next phase of the work relating to whole family support and intensive supports reconfiguration, will have a clear objective to provide intensive support and scaffolding to prevent children coming into care. The impact of foster care recruitment and retention, alongside the introduction of the National Transfer Scheme, support to trafficked young people and continuing care legislation, as well as limited housing stock suitable for young people, are all factors in the over reliance, overoccupancy in residential care and why young people are not transitioning until twenty-one. The National Transfer Scheme and the local authorities' responsibilities to USAC/trafficked young people has led to young people under sixteen being received into residential care. There is an element of control on the age of young people we support, via the NTS schemes, unlike spontaneous arrivals, where the numbers and age of this cohort of young people, are unknown. 1. Board to acknowledge the activity and steps taken to recruit and retain high quality foster carers at local and national level, for children of all ages within North Ayrshire. It is unknown if recruitment and approval of foster carers, will reach the same levels as 2020, pre covid times. There is still no guarantee that we will have enough approved carers to meet the demand of young people, who require alternative care and fostering provision. The increase in approved foster carers will have a direct impact on internal residential provision and should mitigate the need for under twelves to continue to be accommodated in residential care. It is projected that North Ayrshire Council will require thirty new interim foster carers over the next five years to meet the demand of children who require foster care provision. 2. Board will be aware that work is ongoing to scope out a proposal and business case for a supported accommodation in North Ayrshire. This would provide an alternative to young people over sixteen, to transition from internal and external residential care. A supported accommodation resource was fully supported within the workstream, and it was recognised there was a gap service provision and the benefits for young people transitioning from 252
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NORTH AYRSHIRE Health and Social Care Partnership 199 Delivering care together residential care, to eventually their own tenancies, was felt to be crucial. The supported accommodation would only offer support to six young people, which will not mitigate the pressures and capacity significantly, within internal residential care. However, this was felt to be a positive resource, which would assist young people to develop their independence, in a supported environment and gain the life skills and knowledge required to enable them to be in the best place to work towards the goal of their own tenancy. The above issues and activity are all interconnected and relate to future projections and capacity for residential care resources. 3. Due to ongoing capacity issues, over occupancy and an increase in under twelves being admitted to residential care, the strategic direction would be for consideration to increasing capacity of the residential childcare estate with the development of four bedded Houses, that would meet the needs of children under twelve and sibling groups. This would be in line with the Care Inspectorate design guidance on the optimum size of residential childcare resources. 4. The staffing levels within the four houses has remained static since they opened and there has been no increase to staffing levels at times when houses are over their registered numbers. It is the view of the workstream that there are no efficiencies that could be made relating to staffing levels as the compliment of staff on shift is necessary given the number of children in the houses and level of need and complexity of children and young people. 5. The Health and Care (Staffing) (Scotland) Act 2019, and guiding principles for health and care staffing state that the main purposes of staffing for care services are to provide safe and high- quality services and to ensure the best care outcomes for service users. Adequate staffing levels are required to promote nurturing and trauma informed practices within the residential houses. 6. The Health and Care (Staffing) (Scotland) Act 2019, and guiding principles for health and care staffing state that the main purposes of staffing for care services are to provide safe and high- quality services and to ensure the best care outcomes for service users. Adequate staffing levels are required to promote nurturing and trauma informed practices within the residential houses. 7. The Care Inspectorate would not consider registration of a new care home for children with more than four children/young people. 8. Given the elevated levels of staff absence within the Children’s Houses, it is felt that there is a need for the workstream to work alongside the Children Houses staff to look at ways to improve the absence process, the group are hopeful that this would have a positive effect on the wellbeing of staff, resulting in lower levels of absence. 9. The Board to consider re -establishing the matching criteria where possible within our Children’s Houses, given the importance of this within the Care Inspectorates Inspection Criteria. 10. Board to consider development of agreed KIP’S to be tracked and regularly discussed at Management Reviews & Team meetings. It is hoped that by doing so the service will be able to realise efficiencies that will improve the running of our Children’s Houses, resulting in a productive working environment that will enhance the lives of the Children & Young People who reside within our Children’s Houses. 253
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NORTH AYRSHIRE Health and Social Care Partnership 200 Delivering care together Appendix One References Barton, S., Gonzalez, R., Tomlinson, P., & Burdekin, B. (2012). Therapeutic residential care for children and young people: an attachment and trauma-informed model for practice. Jessica Kingsley Publishers. http://site.ebrary.com/id/10504709 Care Inspectorate (2022) Care Homes for Children and Young People–The Design Guide. 2022. https://hub.careinspectorate.com/media/4810/care-homes-for-children-and-young-people-the- design-guide.pdf Fallot, R. D., Harris, M., & Community Connections. (2008). Trauma informed approaches to systems of care. Trauma Psychology Newsletter, 3(1), 6–7 Morris, M. (2023) Reasons to be cheerful: Factors making a positive difference to children in residential care in Scotland. Scottish Journal of Residential Child Care: An international journal of group and family care experience Volume 22.2 Robinson, C., & Brown, A. M. (2016). Considering sensory processing issues in trauma affected children: the physical environment in children’s residential homes. Scottish Journal of Residential Child Care, 15(1), 6–18. Ulrich, R. S. (2001). Effects of healthcare environmental design on medical outcomes. Design and Health: Proceedings of the Second International Conference on Health and Design, 49, 12. Whitelaw, R, (2023) Does Group Size of Provision Matter for Children Who Experience Residential Group Care in Scotland? Youth, 3, 1391 – 1405 Care Inspectorate (2024 a) Key question 7 for care homes for children and young people and school care accommodation (special residential schools) kq7-for-cyp-and-schoolcare-accommodation.pdf Care Inspectorate (2021) Guidance for providers on the assessment of staffing levels Guidance for providers on the assessment of staffing.pdf Health & Social Care Standards (2017) Scottish Government health-social-care-standards-support-life.pdf SCRA (2022) Summary Briefing Paper (1) Characteristics of 5-12 year olds on compulsory supervision orders with residential care conditions Summary-Briefing-Document-1.pdf The Care Trajectories and Nature of Care Received by Children Aged 5–11 Who Are in Need of Therapeutic Residential Care - SCRA The Promise Residential Care (2020 keepthepromise-residential-care.pdf The Promise Plan 24-30 254
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NORTH AYRSHIRE Health and Social Care Partnership 201 Delivering care together prm001_reflect_refocus_reset_plan24-30_s5_v1.pdf Appendix Two Further finance information is available in the attachment below: Childrens House Budget and Spend 1.docx 255
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NORTH AYRSHIRE Health and Social Care Partnership 202 Delivering care together Appendix11Early Intervention and Intensive Support Pathways Position Paper Brighter Pathways – Early Intervention/Intensive Support Pathways Strategic Vision Kevin Mcginn (Planning Manager / HSCP SP&TT ) Kevin McGinn (Planning Manager) Arthur Coutts (Programme Manager Brighter Pathways) Frances Gunn (Service Manager – Children’s Services) 256
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NORTH AYRSHIRE Health and Social Care Partnership 203 Delivering care together Introduction The Aim of this Paper is to give a breakdown of the current Early Intervention & Intensive Support Services within North Ayrshire Some of the topics covered are as follows: • Volume of Services provided for each Category • Working Definition of Early/Intensive Supports within the Workstream. • Service Mapping Exercise. • Suggested Options Please note that this list or the items covered are not exhaustive of all the services at present, it is hoped that this paper will allow for further discussion and each of these can be added to the Final Report. 257
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NORTH AYRSHIRE Health and Social Care Partnership 204 Delivering care together Early Intervention & Intensive Support Workstream As part of the Brighter Pathways Programme of works it was deemed that there would be a need for a Workstream that would look at Early Intervention & Intensive Support Pathways. The workstream convened on Tuesday 2nd of July 2024, with representation from the following services: • HSCP Psychological Services • Universal Early Years • HSCP Senior Manager • Education, Including Psychological Representation • The Whole Family Wellbeing Fund • Rosemount • 3rd Sector • Planning Manager (Front Door transformation) In order to gauge what services were available the workstream initiated a mapping exercise. Definitions – Continuum of Supports Early Intervention Early intervention - can be described as intervening as soon as possible to tackle or prevent problems for children and families before they become entrenched or difficult to reverse. Early Intervention refers to services and supports provided to individuals and families to reduce the need for more intensive and statutory services in the future. Targeted Intervention Focuses on target groups with specific needs and complicating factors, the resource/service has a specific focus by tailoring the intervention to the specific needs of the target group. Intensive Support Refers to a high level of assistance provided to individuals or families often involving concentrated effort and resources over a short period. This type of support is provided in addition to office hours at evenings and weekends to families. 258
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NORTH AYRSHIRE Health and Social Care Partnership 205 Delivering care together Service Mapping Within the workstreams it was discussed that in the main, most of the members weren’t aware of what supports are provided, for both, Early Intervention & Intensive Support. The group felt that it would be beneficial to carry out a mapping exercise that would help to ascertain the following: • Volume of Services provided for each Category • Service Coverage • Contract Length • Age Range • Eligibility Criteria A template to capture this was circulated to the workstream members, with a view of them updating the information. • Within the mapping exercise, it was detailed that within North Ayrshire we have forty- one Early Intervention Services • It was detailed that within North Ayrshire we have seven Intensive Support Services. 7 41 0 5 10 15 20 25 30 35 40 45 INTENSIVE SUPPORT EARLY INTERVENTION Number of Services 259
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NORTH AYRSHIRE Health and Social Care Partnership 206 Delivering care together Early Intervention Coles et al (2016) highlight that in spite of persistent health inequalities and intergenerational deprivation, the Scottish Government continues to aspire towards Scotland becoming established as the best country for children to grow up in. The Getting It Right for Every Child (GIRFEC) framework guides all agencies providing care to children and families to work towards improving children's well‐being via early intervention, universal service provision, and multiagency working. In North Ayrshire, as identified via the mapping exercise, there are numerous early intervention services currently available ranging from universal to targeted early intervention services with host agencies spanning across health, social work, education and the third sector. Universal Health Services Universal Health services include midwifery and health visiting. Midwifery services in Ayrshire & Arran are delivered on a universal basis in line with the proposals outlined in the best start: five-year plan for maternity and neonatal care document published by The Scottish Government in 2017. The Universal Health Visiting Pathway (Scottish Government) is being offered to all pre-school children in North Ayrshire, which provides a robust foundation for consistent identification of need, and timeous onward request for assistance. There is no universal health services offered to children following their transition to primary school, although targeted health services are available to children and young people aged between 5 and18. Targeted Health Services The Early Years Support Team work across North Ayrshire (with the exception of Arran) in conjunction with the HV and although a review of their roles is underway at the time of writing, they provide support to families with pre-school age children around areas including speech and communication, sleep, routines and boundaries, bonding and attachment. These services are accessed via the Request for Assistance (RFA) process which is a GIRFEC process available to enable those acting in a named person or lead person role to request additional support. Family Nurse Partnership (FNP) and Safeguarding Midwifery (SM) services are offered to those who are identified as meeting their acceptance criteria which for FNP is based on age with women of 20 and under having their first child being offered the service, and the service is offered to women up to age 25 who have previous care experience. The SM service is accessed via a referral in the early stages of pregnancy following booking with the community midwife where previous or current risk factors are noted. These may include drug and alcohol use, mental health or learning disability, previous difficulties in bringing up children, being in care as a child or young person, being the victim of harm or abuse, being homeless, and any other factor impacting on the well-being of the unborn baby. The School Nursing service in North Ayrshire provides targeted health support to children and young people who attend an education establishment in North Ayrshire. School Nurses are specialist public health nurses who provide support to children, young people and their families. Their primary focus is prevention and early intervention to ensure children and 260
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NORTH AYRSHIRE Health and Social Care Partnership 207 Delivering care together young people reach their full potential regarding health and wellbeing, thus limiting the risks of poorer health outcomes in adulthood. Children and young people are assessed using a comprehensive approach with a holistic assessment formulating a robust health analysis. School Nurses work in line with the Scottish Government Pathways which include - Emotional Health & Wellbeing, Transitions, Sexual Health, Substance Misuse, Domestic Abuse, Child Protection, Young Carers, Youth Justice, Homelessness and Looked After Children. Currently, Child Protection, Looked After children and Emotional Health and Wellbeing pathways are widely used within our service however, it is important to note that each pathway does not run independently with some children and young people falling under more than one pathway due to their health analysis. Between the period 1st July 2023 to 31st March 2024, 379 children and young people accessed the counselling through schools in North Ayrshire. All 379 reported reduced scores in their Young Persons Clinical Outcomes in Routine Evaluation (YP-CORE) scores meaning that all report improved outcomes following access to a counsellor in school. Of these 379, 11 required onward referrals to CAMHS, and 1 required onward referral to crisis counselling. Play Therapy is also available via school for Care Experienced children who have experienced significant trauma. In total 93 children and young people have accessed Play Therapy since January 2021. The impact has been extremely positive with professionals, parents/carers and children all evidencing change. With one child saying, “I think that I now make better choices for myself” with another saying, “you have helped my heart become more full of sunshine”. The programme has been so well received by the Health and Social Care Partnership (HSCP) they have now invested in a full-time permanent Play Therapist; this has ensured sustainability of the support and allowed investment of CYPCMHWB Framework funding in other programmes. The Community and Adolescent Mental Health Service (CAMHS) covering North Ayrshire has three teams: Specialist Community CAMHS (CAMHS). This team covers the assessment, care and treatment of children and young people experiencing serious mental health problems e.g. low mood, anxiety, suicidal ideation. Specialist CAMHS services are accessed via a referral from either the child/young person’s school or education services, social work, or the child/young person’s doctor (GP). CAMHS Urgent Assessment & Intensive Treatment (CUAIT). This team respond to the urgent needs of young people who are experiencing a mental health crisis and is accessed via presentation at an Emergency Department. Neurodiverse CAMHS (N-CAMHS). This team provides multi-disciplinary neurodevelopmental assessments for children and young people who have been referred by school or GP. Neurodevelopmental assessments may provide a diagnosis of conditions including: autism spectrum disorder (ASD), Attention Deficit Hyper Activity Disorder (ADHD), Foetal Alcohol Spectrum Disorder (FASD), Intellectual Disability (ID), Developmental Language Disorder (DLD), Developmental Co-ordination Disorder (DCD) and Tourette’s / Tics. All CAMHS services can offer targeted support to children and young people from age 5 up to 18. Interventions and support can vary from short term treatments to more complex treatments for children and young people experiencing more severe problems. 261
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NORTH AYRSHIRE Health and Social Care Partnership 208 Delivering care together Early Years Social Work The Early Years Social Work (EYSW) teamwork across North Ayrshire (with the exception of Arran) and are accessed via RFA by the named person. Their remit is to provide support and early intervention to families and the work closely with HV’s and FNP as part of the universal early intervention provision. Three Social work posts in the Early Years Team are funded by the Whole Family Wellbeing Fund meaning that these are short, fixed term posts which if funding ends, could leave a notable gap in service provision. Third Sector Both early intervention and targeted supports are available to children and young people in North Ayrshire via Third Sector colleague organisations. Some examples of early intervention support provided includes that offered via the Children 1st base in North Ayrshire. Children 1s offer early intervention support to children, their families and the people who care for them by offering, emotional, practical and financial supports. More targeted supports are available from organisations including Penumbra, who offer support to young people experiencing self-harm, and the Stronger Families service offered by Barnardo’s. The Whole Family Wellbeing Fund (WFWF) has commissioned a range of support for children and young people and their families. From the Third Sector, these include Impact Arts who provide Art Wise, a 9-week parent and toddler art and sensory programme in Irvine. Impact Arts also support children aged 5-15 whole have experienced parental substance misuse. Baby Bundles delivered with Beith Trust provide essential baby and toddler items to families in need, with many referrals coming from the Health Visitor service. Ayrshire Children’s Services in partnership with Ko-nekt provide Nurture Parenting Courses, supporting parents in a non-judgemental environment to learn about their own triggers and challenges in parenting, as well as exploring some of the common parenting challenges they are experiencing. Also within the WFWF, a support worker from Dad’s Rock is situated in the Children and Families team and this service has been well received within the community, and they have now been able to recruit a second support worker to expand the service, providing one to one support for Dads and other father figures within families, as well as whole family support and drop in peer support groups. Similarly, the Children, Families and Young People Communities Mental Health and Wellbeing Fund, now entering its 4th year, has provided small grants to Third Sector organisations each year. The 6 organisations funded to provide support in 2025/26 include KA Leisure, providing a 5 week EMPOWER programme supporting young people struggling with anxiety, stress and social isolation to develop their self-confidence and take part in physical activity. Saltcoats Link Up who use a wide target approach, inviting the whole community to take part in free family fun activities over the year, whilst staff are able to offer further support and sign posting to those families most in need of help or support from, for example, the community larder, debt advice, and free uniforms and haircuts for back to school. A small local Third Sector organisation called Balance & Bliss have been funded in 2025/26 to support children, YP and their families with a selection of holistic therapies, aiming to build coping strategies and strengthen family bonds. 262
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NORTH AYRSHIRE Health and Social Care Partnership 209 Delivering care together Area Inclusion Workers Area Inclusion Workers are linked to school clusters in North Ayrshire. Their key aims and outputs include promotion of the value of inclusion and encourage and support pupils to attend and to stay in school, developing links between home and school focusing on maximising attendance and provide support to young people and their families by being a key point of contact. They also support and offer advice to children/young people and families with all well-being requirements by carrying out home visits to assess and support identified needs of the child/young person and parents/carers. Area Inclusion Workers also maintain contact with young people and parents in relation to support self-esteem, improving social skills, develop peer relationships, attendance and behaviour. Finally, they support transitions to secondary school or supporting transitions for children and young people who move into North Ayrshire or change secondary school within North Ayrshire. The Area Inclusion Workers are felt to be a valuable early intervention resource who are through evaluation, demonstrating that their input has potential to address issues before the need for escalation. In term one of 2024/25 346 children/young people in North Ayrshire received a 1:1 intervention from an Area Inclusion Worker, with 430 children/young people accessing group work delivered by the AIW. An example of success achieved by the AIW in term 1 include work with1 secondary school pupil who was not attending school but following work with the AIW, their attendance improved to 75.4% by the end of the term. Had this work not been undertaken by the AIW, it is possible that the pupil would have been referred into the Children's Hearings System, which could have resulted in an escalation of service need. In term two of 2024/25, 450 1:1 interventions were delivered which indicates ongoing high levels of early intervention support delivered, which if not available, has potential to escalate therefore requiring further support and intervention. 263
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NORTH AYRSHIRE Health and Social Care Partnership 210 Delivering care together Intensive Family Support Whatever issues families face, Scotland must ensure that intensive family support is available, proactive and characterised by the Ten family support principles: • Community Based • Responsive and Timely • Work with Family Assets • Empowerment and Agency • Flexible • Holistic and Relational • Therapeutic • Non-Stigmatising: • Patient and Persistent • Underpinned by Children’s Rights The majority of services within the HSCP who support families operate generally from 9am to 5pm. Staff will at times wok later and support a family/young person after hours, however they are not contracted or paid for evening and weekend work. In North Ayrshire there are also several services where workers receive an unsociable hour’s payment, the individuals in receipt of this allowance are required to work One Hundred & Fifty hours per year after 7pm or at weekends, these services are detailed below: • Rosemount Team • Young Person Support Team • Families for Children (short break service, fostering & adoption) (proportion of workers) • Family Care Workers (proportion of workers) • CASST • Programme Approach Team • Child Protection Workers (proportion of workers) Developments over the last year have seen the Child Projection team expand and recruit staff who work on a Saturday, this is with a view of providing support to families at weekends. The explicit aims of intensive family support will be to: • Keep families together and avoid children going into care. 264
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NORTH AYRSHIRE Health and Social Care Partnership 211 Delivering care together • Interrupt and address intergenerational cycles of trauma. • Sustain meaningful and loving relationships. Harper House - Specialist Family Service Scotland The Specialist Family Service Scotland offers safe, structured support for the whole family to address their problematic drug and/or alcohol use, improve their mental health and quality of life. The service provides a unique, family-focused intervention programme that benefits each family member and the family unit as a whole. Families stay together at the service, meaning that parents remain the carers of their children at the same time as taking part in the programme. Alongside this, Specialist childcare staff provide support to children and parents. The Harper House programmes are flexible between 12 and 26 weeks, depending on need. Since opening in October 2022, twenty- six adults from within North Ayrshire have been referred for consideration of admission to Harper House. Eighteen of these referrals converted into admissions meaning that in total, eighteen adults and twenty-one children from North Ayrshire have received intensive support via a residential placement within Harper House. The Rosemount Project The Rosemount Project is a crisis intervention and intensive support service designed to ensure children stay with their families - and that families are actively supported to remain together. The service accepts referrals for children aged 8 to 18 years, and the team can provide daily contact and support out with regular working hours, including evenings (up to 9pm, Mon-Thu) and weekends. The service provides immediate support to vulnerable children, young people and parents/carers who are assessed as having a high level of need and risk. The crisis support service usually focuses on children aged 8-16, and the service has one worker who focuses of young people aged 16+, who are not eligible for statutory Throughcare, but require support when threatened with homelessness / going through the homelessness process. Support can also be provided to children and young people who are looked after by the local authority to assist their return to a family setting. This would not include children under the age of eight years who were being rehabilitated. In terms the number of referrals to the service, for the years 01/04/19 to 31/03/24 (past five full financial years), the average number of new referrals was 98.6 per year (493/5 = 98.6). There tends to be some fluctuations in referrals, with a low of 77 in 2020/21 and a high of 118 in 2021/22. However, it is important to note that the number of individuals referred does not reflect the volume of work that is generated by those referrals. That is, it is typically the case that one referral reflects a single child living in a family unit. Also, at the beginning of each financial year, there is an existing caseload of young people and families open to the service, which has a bearing on the caseloads of each worker. When looking at the total number of referrals from 1st April 2019 to 11th December 2024 (564), and the number of parents/carers, siblings, and wider family who were involved in interventions (1,990), this results in an average of 3.5 family members supported within each case. 265
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NORTH AYRSHIRE Health and Social Care Partnership 212 Delivering care together In all but one of the past five financial years, Rosemount support has contributed to over 90% of the children involved with the service remaining at home or in a family setting (2019/20 – 88.8%; 2020/21 – 92.2%; 2021/22 – 90.7%; 2022/23 – 93.6%; and 2023/24 – 95.3%). In regard to age range of children involved with the service, the average age of children referred for support has been 13.7 years. The age range of 13-17 years tends to account for the highest proportion of children referred to the Rosemount service (2019/20 – 70% of referrals fell within this age range; 2020/21 – 65%; 2021/22 – 69%; 2022/23 – 67%; and 2023/24 – 57%). As indicated above, the onset of adolescence appears to be the point at which parents and carers begin to experience increased difficulties managing their children’s behaviours. As is known, there are myriad reasons that young people may be referred to the crisis and intensive support service, with concerns around parenting capacity the most common risk factor. This manifests as a lack of parental supervision, and/or children’s emotional wellbeing being impacted by parental mental health, substance use, or the presence of domestic violence, and so forth. The weekend support that is facilitated by the Rosemount Project is planned and decided on a weekly basis. A decision is taken each Friday regarding the families/young people who we know will require advice and guidance over the weekend. The purpose of weekend contact is to ensure that any safety plan that has been agreed with a parent/carer in respect of their child(ren) is actioned. For instance, if a child has been absconding and failing to return by curfew, we would ask for parents to have notified the relevant authorities and to pursue every avenue to ensure their child is located and returned home safely. Thereafter, it is about ensuring that the consequences implemented by the parent are proportionate and appropriate, in order that the child(ren) come to have more regard for an authoritative parenting approach, and they have an opportunity to develop their consequential thinking, based on the impact and outcome of the behaviours they have engaged in. This is where the team come in to guide and support parents through this process. The emphasis for weekend support is that it is needs led, specific to the issues a family are experiencing, and relevant to the focus of work that takes place over the five working days Monday to Friday. It is pre-planned and agreed upon with every family and it helps provide reassurance that contact will be maintained, proportionate to need, over the 48 hours of the weekend. Further information is provided below regarding the frequency of the support Rosemount has provided at weekends. Locality Social Work Teams The Locality Social Work teams support any child who is deemed to be a child in need, they currently have over 1100 children in receipt of a service. This ranges from short term pieces of support and intervention which may relate to a parent fleeing domestic violence resettling, supporting with the associated impact on their children as well as supporting with parental separation and coercive control. Often situations can be much more complex in nature with significant aspects of inter-generational family trauma apparent with multiple and layered vulnerability and adversity noted within some families . This can often mean that the family support network can have its areas of potential breakdown often resulting in Locality teams having to support and scaffold the practical and emotional support to children. For example, we can have a 11-year-old in Kinship (with the only family member able to provide 266
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NORTH AYRSHIRE Health and Social Care Partnership 213 Delivering care together support) who displays previous trauma in their inability to trust and responds to adult care givers. This is manifested in resistant attempts to care being received. It was identified that there was a need for therapeutic support which is being progressed. The way in which the child struggles to accept care can result in the carer becoming exhausted, frustrated, and not feeling able to manage the situation. This impacts their own mental health which results in them feeling unable to care. This in turn results in spontaneous occasions where they feel they need to relinquish care . We have limited short break carers who can sometimes help to alleviate pressure on such situations . Rosemount workers will work together with Locality workers to help bolster and support such situations. Not all age groups and situations would be eligible for this support or indeed if Rosemount do not have capacity over a weekend to support, this often necessitates the use of Locality based social work staff to both alleviate and respond to immediate situations /source other alternative family members and friends and undertake all necessary police and agency checks to ensure they are a safe option and or also provide 7 day a week support if that is what is considered necessary to support a child remaining at home. Workforce are employed Monday to Friday 35 hours a week so any requirement out-with this is undertaken on the good will of staff being willing to work extra/overtime or take time back . The impact on staffs’ resilience and wellbeing who regularly undertake long, and emotionally demanding work is at risk, which in turn could create secondary trauma burnout or turnover. Any new or emerging concern for an open case requires to be responded or supported as well as any new Child protection child wellbeing matters, this spectrum encompasses both early intervention and prevention but often due to the complexity of family adversity we meet individuals in crisis. That is the level of need from adult population within NAC has a direct impact on the support available to children, this is we have adult population affected by drug and alcohol use. Poverty , mental health vulnerabilities these issues directly impact on the children and young people within our communities also. Many of the needs are experienced by services at points of crisis and thus Localities are required to respond, assess, and ensure children are safe during such times. Family Care Workers- Locality Teams There is one senior and two-family care workers in each locality so nine in total. The Family Care Workers contract is from 7am to 10pm working 7 hours in-between that time 7 days a week, that could be also a split shift to cover mornings and evenings. They receive unsocial hours for late nights after 7pm and weekend working to which a minimum of 150 hours per year is needed to qualify for this. These workers are employed in a range of activities and were employed to work directly with family’s offering intensive scaffolding supporting where required e.g. establishing and supporting parent with bedtime routines and boundaries. Additionally, we have a further 9 family care workers, 2 of which sit in health visiting services. The other 7 posts sit across the Child Protection team (1 post ) and the other 6 are split across Locality . These workers are contracted Monday to Friday core service times . These workers are also employed to provide the same support as the other family care workers but without the unsocial hours component many of whom are able or willing to be flexible regarding their hours however this is not always possible. Due to lack of resource to support family time sessions and to cope with the demand of transportation and court and legally mandated family time hours a number of family care 267
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NORTH AYRSHIRE Health and Social Care Partnership 214 Delivering care together workers hours can be taken up supporting children who are already out-with parental care this takes them away from more preventative support and diminishes capacity in this critical area. The work of family care teams can be invaluable in scaffolding extremely vulnerable situations providing 7 day a week support throughout the year and undertaking significant work and time with families for example in one Locality area alone this year 547.5 unsocial hours were undertaken between 3 workers , supporting families at crucial points out-with core hours when it was required . They are very often due to this intensive work able to establish relationships of trust with families where they feel supported and work alongside them , in many areas they have created community based events working alongside third sector colleagues to put on Christmas events with movies for children in the community, run back to school events over the weekend which are often supported by wider Locality team staff too . These provide free haircuts, arts and crafts activities something to eat, school equipment and clothing. Welcome to all the help build community relationships and trust in and with social services. Community Short Break Service The Community Short Break Service is part of the provision of services for children who are at risk of becoming looked after by a local authority which is set out in Part 12 of the 2014 Act. A local authority must plan to secure relevant services are made available if this would benefit a child‘s wellbeing. The service provides planned short breaks for children/young people aged 0-16 Short Break Care is a targeted intervention and any child/ren being referred will require to have a Lead Professional from the Locality Team The eligibility for short breaks will be where it is assessed that children and young people in the community with birth parents or informal/formal kinship care placements require short breaks to help sustain their placement. This will include children who are on the edge of care, current situation is fragile and at a risk of disruption, and children who are at risk of being looked after. Short Breaks carers are a distinct group of carers, whose role is to support families in the community. This is to ensure that the children and families who use the service do not feel that short breaks are a means of children being accommodated. The focus of the service is to support children to remain at home. The Community Short Break Service continues to be a very useful addition to the existing resources available for children in North Ayrshire. Over the last year the service has provided over 650 overnight short breaks and been central to scaffolding around children and families both in the community and kinship as well as providing a support in maintaining children within their fostering families. Many of the children in the community have been/ are currently subject to child protection planning or are on the edge of becoming accommodated. Over the last year 37% of the short breaks provided by the service have been for children in the community with 30% from kinship and 33% from Fostering. Isle of Arran/Millport It is acknowledged that there are barriers to providing early intervention and intensive support to families who reside on Millport and Arran, there is not the same level of service 268
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NORTH AYRSHIRE Health and Social Care Partnership 215 Delivering care together provision due to need and population numbers. Given the geographical location and the intensive support services being on the mainland this can be resource intense, and Arran has proven difficult to access for services on the mainland. Further exploration required and creative solutions to provide scaffolding and intensive support to the small number of families who require it on the two islands. There are no staff within Arran locality who work weekends/evenings or receive unsociable hours and interventions are provided during core hours. Third Sector supports are available, although the service delivery is slightly different given location. Ther are also challenges relating to recruitment and retention of staff in rural settings. Summary Early Intervention – Key Findings As noted, several early intervention supports are offered by third sector partner colleagues. While many of these services are well established and have built effective partnership working relationships with agencies who work within a lead professional or named person role, some gaps in joint working still remain. Partners in the third sector do not always appear to be included within joint decision-making processes which may lead to a disconnect within assessment and intervention planning, as supports may be at risk of being duplicated or contradicted, neither of which provides the most effective and consistent support for families or the best use of limited resources. The mapping exercise and associated analysis and discussion within the workstream also highlighted some lack of professional awareness of services and their roles and remits, which can contribute to services not being utilised to fulfil their maximum potential. The mapping exercise also highlighted that some services rely on short term funding to operate, which leads to a sense of precariousness and raises concerns about longevity and the ongoing potential for gaps in service provision should funding come to an end. This is a particular concern given the difficult financial context at present. Intensive Supports – Key Findings Other models of Intensive Family Support have been considered and evaluated with suggestions for areas of improvement within the Rosemount Service, see appendix one The current intensive family support provision within North Ayrshire is based on age, eligibility criteria and what service you are involved with. There is no universal service that can provide flexibility and intensive family support to all families where it is deemed necessary. Some elements of intensive family support are provided by Family Care Workers, Child Protection Team and the Short Break Service. Families who are involved with Rosemount can receive seven-day support. To provide an intensive support service that would meet the needs of any child in any circumstances would require a reshape of the workforce or a specific team to provide this level of intervention. This would involve a change to current contractual arrangements which would include weekend and evening work. There are potential challenges associated with this approach relating to retention and recruitment of staff which is alluded to in the Setting the Bar for Social Work in Scotland (May 2022). 269
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NORTH AYRSHIRE Health and Social Care Partnership 216 Delivering care together It is recognised that there is lack of capacity within some services to offer intensive family support in evenings and weekends due to contractual arrangements. To scaffold and to offer intensive family support requires a service that operates evenings and weekends and needs to be considered in any review or change to service moving forward. The needs of each family are different and unique, and any support needs to be tailored and specific. The Promise supports creativity in terms of support families might need and to ensure the workforce in flexible and responsive. There are challenges and barriers to provide scaffolding support and availability of intensive support to families in crisis on Millport and Arran, these families are hard to reach due to location and lack services in that geographical area which requires a creative solution during such crisis periods. Intensive family support services must operate out with a Monday-Friday, 9am-5pm approach. There must be no concept of an ‘out of hours’ service. Families do not operate on those timescales and support must be responsive to family need.” The Promise “There is not a ‘one size fits all’ approach. The crux of success lies in the family-workforce relationships.” The Promise • The HSCP do not have an overall resource that can provide intensive support 24-7 or 7 days per week to any child in any situation. • There is variance in support offered from different teams and services. • The Rosemount Service offer a crisis response at weekends and have seen a reduction in the need to offer support every weekend. In 2023-2024 the service offered support 29 out of 52 weekends and the number of families supported at weekends went up from 1.5 to 1.9 in 2023/24. • The average time cases had been opened to the Rosemount Service at the point of closure over the past 5 years was 12.9 months • Concerns that current model in providing intensive support within locality teams is supported by some staff who don’t receive unsociable hours who work some evening and weekends based on goodwill and work in excess of 35 hrs which is not cost effective and could lead to burn out and concerns for staff wellbeing. • There are barriers to providing intensive family support due to capacity and staff contractual arrangements. 270
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NORTH AYRSHIRE Health and Social Care Partnership 217 Delivering care together Workstream Suggestions Given the information provided within this paper, the workstream wishes to highlight the following areas: Intensive Support Suggestions It is the view of the Workstream that Intensive support services in terms of volume of provision are underrepresented within North Ayrshire, it is felt that there is a need to carry out an objective in-depth review of how our Intensive Support services are setup, accessed and communicated to both the people of North Ayrshire & the staff who may require to access these supports. • Consider how we maintain and develop the intensive support services to improve practice standards and support to families and children and young people. • To consider engagement with families and get their views on their experiences of services, what's working well, what additionality is required for the family and really listening to what children and their families say they need to help them grow rather than fitting into what the system and services currently offer. • Consideration of an in-depth review and evaluation of intensive support provision within North Ayrshire. • Consider Thematic issues key characteristics of young people who become care experienced to intervene at an earlier stage, age, other factors, experiences, environment and adversity. • Is current model for intensive support cost effective (overtime budget) consider if the existing model is offering adequate support. • Is the current service provision providing the intensive wrap around support which is timely and responsive to family need. Early Intervention Suggestions It is the view of the workstream that Early Intervention Services are well represented across North Ayrshire, it is felt that there is a need for an improvement in how we communicate the service to both our service users and staff across the Partnership. The workstream recommends that a partner engagement group and associated programme of work is commenced to build on existing work including the Named Person Service Directory and existing community mapping (Supports Available in Your Community | NA community WB supports and services ) to ensure cohesive and contemporaneous awareness of all services operating in North Ayrshire. It is proposed that this could be a sub-workstream of the North Ayrshire GIRFEC strategic group. 271
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NORTH AYRSHIRE Health and Social Care Partnership 218 Delivering care together Early Intervention - Front Door Transformation The workstream is acutely aware of the proposed transformation of the front door work and potential impact and changes to access to services and early intervention. The vision of the front door transformation work would be that families would be able to access advice, support and guidance from the first point of contact team when they need it, rather than at point of crisis. The support would be provided based on good conversations rather than the menu of options available across services. The first point of contact team will build relationships and links with community and universal supports across the locality allowing promotion of what is there naturally. Support would be provided to the whole family based on their individual needs instead of multiple teams being involved. A review of North Ayrshire wide GIRFEC processes with a focus on Team with The Family processes is indicated. It is proposed that the North Ayrshire GIRFEC strategic group carries this out. This offers an opportunity to bring consistency to GIRFEC processes to ensure that early intervention supports are consistent and robustly planned and implemented ensuring that all supports offered to families are included within planning processes. A strategy to ensure knowledge and information around early intervention services is required. This will include actions like the update of the NPS directory which is underway, and the forthcoming engagement events hosted by the WFWF, however consideration of best use of digital resources is indicated. A website holding contemporaneous information on services available to support families in North Ayrshire would be a valuable resource for both professionals and families and would support the GIRFEC aim of getting the right supports in place for children and families at the right time. A review of referral and RFA processes would be helpful in evidencing if these processes are providing a barrier to access and if a self-referral model could be implemented. Within this, consideration of the current signposting process could be considered to ascertain if facilitated introduction may support families to better understand how and why engagement with services would be beneficial in improving outcomes, as this has potential to support meaningful partnership working between families and early intervention services. Consideration of funding and resourcing of early intervention services is crucial. The evidence shows clearly that investment in early intervention supports families and is in line with key policy drivers like The Promise, yet in the current financial crisis difficult decisions have to be made around service funding provision and there is evidence that some early intervention service with proven track records of providing evidence-based support to families which improves outcomes are at risk of losing funding. This leads to concerns that the burden on crisis services may be at risk of increasing if early intervention services are cut. Temporary Funding The workstream would like to raise the boards awareness of the services within North Ayrshire that are currently being supported through temporary funding, these include: Whole Family Wellbeing Fund From February to December 2024, the FCWS received 288 referrals. Of these, 166 referrals (55.9%) involved at least one child within the family exhibiting a neurodiverse diagnosis or presentation. 272
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NORTH AYRSHIRE Health and Social Care Partnership 219 Delivering care together Compared to the previous update (April to September 2024), referrals with known or suspected neurodiversity increased from 48% to approximately 56%, indicating rising demand for support. The workstream wish to highlight that should this service cease to continue, there could be a situation where families are becoming known to services with a higher level of need. Strategic Direction and Next Steps The workstream has provided the current position and mapping of early intervention, targeted support and intensive support pathways. In relation to early intervention services, it is recommended that the GIRFEC strategic group in North Ayrshire acts to provide oversight and a reporting structure to ensure the progress of actions taken to address the mechanisms above. This will allow action planning and evaluation of progress towards the recommended actions. The workstream findings indicate a complex picture and gaps in providing intensive support to all families. It is suggested therefore that the next step is establishment of a working group to undertake a full review of the current service provision for providing whole family support/intensive support within North Ayrshire. It is suggested that this working group is chaired by someone objective, with the required level of seniority, given the scope and potential complexity in realigning services, organisational restructure, this could also involve a review and possible change to contractual arrangements where indicated. It should also include a review of uptake of the supports offered by Harper House, as data suggests this service may not be utilised to maximum effect. Support from the engagement team will facilitate qualitative understanding of the impact on families of the current service and will support forward planning. A small group of HSCP professionals should liaise with the CPC Evaluation and audit subgroup to establish an audit and evaluation process to allow records of families who have accessed intensive supports within North Ayrshire over the last five years to be retrospectively evaluated, to understand the full impact of these services in supporting families to remain together. The output from this working group should be an options paper, which in conjunction with the engagement and evaluation activities will allow the Board to fully consider options the redesign of family support and intensive support provisions to ensure families at most risk of harm or separation will be properly supported to ensure their children can stay wherever it is safe to do so, and all options to keep families together will have been exhausted before any decisions are made about going into care. 273
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NORTH AYRSHIRE Health and Social Care Partnership 220 Delivering care together Appendix one REACH - Intensive Support to Young People and Families REACH is multi-disciplinary team that provides intensive support to families with multiple complex needs, where there is a significant likelihood of the young person (aged 12-18) becoming accommodated away from home. Perth & Kinross were in a similar position to North Ayrshire five years ago, they had 29 external placements, and they decided to close the only internal children’s house and the staff and funding from residential house moved to the REACH intensive and crisis support service. The service provides 24hrs support they have a have multi-disciplinary team which consists of five social workers, ten support staff, teacher, speech & language, clinical psychologist and data analyst. The service is measured and evaluated on numbers in external residential care which has reduced to twelve. Service costs are approx.1.3 million. The service case manages all children on edge of care and manage high risk situations in the community. Glasgow Intensive Family Support Service (GIFSS) is a partnership approach between 5 services - HSCP, Aberlour, Action for Children, Includem, and Right There - with third sector organisations being the main service providers. They have 62 workers Glasgow-wide and 3 service managers. Their annual budget is around £2.7 million, and their support staff are equivalent to our grade 7 workers. The service provides support from 8am-10pm, 7 days per week. The age range for GIFSS is 12-18, 160 families open at any one time and the average length of time they are involved with a family is 10 months. The service has developed their own values of Voice, Validation and Hope, as a framework for practice. There were similarities to Signs of Safety framework, taking a strengths-based and empowering approach to practice. The workers in the team have full access to CareFirst which they reported was the only arrangement of this kind in Scotland, where third sector agencies get access to CF6. The service was developed based on research that indicated that 66% of children who had been looked after by Glasgow City Council returned to their families at age 16. It was noted that they may return more traumatised by their experience of being looked after - sometimes in multiple care settings - than if they were supported to remain together with their family. 274
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NORTH AYRSHIRE Health and Social Care Partnership 221 Delivering care together Appendix two Analysis/Evaluation of crisis/intensive support models Both the intensive and crisis support services evaluated operate increased hours compared to the Rosemount Service, REACH are 24hrs and GIFS are 8am-10pm 7days a week. Rosemount offer evening support from 9am up until 9pm in the evening, and any visits at weekends are planned on a needs-led basis. This decision is taken each Friday, based on the presenting difficulties that have been supported by the workers. At present, there has not been any data that would suggest a change is required to how weekend support is provided by Rosemount. For example, there has not been evidence of situations involving families open to the Rosemount service coming to the attention of Ayrshire out of hours that have been significant enough in nature that it would require funding to have staff working a full shift over a Saturday and Sunday. The Rosemount Service does sit within Children & Families services, with an age range of young people from 8-16, therefore, there would only be a finite number of calls received by out of hours that would involve situations where the service may need to be involved. Also, if the families who came to the attention of out of hours were not known to locality services, those cases would first need to be assessed by Service Access to determine whether a threshold had been met to make a referral to the Children & Families team. Thereafter, it would be decided whether Rosemount was required. I would suggest that very few referrals received by out of hours would require an immediate referral to Rosemount and that it would not be cost-effective to have a team of staff working shifts over a Saturday or Sunday. Rosemount is staffed by experienced workers who can assess the need for families to be contacted on a Saturday and Sunday. Visits are undertaken by two workers and tend to be in the morning, and occasionally into the early afternoon, depending on how many cases may require a visit. The weekend work is over and above the 35 hours each staff member works each week, however, there is a commitment by the team to ensure they are available when required. This was evidenced in the COVID/post-COVID financial years where in 2020/21 and 2021/22, Rosemount covered 65% (34 of 52) and 90% (47 of 52) of weekends, respectively. In 2022/23, the service was still required to cover a substantial number of weekends, 30 of 52 (58%), but the average number of families was down from 3 per weekend in 2021/22 to 1.5 in 2022/23. Over the last fiscal year 2023/24, Rosemount covered 56% (29 of 52) of weekends and there was a slight rise in the average number of families who were contacted/visited at weekends – up from 1.5 in 2022/23, to 1.9 in 2023/24. Thus, there is a positive norm within the team when it comes to workers making themselves available to cover weekends as and when required. The GIFS staffing is unqualified workers equivalent to social work assistants, Rosemount have eight grade 10 staff who have either Social Work or Community Education qualifications, as well as two Social Work assistants. In relation to the REACH Intensive Support model, they had noted that there are benefits of this crisis/intensive support service having full case management responsibility for young people, as well as the internal resources within the service to offer the required wrap around and scaffolding support to families. They had reflected that decision-making is more streamlined and there can be less professional disagreement in relation to thresholds around risk, and more opportunity for positive/proportionate risk taking, when utilising a strengths- 275
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NORTH AYRSHIRE Health and Social Care Partnership 222 Delivering care together based approach. Case management responsibility enables this service to have full autonomy for decision making as lead professionals. The current structure and grading at the Rosemount Project allow for workers to hold either a Social Work or Community Education degree. At present, there are two qualified social workers within the team, which would be viewed as a barrier to considering a similar case management model as a test of change. At present, the Rosemount Project can only be accessed by our colleagues in the Children & Families Social Work teams, who retain case management responsibility / Lead Professional status. Given that Rosemount is an intervention service, this frees up the allocated worker from the team to plan intensive support, at times, on multiple days of the week, to address the presenting concerns. The work undertaken by Rosemount is reflected within the Child’s Plan / Signs of Safety assessment, as well as the Care First observations. The multi-disciplinary team that the Reach Service have in place is a model that is beneficial when considering a multi-agency, holistic approach to supporting young people to remain in the community who are vulnerable and present a significant level of risk. REACH also manage cases involving sexually harmful behaviours and Youth Justice. This is a model that would require significant investment and transformation within the Rosemount and other services, given there is a dedicated Youth Justice team within North Ayrshire. However, when Rosemount are involved in supporting children and young people, the allocated Rosemount worker is invited to attend all multidisciplinary meetings/forums concerning a child – Child Protection, Looked After reviews, Vulnerable Young Person’s (Young Persons Support & Protection Pathway), Team around the Child, Children’s Hearings, and so forth. Therefore, there are robust processes in place within the HSCP and Education that allows for Rosemount workers to contribute their views and assessment in relation to a child’s care plan. Also, the difference in demographics for Perth & Kinross (where REACH is operational) and North Ayrshire differ. For instance, in terms of the local authority share of the 20% most deprived SIMD data zones, North Ayrshire is 3rd nationally, with 37.8%; whereas Perth & Kinross are 25th, with only 5.9% of their data zones within the 20% most deprived in Scotland. This, along with the fact that Perth & Kinross have no residential children’s houses within their authority, and they only had one children’s house prior to REACH coming into operation, is indicative that the level of need throughout North Ayrshire is significantly greater. If you consider that the operating cost of REACH is between £1.3-1.5 million, it could be that to run a similar model in North Ayrshire would cost considerably more. The yearly budget for the Rosemount Project is less than half of the operating cost of REACH. It was acknowledged that it would be beneficial for the team at the Rosemount service to have a bespoke provision of training that would reflect the role that they fulfil within the HSCP. Recently, all staff have been training in the Building Positive Relationships (Non-violent Resistance) parenting approach, which the team are utilising to inform an 8-week parenting group, as well as to inform the parenting advice/guidance that is provided individually to parents. The BPR approach has been well received among the team and augments the already existing strategies and knowledge base that the workers utilise in their practice. However, it is recognised that the non-violent resistance model is utilised in other areas of practice, such as, Fostering & Adoption, and colleagues within Educational Psychology in North Ayrshire are 276
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NORTH AYRSHIRE Health and Social Care Partnership 223 Delivering care together also seeking to embed this model within the nurture approaches that are used within schools and when working with parents. It would be beneficial if the Rosemount team could also receive training in a Family Group Decision Making model that would inform and benefit the family sessions that the team delivers. The REACH service had described how their staff received training in this approach via Robert Gordon University and how this approach has proven effective in helping them significantly reduce the numbers of children they have in external residential placements. In relation to the Rosemount service, it is noteworthy that there has been a turnover in staff over the past 2-3 years, with five of current ten workers being new to the team. The more experienced workers within the team have previously had the benefit of participating in training that the newer members have not. Therefore, it is felt now would be a good time to provide training in a Family Group Decision Making model as it will refresh the more experienced workers practice, whilst allowing the newer members of the team an opportunity to strengthen their knowledge and practice, which will ensure a more robust delivery of service. There is a good level of support that takes place within the team in relation to sharing knowledge and practice experience, however, a bespoke training provision that reflects the unique role that the Rosemount service has within the HSCP would be beneficial. It is recommended that the service would benefit from a more bespoke training provision for the Rosemount team would be cost effective, given the possibility that the Learning & Development team within the HSCP could be used to source and/or deliver some of the training opportunities. Also, colleagues in the Families for Children team have generously offered Rosemount workers access to online training that their team use. Learning and development has been and will continue to be a prominent focus within the Rosemount service, going forward. 277
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NORTH AYRSHIRE Health and Social Care Partnership 224 Delivering care together Appendix Three Breakdown of Services Early Help Art Wise Ayrshire Attainment Ayrshire Breastfeeding Centres Baby and me Dance Beith Astro Summer Camp Beith Trust Garnock Valley Helping Hands Bump Buddies Child Massage -(FFC) Dads Support Worker Health Visiting Service Integrated Infant Feeding Team Tea & Tots Targeted Intervention Early Years Social Work team Early Years Support team Family Nurse Partnership Intandem Maternity & Neonatal Psychology Interventions ( MNPI) Mini Minds Matter (Infant Mental Health Service) Autism Support Ayrshire Neighbourhood Community Links Perinatal Wellbeing Team Play Therapy Refugee Support Team Safeguarding Midwifery Team Stronger Families (Kinship) Stronger Families ( Service Access/MAASH) Throughcare Team Unpaid Carer Service Young Person Support Workers Youth Justice Specialist Intervention Arran Social Services - Family Care Worker Child Protection Team Child & Adolescent Specialist Substance Team (CASST) Family Care Workers Family Centred Wellbeing Service Pathways to a Positive Future Rosemount Intensive Support Team Locality Social Work Teams North Ayrshire Women's Aid Star Centre 278
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NORTH AYRSHIRE Health and Social Care Partnership 225 Delivering care together Appendix Four Caseload Information 181 116 106 105 105 101 92 83 80 72 63 27 20 128 Child Protection Team Three Towns 1 Kilwinning Irvine 2 Universal Early years Social Work Irvine 4 Three Towns 3 Three Towns 2 Kilbirnie/Largs 2 Kilbirnie/Largs 1 Irvine 1 Arran ( HSCP) Irvine 3 Rosemount Open Caseloads Child Protection Team 14% Three Towns 1 9% Kilwinning 8% Irvine 2 8% Universal Early years Social Work 8% Irvine 4 8% Three Towns 3 7% Three Towns 2 7% Kilbirnie/Largs 2 6% Kilbirnie/Largs 1 6% Irvine 1 5% Arran ( HSCP) 2% Irvine 3 2% Rosemount 10% PERCENTAGE OF CASES 279
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NORTH AYRSHIRE Health and Social Care Partnership 226 Delivering care together Appendix12 Best Practice Models & Research Position Paper Brighter Pathways – Best Practice Models & Research Strategic Vision Kevin Mcginn (Planning Manager / HSCP SP&TT ) Arthur Coutts (Programme Manager) Wendy Van Riet (Director of Psychological Services) 280
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NORTH AYRSHIRE Health and Social Care Partnership 227 Delivering care together Introduction The Aim of this Paper is to give a breakdown of the work that has taken place to date within the Best Practice Models & Research Workstream Some of the topics covered are as follows: • Workstream Structure. • Services Represented. • Workstream Focus. • Current Position Within Services. • Suggested Improvements. Please note that this list or the items covered are not exhaustive of all the services at present, it is hoped that this paper will allow for further discussion ad each of these can be added to the Final Report. 281
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NORTH AYRSHIRE Health and Social Care Partnership 228 Delivering care together Best Practice Models & Research Within the Brighter Pathways scope of works, a workstream was commissioned to review Best Practice Models & Research, the workstream was to be chaired by Wendy Van Riet. The Workstream members represent various services including: • Children’s Residential Staff. • Rosemount Intensive Support Team. • Family for Children. • Psychological Services. • Strategic Planning & Transformation Team. Workstream meetings were planned into the diary to take place on a four-weekly basis, initial discussions indicated that the potential scope for this work could be vast, with this in mind the group took the decision to focus on the areas that it was felt would make the biggest impact initially, this was deemed to be Residential & Family Based Care. Data given to the workstream indicated that there were high numbers of children in internal residential care and external residential care, who had previously been in kinship care and internal foster care provision. Furthermore, there was also a number of children in external residential care who were previously cared for within internal children’s houses. The workstreams focus was on how best we can support foster carers, kinship carers and internal residential houses to better support children and young people with complex needs and behaviours, with an objective of sustaining their placement, and provide better outcomes and prevent escalation to external high-cost resource. 282
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NORTH AYRSHIRE Health and Social Care Partnership 229 Delivering care together Fostering, Adoption & Kinship Care In 2023 there was a recognition that services could not be sustained and would be better supported if there was more therapeutic interventions and supports available to support families as a result of the complex and challenging needs of the children and young people, which appeared to contribute to the breakdown of families and thus increasing the numbers entering residential facilities, whether these were internal or external “specialist” resources. The aim of the therapeutic element of the services is to seek to maximise, the effectiveness and utilise the skills and training that workers have engaged in or will be engaging with, in order to offer a level of therapeutic intervention to children and young people and those caring for them. The interventions have been and will be offered to those people from across the range of services associated with the Families for Children Team, in North Ayrshire i.e. Adoption, Fostering and Kinship. It is anticipated that these interventions will increase the stability and security of households, enhance the mental wellbeing of children, and will enhance the therapeutic work that has already taken place throughout 2024. The Families for Children team in North Ayrshire (the Team) recognise that caring for children, who have experienced trauma can be difficult. The Team, also understands, that they have a responsibility to offer a level of support and care that nurtures and promotes the mental health and well-being of all care experienced children and young people, whether they are in foster or kinship care or adopted, in accordance with various Government initiatives in recent years (e.g. The Promise, The Care Review) Research is clear that “early experiences….which often precede entry into care, may impact on wellbeing” (Monero 2012) and there is much evidence about the mental health and wellbeing of care experienced young people having a detrimental effect on their outcomes. The Team recognises that it is not sufficient to merely acknowledge and understand this, there is a duty of care for workers to respond and seek to improve outcomes for children and young people. There is recognition that protective factors include social support, good social and emotional skills, or more specifically, emotional identification, coping skills, communication skills, resilience and self-efficacy. The presence or accessibility of each of these factors, can contribute to positive mental wellbeing amongst care experienced young people. The Team understand that care experienced children and young people require stability and a sense of security. Meeting the needs of this group of children and young people can be difficult especially when children exhibit challenging behaviours and struggle to regulate their emotions. Understanding the distress that is expressed through these behaviours is not always understood by the people around the child or young person, which makes delivery of attuned care complicated. This can lead to instability in placements and the children and young people experience that their needs can’t be met. As a result, the Team felt that it was important to find interventions and use these to promote stability and in turn, better outcomes for our young people. Instability in placements can also occur due to lack of systemic support for the carers, which can affect the capacity of carers to promote the mental health and wellbeing of young people in their care (Fergeus et al. 2019). Therefore, the Team understand, that there is a need to support and equip those responsible with providing care, with skills, that assist them 283
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NORTH AYRSHIRE Health and Social Care Partnership 230 Delivering care together in undertaking the care giving task. Ensuring a trauma and psychological informed culture in which people can ask for support is essential. Importance for good communication between the different services/ professionals who are involved in the care of a child or young person, is apparent. The embedding of the GIRFEC model in children services is based on the understanding that working together in partnership will create a better caring environment and will ensure support for both the child, the family and the professionals. It provides a learning environment for all, where working towards the same goal in the same direction with the child’s wellbeing at the centre is key. There are plans to increase the work undertaken with siblings and consideration, as a result, of the workstream, will be given to establishing better partnership working with residential services. This has been achieved with the Rosemount project with better forms of communication and discussions and the expectation would be that the same can be said for our colleagues in residential care. The Fostering Service has been experiencing an acute crisis relating to recruitment and retention of foster carers which has led to fostering provision being a diminishing resource for children of all ages. Fostering is a highly regulated area of practice and should adhere to the statutory requirements on placement limits under The Looked After Children (Scotland) Amendment Regulations 2014. The current position is that we have a number of carers who have more than three unrelated children in their care. The intention of placement limits was to increase placement stability and more nurturing environment for children in foster care. To enable foster carers to provide more focussed attention and support to each child, leading to better emotional and developmental outcomes. The out with approvals relating to placement limits raises concerns regarding these caring situations being high risk of carer burn out to foster carers who are providing care to four or more children. Rosemount Service The Rosemount Team offer support and interventions to children in family-based care, kinship and foster care and post adoption. Referrals to Rosemount are made when caring situations are at risk of disrupting and Rosemount can provide intensive support (evening/weekends) and interventions to prevent the placement disrupting. These interventions will be direct work with carers/parents, family work and direct work with child/young person. Through discussions in the workstream and the range of professionals involved with children in foster care it was agreed that a formal referral process would be beneficial where Rosemount intervention was requested. This was suggested and developed to support the following areas: • Intervention and role clarification • Touch points, sharing of information, progress/difficulties • Mechanism to review and measure intervention • Prevent duplication of role • Less confusion for carers/clarity of different roles • Increased joint working 284
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NORTH AYRSHIRE Health and Social Care Partnership 231 Delivering care together Children’s Residential Houses At the time of writing, within North Ayrshire we have Four Residential Houses, each being registered to have eight placements for Children & Young People, the houses are detailed below: • Abbeycroft • Achnamara • Canmore • The Meadows Each of the Houses have the same staffing structure consisting of 18.73 FTE, this is broken down for each establishment below: House Manager Assistant Manager Snr Residential Worker Residential Worker Total FTE Abbeycroft 1.00 1.00 5.36 11.36 18.73 Achnamara 1.00 1.00 5.36 11.36 18.73 Canmore 1.00 1.00 5.36 11.36 18.73 The Meadows 1.00 1.00 5.36 11.36 18.73 Total 4.00 4.00 21.46 45.44 74.92 Cumulatively, our Children’s Houses are registered to care for Thirty-Two individuals. Children’s Houses Landscape Over several years our children’s houses have been experiencing a period of sustained challenges in dealing with both the increasing needs & the volume of Children & Young People residing within our residential establishments. During this time, it has been common that our Houses are oversubscribed in terms of the numbers of Children, at the time of writing each of the four houses have Nine C&YP. Staff have detailed that there is a feeling that as an organisation we have ‘Normalised’ situations such as being over in our numbers within the houses. This includes it being deemed acceptable for Young People to have to sleep on fold up beds or sofas in the games room or lounge. Crisis placements, which don’t give the opportunity for matching the best fit for a child, can lead to destabilising the overall group of children and staff in a house. It is felt that the impact that this has on the other Young People and their home environment isn’t being considered when decisions are being taken. Timely discussions and planning of the different options available to a young person is important to help them transition into a new phase in their development. Identifying need and planning for the transition at PAM or LAC reviews at the right time needs to be the rule and embedded in governance process. This includes considering how core relationships that young people have established during their placement(s) can be nurtured in a safe way. 285
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NORTH AYRSHIRE Health and Social Care Partnership 232 Delivering care together Residential Staff Residential staff have been on a journey to develop a framework based on the 6 nurture principles: 1. Children's learning is understood developmentally. 2. The house offers a safe base. 3. The importance of nurture for the development of wellbeing. 4. Language is a vital means of communication. 5. All behavior is communication. 6. The importance of transitions in children's lives. This framework has been put in place to ensure that the increasing complexity of children coming to the service can be met, considering the latest evidence base. Implementation of the framework has been hindered by pressures in the team and is still ongoing. Children often show their distress through behavior and with the increase in case complexity, over establishment and crisis placements, management of behavior in the units requires a higher level of staff skills. Increased complexity of the presenting problems (neurodiversity/ trauma/ disabilities/ UASC) means that working in collaboration with specialist services is essential as well as receiving opportunities for ongoing training. The houses are struggling at times to recruit new staff and considering workload, remuneration and available support for staff will be important going forward. Implementing diverse ways of working according to drivers like the nurture framework and trauma-informed care feels an impossible task when the day-to-day pressure does not allow staff space and time to consider this. We need to support our staff to develop their skills and knowledge of working in a way that is driven by supportive leadership that continues to embed trauma-informed care in a consistent and planned way. The overall care system needs the right skill mix in professionals to create a system that has a greater focus on early intervention, continued supports where necessary, build capacity & resilience in families so that breakdown of family relationships can be prevented or mitigated. Support for Staff Ensuring stable and caring placements for children and young people who have different needs due to their early life experiences is complicated. It requires carers to work in often stressful and stretched environments. Staff will need the ability to regulate and understand their own emotions as well as understanding how their own vulnerabilities influence their behaviour and reactions while trying to be attuned to the varied needs of the children and young people under their care. This is a difficult task at the best of times but becomes more difficult if systemic pressures like emergency placements/ over-establishments become the norm. This will affect staff wellbeing, which in turn will affect the wellbeing of the children and young people under their care. High levels of sickness and burn out in the staff group are a likely consequence of this. Deterioration of behaviour and increased levels of distress seen in the children/ young people can also (at least partly) be contributed to this. 286
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NORTH AYRSHIRE Health and Social Care Partnership 233 Delivering care together Educational psychologists (Eps) have been supporting the children’s houses over several years with consultations when requested. Since 2018 EPs have rolled out training across the houses in the area of Nurturing approaches. By 2023 every available worker was trained in the 6 Nurture Principles. The training also gave opportunity for collaboration between the 4 children’s houses. Support for the children’s houses with complex case management, joined training and collaboration has seen improvement of service delivery in the past, although it hasn’t been without hurdles. Focus on supporting staff/ carers regularly and appropriately is going to be essential to make the care system more sustainable. Ensuring collaboration between children’s houses in regards of shared training and support will strengthen the system overall. As part of this work stream a scoping exercise was started in December 2024 to engage with the children’s houses to ascertain what support is felt as most helpful and needed, what is already available and what gaps need to be considered. One of the early identified gaps is the regular and consistent support for case discussions when problems for a particular child/children is more complex and/or supports that have been put in place are no longer sufficient. This might also include considering the impact on the overall home environment and distress that might be seen in the overall group of children and staff. Making sense of the changing situation, formulating the problem and considering how to best respond will be important to prevent escalation and potential breakdown of placements. In May 2025 a pilot for a CEYP Consultation Team has been proposed, which will make an offer to the children’s houses in North Ayrshire for regular support. The pilot will give the opportunity for further assessment of training and supports needs for staff and inform future service development. The CEYP consultation team will aim to: • Give opportunity for regular ongoing support with complex case and systemic issues. • Build supportive relationships with the staff to create a safe environment for more in- dept assessment of staff needs. • To seek opportunities for joined learning and training. Making a commitment to the teams for a link with one psychologist over a period of time is going to be essential to build the safety and strength of relationships, which will increase the chance of a positive outcome of this pilot. If we are asking staff to provide an emotionally safe home environment with consistent care, we should provide the staff emotionally safe and consistent support. Transitions Transitions for CEYP population will bring potentially extensive difficulties- for the child/ young person as well as for the adults around them. Therefore, any transition should be well supported and planned. In the current situation this is not always possible. Emergency placements, young people needing to move to independently living, children/ young people returning home, moving to another placement, are all situations that can cause high levels of distress and therefore difficulties in management of the situation. Ensuring clear planning around these changes will be essential. Bringing professionals together that can support each other, and the young person is needed to increase the change of a successful transition and navigating through periods of changed needs. Considering a model of care that includes an MDT/ consultation team to support transitions and changes in presentation/ need could be an option. Bringing 287
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NORTH AYRSHIRE Health and Social Care Partnership 234 Delivering care together particular expertise into the existing team around the child, when the team and/or the child is stuck, could prevent breakdown in placements if engagement is timely. The Families for Children’s team can convene unplanned ending /reflective meetings when a foster care placement has an unplanned ending if the child was placed for over two years. This is an opportunity for the fostering service, social worker and foster carer to reflect on the circumstances that led to the placement disrupting. It is an opportunity to consider appropriate matching, learning that can be taken from the situation and any development needs for the different parties involved. It can highlight supports that needs to be put in place to increase the chance of a positive outcome. There is no mechanism in place to discuss unplanned endings for children in internal and external residential care. A similar process to foster care would be needed to give timely opportunity for highlighting difficulties and need for increased support. 288
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NORTH AYRSHIRE Health and Social Care Partnership 235 Delivering care together Key Findings As stated at the beginning of the report, this work stream had a potential vast area to cover. The decision to focus on Residential and family-based care was made because the need for cost reduction in external placements for children and young people. The discussions in the work stream were reflecting the complex systems and landscape the residential and family- based care is existing in. This highlights in turn how complex the search for potential solutions to this problem is. The overlap with the other work streams is also illustrating the entanglement of the different parts of our services existing in and around Residential and family-based care. Key findings highlighted in the work stream discussions are: 1) The complexity and inter relatedness of the different services across the caring system- which makes solutions unlikely to be easy and quick. 2) Improvement of communication channels and structures need to be considered; development of an MDT/ consultation team where transitions/ changes in needs could be considered could be part of the supportive structure. 3) Clarity on accountability for different parts of the caring system and the different services within it; because of the inter relatedness it becomes almost inevitable that everyone is looking at everyone else to bring relief and solutions to the pressures. The result is that individual services are waiting for the wider system to tell them how to move forward, while the wider strategic system is waiting for individual service improvements to be made and data/information to inform strategic planning. 4) Need for (brave) leadership – it has become apparent that although there might be smaller improvements that can be made without extra cost, considering a solution to the overspend in external placements is unlikely to be possible without a ‘Spend to Save’ opportunity. Ultimately a lot of the difficulties are predicated on a lack of capacity in the system. Without the extra capacity it is unlikely that any considered model of care is able to be implemented. 5) There is a need for more accurate and detailed data collection across our system to illustrate and evidence the on the ground experience of children/YP, families and workforce. 6) There are different care models already implemented across Scotland – no need to ‘reinvent the wheel’. All care models considered in the work stream have as commonality that the setup of a CEYPs (Care Experienced Young People) Team, that is multi-disciplinary and is able to support the existing services is part of the wider solution. The CEYP population has specific needs and risks that need dedicated time and expertise to help with creating the best outcomes for these children and YP. Ensuring a stepped and matched care model is the other element that needs to be considered. 7) Research was undertaken on the Mockingbird Programme which is an innovative fostering model designed to provide sustainable and supportive foster care. The programme has evidence-based outcomes for supporting and sustaining placements, assists in retention of foster carers and can lead to cost avoidance with a reduction in disrupted placements and the use of external resources. 8) Considered and evaluated intensive support models that are utilised in other Local Authorities. 289
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NORTH AYRSHIRE Health and Social Care Partnership 236 Delivering care together Strategic Direction 1. The Board Consider increasing capacity of placements across the residential estate. 2. Ensuring multi-disciplinary input and a matched/stepped care model – existing implemented models can be amended to a suitable model for the HSCP. 3. Ongoing support and training for staff across services working with Care Experienced young people their carers, in such areas as blocked care and therapeutic parenting, which requires more specialist input. Clear governance around the delivery needs to be established. 4. Stop normalising poor service – Setting standards for what ‘good enough’ means in this context. 5. Apart from keeping the Children and YP at the center of our decision making, there needs to be acknowledged that this must include consideration of the wellbeing of staff. Without a healthy and stable workforce, good enough care is not possible. 6. Utilizing the agreed matching process within residential care to mitigate over occupancy & staff burn-out, this might only be achievable if there are more capacity/resources. 7. The implementation of a new referral template for referrals to Rosemount for children in family-based care has been implemented. 8. Continue to promote the recruitment and retention of high-quality foster carers to offer family-based care, which would prevent out with approvals and higher risk caring situations. This would also include extensive support and development of foster who were equipped for the role. 290
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NORTH AYRSHIRE Health and Social Care Partnership 237 Delivering care together Appendix13 Pilot CEYP Service Care Experienced Young People Service (CEYP Service) – PILOT Background In response to the work undertaken in the Brighter Pathways programme board, alongside statutory commitments outlined in “The Promise” (Scottish Government, 2020), services have considered the need for dedicated support in accessing existing Child and Adolescent Mental Health Services (CAMHS), in addition to specific, specialist provision for the for the CEYP population. The CEYP population often struggle to get access to mental health support through CAMHS, resulting in unmet need and poorer health outcomes (Independent Care Review, 2020). Whilst mental health support to the young people and their family/ carers is provided by parts of the Ayrshire HSCPs, Education and third sector, scoping exercises have revealed that there are gaps in service delivery. There is lack of a stepped care approach, with high pressure on existing services, difficulties in accessing those services that do exist and reliance on external funding sources for supportive 3rd Sector. Mental health support for the CEYP population often works through supporting the people that care for the young people as well as providing direct individual support. The increased complexity that is being observed by professionals working with this population, alongside increased complexity in the non-CEYP population, means that the specific needs of this population are difficult to maintain in a “Treatment as Usual” service. Providing support for the system around CEYP is therefore essential to prevent placement breakdowns and need to access expensive external placements. Pilot As part of the work for Brighter Pathways, a scoping exercise was undertaken, involving discussion with staff from North Ayrshire children’s homes. Outputs highlighted a number of thematic points related to staff support and demand, in addition to clear evidence of systemic pressures, which were compounded by lack of access to dedicated CEYP services. A Community of Practice (COP) CEYP Psychology was brought together, utilising core Psychological Services funding, to bring together CAMHS psychologists and educational psychologists from the Ayrshires to share good practice and map common supports. Parallel to this, CAMHS Service Management agreed to the commencement of a Pilot CEYP service, funded through a small underspend within the CAMHS Psychology Service, to enable some of this good practice to be taken forward and established. The initial business case, hosted within NAHSP, has a remit for two years to investigate the outcomes of a bespoke CEYP service. The service is comprised of staffing from within Psychological Services, with additional funding secured for North Ayrshire from the ending of the commissioned Notre Dame Service Level Agreement. This additionality will create a wte service of 1.6, across multiple bandings and professional groups. Further funding is being sought from the South and East HSCPs at the moment to ensure provision on a PAN Ayrshire basis. Expansion of the team with further psychology, nursing and/or AHP time will be essential, if agreement is reached to continue beyond pilot timeline. 291
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NORTH AYRSHIRE Health and Social Care Partnership 238 Delivering care together Whilst CEYP services are already established within some NHS Scotland Boards, the pilot service will only replicate limited aspects in order to manage demand and cover off high value outcomes. Further expansion of the service will only be possible with increased funding. With this in mind, the service will focus on support, consultation, reflective practice and training for staff of the children’s houses. A professional support line (TEAMS/ telephone), which would enable professionals working with this population to access support and consultation in a timely manner, will be a central outcome of the pilot. Allied to this, will be an 18-month plan to establish a multi-agency, multidisciplinary steering group, to allow for dissemination of message and evidence, whilst also providing a forum for scoping and direct professional feedback. There is awareness that some of this work is also undertaken by educational psychologists and therefore a strong working alliance will be helpful to ensure that the different psychology staff are able to complement each other. Individual support The CEYP service has been granted funding from North Ayrshire HSCP (previously allocated to Notre Dame) which provided dedicated trauma focused assessment and treatment for children who had experienced significant trauma and were actively engaged with Child and Family Social Work Services. The overlap between the CEYP and Trauma population in Children and Young People is extensive, meaning the blending of services will be relatively seamless. . The service intends to commence in November 2025. Capacity within the assessment and treatment aspect of the service will be limited, and this will require significant engagement and collaboration with core CAMHS. Work plan/timeline Task Information Due date RAG Confirming funding - Funding for ‘Notre Dame’ service - Funding for CEYP pan-Ayrshire service End Oct 2025 Recruitment - Depending on funding streams that are becoming available to the service recruitment to start for workforce Oct 2025 – Jan 2025 Meeting with Stakeholders/ Needs assessment - Children’s houses NA/ EA - Rosemount - CAMHS - SW teams - IMH service - Children’s first ……. Sep 2025 – Jan 2025 Set up Steering group - Steering group for stakeholders working with CEYP Sep 2025- Oct 2025 Scope/SOP/Pathways/ access criteria for ‘Notre Dame’ service Discussions with stakeholders will need to inform pathways/ criteria of the service; available capacity and need of stakeholders will determine the scope of the service Sep 2025 – Jan 2025 Scope/SOP/Pathways/ access criteria CEYP Service Discussions with stakeholders will need to inform pathways/ criteria of the service; available capacity and need Sep 2025 – Jan 2025 292
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NORTH AYRSHIRE Health and Social Care Partnership 239 Delivering care together of stakeholders will determine the scope of the service Development of CEYP advice/consultation line Development of telephone line for professionals to discuss CEYP for advice/ consultation Sep 2025- Dec 2025 Outcome measures/ KPIs To be decided what outcome measures/ KPIs need to be set/ considered for the service Sep 2025- Dec 2025 Reporting The CEYP Service is based in the CAMHS Psychology service and will therefore fall under the same governance structure as the CAMHS service. The CEYP Clinical lead will report to the CAMHS CGG. Author : Dr Wendy van Riet – Director of Psychological Services Sponsor/Responsible HOS/Principal Manager : Thelma Bowers 293
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Integration Joint Board 13 November 2025 Subject : Child and Adolescent Mental Health Services (CAMHS): Neurodiverse CAMHS Team Waiting Times and Mitigation Plans Update Purpose : This is presented for awareness and discussion Recommendation : Is it recommended that the IJB: a) Notes the current pressures, emerging risks and scope of re-design work undertaken in relation to Neurodevelopmental pathways for children and young people. b) Notes the Continuous Improvement of the CAMHS service and the development of options for a pan Ayrshire diagnosis and treatment model of care for neurodivergent Children and Young People, that sits separately to a Tier 3 CAMHS service. Noting that this service would require investment which is not currently available. c) Notes the clinical, operational and reputational risks associated with the current situation – that being the absence of a diagnostic or assessment service for those who don’t meet the N-CAMHS service specification. 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 1. EXECUTIVE SUMMARY 1.1 Referrals for children and young people seeking a neurodevelopmental diagnosis in NHS Ayrshire and Arran have increased considerably in the past five years. The waiting list for the Neuro CAMHS service now exceeds 2,441 with maximum waits of 3 years and 6 months. In the absence of further resource intervention, projected waits could reach 10 years, which would mean that a child referred in 2025 might not be assessed before leaving school or reaching adulthood. Agenda Item 7 295
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NHS Ayrshire & Arran implemented the National CAMHS Service Specification in August 2023, meaning that only children and young people with a co-occurring moderate to severe mental health condition are accepted to CAMHS. The Implementation of the National CAMHS Specification report, presented to the North, South and East Ayrshire Integration Joint Boards (Appendix 1 – North IJB report 16th March 2023) noted that while the National CAMHS Service Specification had been implemented, there was no investment or funding to deliver the corresponding National Neurodevelopmental Specification. The paper highlighted the resulting service gap for children and young people requiring neurodevelopmental assessment who do not meet the CAMHS criteria and confirmed that each IJB is working collaboratively to develop local pathways and a new Pan Ayrshire model to develop proposals to address this unmet need, through both better use of existing resources and pathways and developing options for service development, including diagnostic capacity, if and when funding or investment is available. 1.2 Since full implementation of the National CAMHS Service Specification in August 2023, only those young people with co-existing moderate-to-severe mental health conditions are accepted to CAMHS. To date, 560 referrals have been screened as non-specification and informed about the Neurodevelopmental Empowerment & Strategy Team (NEST). While this ensures compliance, it also highlights significant unmet diagnostic demand, which is reflected in the rise of complaints, FOIs and MSP enquiries relating to neurodevelopmental waiting times and access pathways. 1.3 The IJB is asked to note the current pressures, emerging risks and the scope of the redesign work undertaken. NHS Ayrshire and Arran and the IJBs are not alone in the management of this response to a universal population wide Public Health referral demand with evident national challenges in addressing demand and unmet need for children and adults for neurodevelopmental assessment, diagnosis and support. The Health, Social Care and Sport Committee are undertaking an ongoing inquiry and more recently a new Children and Young People’s Neurodevelopment Taskforce has been established. This cross-sector group has been set up to drive forward work identified to improve, and support implementation of the Children and Young People’s Neurodevelopmental Specification following a review into its implementation. 2. BACKGROUND NHS A&A CAMHS service redesign during 2021-2025 has introduced new roles, urgent care pathways and digital innovations. CAMHS have worked closely with Benson Health to develop a DCAQ model to inform the redesign of the service by analysing information and data from Care Partner and Trak Care. 296
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Phase one of the redesign was to understand the referral patterns into the service to support workforce redesign and innovation. This resulted in the creation of new roles to help alleviate the shortages of clinicians able to prescribe with the creation of Advanced Clinical Nurse Specialists (ACNS) and Pharmacy prescribers. The creation of CAMHS Urgent Assessment Intensive Treatment (CUAIT), the unscheduled team, means that there is a 7 day a week service 8am – 8pm which did not previously exist. Appendix 2– Redesign work in CAMHS provides further detail. A CAMHS Participation Officer ensures that young people family/carers are fully involved in the redesign of services and have their voices heard in terms of making improvements. The snapshot below from the Benson dashboard provides an illustration of the performance management framework and oversight in place for CAMHS services in Ayrshire and Arran. Mental Health Outcome Framework funding was utilised to support the development of the unscheduled care team and to work through the waiting list of young people waiting on the neurodevelopmental list. NHSA&A started to implement the National CAMHS Specification in February 2020 culminating in the full implementation by the 1 st Aug 2023. A Pan Ayrshire Neuro Event was held on the 16th Feb 2023 led by Glasgow University. A number of Pan Ayrshire public engagement events have been held 2023-25 with a communications plan and approach in place to advise of the changes to referrals and input for families already on CAMHS list. 297
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Since the implementation in August 2023 there have been 560 young people referred to CAMHS who do not meet the specification as laid out by Scottish Government. These young people and families have been sent a standardised letter explaining this which contains further information on services and resources available as delivered by Neurodevelopmental Empowerment and Strategy Team (NEST). It is important to note that in addition to the 560 young people who have been referred and do not meet the specification, there is a potential significant unknown number of children and young people who require a neurodevelopmental assessment but have not been referred as the referrer has been aware of the criteria and has nowhere to refer to in the absence of a neurodevelopmental assessment pathway out-with the CAMHS criteria. There are increasing challenges associated with prescribing and shared care arrangements following ADHD diagnosis. A proportion of children and young people are assessed privately or transition to adult services before prescribing arrangements are in place. There are currently no shared care arrangements within NHS Ayrshire & Arran for prescribing following a private ADHD diagnosis undertaken outwith N- CAMHS or an NHS-private provider commissioned diagnostic service. In these cases, prescribing and ongoing monitoring remain the responsibility of the private clinician, and families must meet these costs privately. Where diagnostic assessments are undertaken by a provider commissioned by NHS Ayrshire & Arran, shared care arrangements are in place whereby General Practitioners prescribe under the guidance and clinical monitoring of CAMHS. Guidance and a Service Level Agreement (SLA) have been developed to support GPs in implementing these arrangements safely and consistently. Engagement with service users has highlighted the strain that private prescribing places on families and the inequity it creates in access to treatment. The national shortage of ADHD medication, which lasted approximately 13 months, further limited the service’s ability to initiate new prescriptions during this period, creating additional backlog pressures that continue to be addressed. Work is ongoing with other NHS Boards and national colleagues to identify sustainable prescribing solutions and support the continued development of neurodevelopmental services across Scotland. The Health, Social Care and Sport Committee are undertaking an enquiry focussed on - 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 298
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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 A response was submitted to the committee in review to a call for views - a copy of this is included as Appendix 3. Thelma Bowers attended the Committee in October 2025 to give evidence on ADHD and ASD Pathway Support. The Committee focus was on the national growing issue of increasing demand and lack of capacity to access an assessment and/or treat neurodevelopmental conditions. Whilst this report focuses on children and young people, there is a recognised transition risk as individuals reach adulthood while still awaiting neurodevelopmental assessment. This has consequential impacts on Adult Community Mental Health Teams (CMHTs), which currently have no dedicated resource or funding to provide neurodevelopmental assessment or follow-up care. Work is therefore underway to develop a pan Ayrshire business case and service model to address this gap across Ayrshire and Arran, however the successful implementation of any future model is reliant on investment and funding being made available. 2.2 ASSESSMENT Waiting Times and Referrals Referrals to CAMHS continue to increase, with the main reasons for referral being anxiety. The service has seen an increase in referrals of 284% in the period (2019- 2024). The graph below illustrates the waiting list growth for Neurodevelopmental support via CAMHS showing that it has quadrupled from 628 in 2020 to 2,441 in 2025 with the longest wait currently 3 years and 6 months 299
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The children and young people currently on the waiting list will progress for further planned Neurodevelopmental assessment around autism spectrum disorder (ASD) attention deficit hyperactivity disorder (ADHD), exposure to alcohol and/or substances, Learning Disability, multiple diagnosis, whilst also considering alternative formulations including developmental trauma, attachment and relational difficulties. The graph below shows that ADHD accounts for around 50% of cases and a rise in dual ADHD/ASD presentations. There has also been an increase in dual ADHD/ASD cases with these complex presentations making throughput slower. • 37% of those waiting are under 12 years and 24 % are 14 years and above; • one in three are projected to turn 18 before assessment. • There are currently 174 young people aged over 18 years who remain on the Neurodevelopmental CAMHS waiting list with the oldest being 20 years old. • CAMHS do not operate an out of age policy, so will conclude all assessments if they are on the waiting list. This is expected to be approximately 33% of the waiting list by 2028. • 10-12% will likely transition into adult services which will have an impact on Adult Community Mental Health Teams. 300
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DCAQ modelling predicts that the waiting list will extend to 8–10 years by 2028 without additional capacity. Referral Pattern and Demand The referral pattern highlights the geographical variation across East, North and South Ayrshire between 2019 and 2025 with North showing the highest percentage of referrals followed by South and then East. The change to the National Specification reflects the reduced referrals in certain areas due to the absence of a universal diagnostic service. Additional information includes a notable: • Source shift: Schools ↓ from 67 % (2020–23) to 25 % (2024–25); GPs ↑ from 24 % to 63 % due to Specification change. However, this data reflects the reduction in referrals from education following the specification being implemented where previously schools were encouraged to undertake the referral to CAMHS for a Neurodevelopmental presentation. • Geographical variation: North +365 %, South +309 %, East +200 % since 2019/20 • Non-specification referrals: Audit (Nov 2022–Feb 2023) showed 69 % of ND referrals had no co-existing moderate-to-severe mental health condition, therefore not meeting CAMHS criteria. These cases consume substantial time in triage, screening, and communication, diverting specialist capacity from those meeting criteria. In 2024-2025 CAMHS received; 44 formal complaints, 71 telephone /informal complaints direct to service. Also notably from February 2025, 47 FOI’s and 84 MSP enquiries. The service meets with NHS A&A complaints department on a regular basis and the leadership team meet every Monday to action any complaints. An established complaint, FOI, MSP database has been set up to record, monitor and 301
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respond within the team. This has enabled the service to identify emerging themes and resulted in the development of standardised letters and a frequently asked questions leaflet. Additional Pressures In addition to delivering scheduled CAMHS and N‑CAMHS assessments a substantial proportion of clinical and managerial time is spent on essential activity that is not captur ed in RTT figures. This non-RTT activity equates to an estimated 15–20 % of total clinical capacity, representing significant opportunity cost across the system. The summary below describes in more detail the activity, volume and impact. Area of Activity Description / Indicative Volume Impact / Value Referral Screening and Triage > 560 referrals screened since Aug 2023 (20–40 min each) Ensures compliance with Specification and equity of access Clinical Decision Support for External Assessments ≈ 200 cases prepared for Helios/Purple House (30–60 min each) Enables safe commissioning and quality assurance Participation in Multi- Agency Panels and Transformation Work Regular input to HSCP panels, ND Implementation Group (~ 0.5 WTE weekly) Supports whole-system redesign and prioritisation Complaints, FOI and MSP Enquiries 44 formal, 71 informal, 47 FOI and 84 MSP enquiries (2024– 25); 45 min–2 hrs each Promotes transparency and learning QUALITY/PATIENT CARE 2.3 The absence of a dedicated wider neurodevelopmental pathway creates a clinical and reputational risk to NHS AA and the 3 Health & Social Care Partnerships. NHS AA are not alone in this position which is shared across many other Boards and HSCPs with work to improve this being highlighted at a national level. The quality-of-service delivery is also monitored with feedback from children and young people utilising KIDSCREEN which is a health related self-assessment quality of life questionnaire for children, young people and parents . A Quality Improvement Lead and Participation Officer are based within the service to support service improvement. 302
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3. PROPOSALS 3.1 Collectively, these activities represent essential work that maintains safe clinical governance, quality assurance, and effective partnership functioning across CAMHS and N-CAMHS. CAMHS continue to maximise clinical impact within existing revenue resources, utilising Recovery and Renewal and Mental Health Outcomes Framework (MHOF) funding to support workforce training and the development of a multi-disciplinary approach to assessment and treatment. Investment in the West Road premises has co-located the Neurodevelopmental CAMHS team, improving efficiency through dual- clinician assessments, reducing travel, and enhancing access to shared clinical and physical health facilities, including ECG and phlebotomy. The service is also piloting digital innovation through the Brain Gaze proof-of-concept, using eye-tracking and cognitive biomarkers to support ADHD and related assessments, with the aim of reducing assessment times and providing objective data. Further investment across the three Health and Social Care Partnerships (HSCPs) has strengthened the Neurodevelopmental Empowerment and Strategy Team (NEST), which provides early support and training for families. NEST also work with teams, services, organisations, third sector and community groups across Ayrshire providing training and awareness raising for the workforce and communities who serve our neurodivergent children/young people and families. Previous MHOF funding enabled the temporary commissioning of external providers to undertake neurodevelopmental assessments and reduce the waiting list backlog; however, there is currently no ongoing funding available to continue external commissioning, creating a sustainability risk without further investment. Ongoing development of an outline business case for a pan Ayrshire ND Diagnostic Service which will sit separately from CAMHS, this should be concluded by the end of 2025. The business case will outline options appraisal including investment and a preferred model for a new Neuro-developmental service for children and young people who do not have co-morbid mental health concerns, this requires further investment. Due to ongoing difficulties in recruiting Consultant Psychiatry, CAMHS have developed extended roles including Advanced Clinical Nurse Specialists (ACNS), Pharmacist Prescribers and a GP with Special Interest within the Neurodevelopmental CAMHS team. CAMHS have also provided training and supervision to allow nurses to undertake the ACNS training from within the service including diagnostic assessment, physical health assessment and prescribing. This can take between 12 and 18 months to complete. The ACNS provide a dual role of diagnostic assessment and prescribing of medication 303
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The Psychiatry complement has increased to 3.5 following success Consultant CAMHS Psychiatry recruitment and routinely the majority of their caseload sits within the Community CAMHS and CUAIT. A Quality Improvement Lead and Participation Officer are based within the service to support service improvement. Development of post graduate training by NES and Universities across Scotland is ongoing and the staff team within CAMHS have supported the development of the education resources aimed at a wide range of audience. Implementation of local GP prescribing guidance and reinforcement of shared care protocols through the Area Drug and Therapeutics Committee (ADTC). Inclusion of prescribing capacity and pathway development within the Outline Business Case (OBC) for the pan-Ayrshire Neurodevelopmental Service, including recruitment and training of prescribing pharmacists and specialist clinicians to strengthen safe and sustainable prescribing practice. Ongoing oversight through the Neurodevelopmental Implementation Group to ensure consistency, safety and clinical governance across the system. 3.2 Anticipated Outcomes The Ayrshire and Arran CAMHS Service is now fully aligned to the National Specification, the work outlined in the report describes the focus to utilise existing resources creatively and to best effect in the absence of a pathway for children and young people that don’t meet the CAMHS specification but require Neurodevelopmental Support. The development of the Pan Ayrshire Business Case will describe the pathways and workforce model required to meet the current and projected need and demand and will set out the investment required. It is anticipated this can be used to influence and shape any future national direction and resource allocation. 3.3 Measuring Impact Quantitative: • Impact on waiting times through co-location and digital solutions, number of assessments completed, diagnostic accuracy Qualitative: • Staff focus groups to capture perceived benefits of co-location, MDT collaboration and new advanced roles. • Children, young people and family feedback on accessibility, experience and quality of care. 304
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4. IMPLICATIONS 4.1 Financial As noted there remains no dedicated or recurring funding to implement the National Neurodevelopmental Specification, and current mitigation activity is being delivered within existing CAMHS resources. 4.2 Human Resources Workforce constraints remain a key determinant of waiting times and service sustainability. Neurodevelopmental CAMHS have 9.35 WTE clinicians comprising of Psychology, ACNS, Mental Health Nurses, Occupational Therapists, Speech and Language Therapists currently providing assessment and diagnosis across Ayrshire & Arran, the staffing complement is 12.35 WTE for the diagnostic team which is complemented by 3.2 WTE clinicians who provide ongoing pharmacological and nonpharmacological interventions. (Pharmacists and Music Therapist). Recruitment and retention with Neurodevelopmental CAMHS is impacted by the competitive pay and conditions offered by the private sector for highly trained clinicians. This can be evidenced with Band 7 ACNS being offered a Band 8C pay salary with all of the conditions available to them within the NHS. 4.3 Legal “None”. 4.4 Equality/Socio-Economic Allocation is made from waiting lists in chronological order to provide equity. In recognition of complex mental health and neurodevelopmental priorities are cognisant of this. Any requests for prioritisation are discussed in a multi-disciplinary review with representation from each of the teams. A review of referral criteria including the guidance for prioritisation is currently in progress. Referral patterns by SIMD and HSCP are monitored through Benson Wintere dataset to address inequity. 4.5 Risk The current neurodevelopmental waiting list within CAMHS, with the longest wait at 3 years and 6 months presents significant clinical risk. Delayed diagnosis contributes to unmet need, deterioration in young people’s wellbeing, and reduced capacity across CAMHS, education and social care systems, often leading to escalation through crisis pathways and a variety of whole system costs. There is also a transition risk as a number of young people reach adulthood while still awaiting assessment. This creates additional pressure on Adult Community Mental Health Teams (CMHTs), which currently have no dedicated resource or funding to provide neurodevelopmental assessment or ongoing care. 305
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Prescribing responsibility and continuity following ADHD diagnosis present a further governance risk. Shared care arrangements with General Practitioners are inconsistent, and Adult Community Mental Health Teams (CMHTs) and CAMHS are not resourced to provide ongoing prescribing or monitoring unless patients meet referral criteria. This can result in delays to medication initiation or continuation post- diagnosis, increasing the risk of treatment interruption and inequity of access across Ayrshire and Arran. A range of mitigating actions are underway to reduce the projected 10-year wait. These include: • Workforce expansion through recruitment and training of Advanced Clinical Nurse Specialists (ACNS), Allied Health Professionals and Pharmacy Prescribers. • Digital enablement through the Brain Gaze pilot. • Co-location and process redesign at West Road to increase throughput and efficiency. • Referral management and redirection to NEST to reduce inappropriate inflow. • Development of a pan-Ayrshire Neurodevelopmental Diagnostic Service through an Outline Business Case (OBC), outlining the model and capacity which will be capable of delivering the required number of assessments per year to address the current backlog and future prevalence – noting there is no funding currently available to support a new service development. • Implementation of local GP prescribing guidance and reinforcement of shared care protocols through the Area Drug and Therapeutics Committee (ADTC). • Inclusion of prescribing capacity and pathway development within the Outline Business Case (OBC) for the pan-Ayrshire Neurodevelopmental Service, including recruitment and training of prescribing pharmacists and specialist clinicians to strengthen safe and sustainable prescribing practice. • Ongoing oversight through the Neurodevelopmental Implementation Group to ensure consistency, safety and clinical governance across the system. 4.6 Community Wealth Building “None” 4.7 Key Priorities The IJB and NHS Ayrshire and Arran are delivering on the CAMHS Specification and challenges remain with mirroring this for the Neurodevelopmental Specification. It has been over two years since the decision to protect the CAMHS service and revert to alignment with the National Specification and work has progressed over this period to develop new pathways and models of care. This is a complex issue demonstrated in the time and effort to conclude the whole system programme of work which remains ongoing. 306
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5. CONSULTATION The HSCP are committed to involving and engaging external stakeholders to shape future proposals including through stakeholder engagement sessions. CAMHS have worked closely with the three HSCP’s to develop the non CAMHS Neurodevelopmental business case along with the development of the support pathways for young people who do not meet the referral criteria for CAMHS. Pan Ayrshire Engagement Sessions and North Ayrshire specific engagement exercises have been undertaken and are ongoing both through NEST and through a programme of engagement work undertaken by the CAMHS and Mental Health engagement officers Caroline Cameron, Director Thelma Bowers, Head of Mental Health (thelmabowers@north-ayrshire.gov.uk) Appendices • Appendix No 1, IJB Report 16th March 2023 • Appendix No 2, Redesign work in CAMHS 2021-2025 • Appendix No 3, Health and Sport Committee NHS AA Response 307
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Appendix 1 Integration Joint Board 16th March 2023 Subject: Implementation of the National CAMHS and Neurodevelopmental Specifications Purpose: The report is for: Awareness Discussion Recommendation: IJB are asked to: Note the successful implementation in Ayrshire and Arran to meet the National CAMHS Specification, noting the ongoing demands and risks placed on the service of accepting referrals for young people that do not meet the national criteria and specification. Through the 3 HSCPs in Ayrshire and Arran take forward work at pace with partners to progress whole system plan(s) to meet the National Neurodevelopment Specification, noting approval that referrals not meeting the CAMHS specification will cease to be accepted by CAMHS from 1 August 2023. Direction Required to Council, Health Board or Both Direction to: No Direction Required North Ayrshire Council NHS Ayrshire & Arran North Ayrshire Council and NHS Ayrshire & Arran √ Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership ND Neurodevelopmental Diagnosis RTT Referral to treatment time N-CAMHS Neuro- CAMHS CAMHS Child and adolescent mental health services DNA Did Not Attend 1. EXECUTIVE SUMMARY 1.1 Child and Adolescent mental Health Services (CAMHS) are now aligned and resourced to fully implement the NHS Scotland National CAMHS Service Specification published in February 2020 CAMHS national service specification. The specification describes the role of CAMHS as providing access to multi- disciplinary teams that provide: Assessment and treatment/interventions in the context of emotional, developmental, environmental, and social factors for children and young people experiencing mental health problems. Training, consultation, advice, and support to professionals working with children, young people, and their families. This report provides an update on the implementation of the National CAMHS Specification, to ensure the IJB are aware of the progress and supportive of the 308
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work required with partner services in the development of Neurodevelopmental Services for children and young people where there is no co-occurring mental health presentation. This development both on a Pan Ayrshire basis and within HSCP areas is required to meet the National Neurodevelopmental Specification for Children and Young People: National Neurodevelopmental Specification for Children and Young People 1.2 The National Neurodevelopmental Specification is for children and young people who have neurodevelopmental profiles with support needs and require more support than currently available. These children are often referred to CAMHS but do not always meet the mental health criteria described in the CAMHS national service specification criteria. 1.3 Currently in Ayrshire and Arran the CAMHS service accepts referrals for young people requiring a Neurodevelopmental Diagnosis (ND) regardless of whether a mental health need is evident. This practice is not in alignment with other CAMHS services in Scotland and lacks alignment with the National Specification for CAMHS. The report outlines the impact on the CAMHS service in Ayrshire and Arran of continued acceptance of neuro referrals which do not meet the criteria, the significant increase in number of referrals and the critical risk this poses to the CAMHS service being able to deliver the core and unscheduled care CAMHS service. 1.4 To fully deliver CAMHS in alignment with the National service specification and ensure the service can maintain performance and clinical standards the service must start signposting referrals to alternative pathways for those young people who do not meet the service specification access criteria. These are largely for young people requiring a neurodevelopmental diagnosis in the absence of a mental health need which have historically been accepted before the national specification was developed and now account for significant waiting times within the CAMHS service. This is required to ensure safe service sustainability and to enable CAMHS resources to be allocated to young people with mental health needs in alignment with the CAMHS pathways developed by the Extreme Team reform work. There is a significant risk to the Ayrshire and Arran CAMHS service of continuing to accept referrals until August, it is likely that national performance targets for CAMHS waiting times will be breached as the service continue to accept referrals over the period required for the Neuro specification to be implemented. 2. BACKGROUND CAMHS Specification 2.1 Child and Adolescent mental Health Services in Ayrshire and Arran are now aligned and resourced to fully implement the NHS Scotland National CAMHS Service Specification published in February 2020 Child And Adolescent Mental Health Services: national service specification - gov.scot (www.gov.scot). This follows a significant amount of Reform work in the preceding 3 years and is a culmination of the combined work of the CAMHS Extreme Team and CAMHS Implementation group. 309
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The specification describes the role of CAMHS as providing access to multi- disciplinary teams that provide: Assessment and treatment/interventions in the context of emotional, developmental, environmental, and social factors for children and young people experiencing mental health problems. Training, consultation, advice, and support to professionals working with children, young people, and their families. In Ayrshire and Arran reinforced by Scottish Government investment for recovery and renewal for Mental Health there has been significant investment in the redesign and development of the service to meet the specification and the needs of the children, young people, families, and carers. CAMHS will offer assessment, treatment and care to children and young people experiencing moderate to severe depression, moderate to severe anxiety problems, self-harming behaviours, and other diagnosable mental health conditions where there is an indication for treatment and therapeutic care. Young people requiring CAMHS will present with mental health problems that are causing significant impairments in their day-to-day lives. Such presentations can result in both the need for scheduled and/or unscheduled care and to this end there has been investment in the development of an CAMHS Urgent Assessment and Intensive Treatment service that is now operating across seven days which complements the traditional core CAMHS service model. 2.2 A Neurodevelopment CAMHS service (N-CAMHS) has also been developed specifically for those children and young people whose Neurodevelopmental Disorder co-exists with a clearly defined and treatable mental–illness. This service offers specialist clinical support, assessment and diagnosis for children and young people experiencing the combined challenges of mental ill-health with conditions such as Autism or attention deficit hyperactivity disorder. 2.3 The CAMHS Extreme Team was commissioned in 2020 to respond to the Reform question: How will we improve Children and Young People’s Mental health and wellbeing with timely access to services and support to Children, young people, and their families at a locality level? The program of work undertaken by the Extreme Team at pace centered the reform question on delivery of the new CAMHS National service specification and delivered Transformation in key areas of enquiry over an intensive 6-month period and critically developed and defined: Three core CAMHS pathways: Core CAMHS delivery, Unscheduled Care CAMHS Neurodevelopment CAMHS Clarified the provision of psychological interventions and professional roles from CAMHS and Educational Psychology for Children and young people across the three Partnerships in Ayrshire and Arran. 310
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The Extreme Teams programme of work formally concluded in June 2021 with the achievements noted above. To ensure that these changes could be embedded and achieve consistency of service excellence across the whole system a CAMHS implementation group continued to meet with the same membership as the core Extreme teams. The focus of the work of the group over the last 2 years has been on the monitoring of recruitment plans, workforce modelling, waiting times for the Neurodevelopment service and review of the developing evidence base to inform ongoing development of the service and inform future planning in alignment with the service specification. In addition to the Extreme Team reform programme there have been other whole system developments which complement and enhance provision to the whole population and wider communities. Neurodevelopmental Specification 2.4 The Children and Young People's Mental Health and Wellbeing Taskforce reported in 2019 and recommended that Scottish Government and Partners should: "Develop a Neurodevelopmental Service Specification for use across services in Scotland". The National Neurodevelopmental Specification is for children and young people who have neurodevelopmental profiles with support needs and require more support than currently available. These children are often referred to CAMHS but do not always meet the mental health criteria described in the CAMHS national service specification criteria. 2.5 The Specification complements, and sits within, the Getting It Right for Every Child approach. It reflects the principles of UNCRC, the Universal Health Visiting Pathway, and Ready to Act for Allied Health Professionals. The Specification aims to ensure that children and families receive the supports and access to services that meet their needs at the earliest opportunity, based on the GIRFEC approach. For many children and young people, such support is likely to be community based, and should be quickly and easily accessible. 2.6 The Specification outlines that children, young people and their families will be able to access additional support, appropriate for their neurodevelopmental needs, through universal services, such as via the named person, and community based mental health and wellbeing supports and services. Universal services should work closely with professionals working in neurodevelopmental services, relevant health and social care and education services. These professionals should be linked with CAMHS so that children and young people with both neurodevelopmental and mental health support needs can get the additional support they require. 2.7 Professionals providing support will also provide assessment, formulation, recommendations, and where appropriate and helpful, diagnostic assessment for those children and young people to help them understand their neurodevelopmental differences and support needs. Understanding of support needs can be enhanced by diagnosis but should not wait for diagnosis. The National Neurodevelopmental Specification sits along the Service Specification for CAMHS and the same principles underpin both specifications. There are 7 standards of care set out to provide the minimum stand of care expected from neurodevelopmental services. These are: High Quality Care and Support that Is Right for Me 1. I am fully involved In the Decisions about my Care 311
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2. I will receive High Quality Assessment, Formulation and Recommendations that are right for me 3. My Rights are acknowledged, Respected and Delivered 4. I am fully involved in Planning and Agreeing my transitions 5. We fully involve Children, Young People and their Families and Carers 6. I have confidence in the Staff who support Me 2.8 Across Ayrshire and Arran the requirements of the Neurodevelopmental Specification have not been implemented or met. In order to achieve a whole system approach the neurodevelopmental specification needs to be cross sector and involve health, education, social services and the third sector. The specification sits as part of a whole system, with a single point of access, whereby health, education, social services and third sector professionals actively seek to understand each other’s unique contributions and respect each other’s areas of expertise. A stepped and matched care pathway is needed so additional supports for example from CAMHS can be accessed as needed, this stepped support from CAMHS is in place in Ayrshire and Arran with the establishment of the Neurodevelopment CAMHS service. 2.9 Professional staff supporting the implementation of the neurodevelopmental specification will include registered children’s professionals with additional training in the identification, assessment and formulation of neurodevelopmental conditions, including: Speech and Language Therapists General Practitioners Paediatricians Occupational Therapists Peripatetic Teachers Educational Psychologists Nurses Clinical Psychologists Social Workers Children and Adolescent Psychiatrists Physiotherapists This illustrates the whole system approach and range of professionals required to support young people. 312
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A timely response to requests from families and carers who have concerns about their children’s neurodevelopmental profiles and needs can reduce family and carer stress, improve confidence in adopting positive and supporting parenting approaches, and receive support, guidance and interventions that are tailored to the needs of their children, increasing the prospects of early improvements in outcomes. It is nationally recognised that the implementation of the neurodevelopmental specification will reduce the numbers of children and young people referred to CAMHS, and rejected, as they do not meet the CAMHS referral mental health and risk/impact criteria. In Ayrshire and Arran to date the CAMHS service has not rejected any referrals for young people where there is a query of a Neurodevelopmental Disorder or a request for diagnosis. Impact on CAMHS Service in Ayrshire and Arran 2.10 The key performance standards that the service are measured against and is required to provide is our Referral to Treatment (RTT) for all referrals. It is required by Scottish Government that every child or young person referred to CAMHS is assessed and receives a form of treatment and intervention within 18 weeks of that referral. Ayrshire and Arran CAMHS continue to meet more than the 90% compliance against this target. The achievement of this target however continues to present challenges in the context of increased referrals and demand which has doubled between 2022 and 2023 compared to previous years of referral activity. 2.11 The increasing trajectory and trend of referrals to CAMHS since June 2022 has shown no sign of abating which also peaks over holiday periods. This can also be compounded by unprecedented number of DNA’s resulting in significant backlog in children and young people awaiting assessment. Between June and August 2022 there was a 20% DNA Rate in which one in every five assessments were not attended. An assertive recovery mitigation plan was developed by the service leadership and management team to respond to this increased demand and reduction in waiting time performance. The projected wait time in October for November/ December if remaining unaddressed, would have resulted in a potential reduction in performance to as low as 14% compliance equating to a wait of 91 weeks. The recovery plan was implemented in early October 2022. The results reported in January 2023 for December’s position is 96.5%, based on scheduled appointments January RTT% is projected at 99% with February at 100%. Appointments have not been allocated for March 2023 at the time of writing. The waiting list as of 31 December 2022 has only 2% breached and 98% waited less than 18 weeks. 2.12 The key area of challenge in the context of service reform remains the high demand and subsequent long waiting time for Neurodevelopmental (ND) diagnosis. CAMHS currently accepts referrals for young people requiring a ND assessment regardless of whether a mental health need is evident. This is currently practice which is not in alignment with other CAMHS services nationally and lacks alignment with the CAMHS National service specification. 313
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Figure 1 below shows the trend in referral to CAMHS for ND difficulties and the increase over time. Figure 2 below shows the ND referrals compared to referrals for other reasons to CAMHS. Figure 3 below shows that 69% of young people referred to CAMHS with ND concerns did not have a co-existing or suspected mental health difficulty. Figure 1: Referrals to CAMHS for ND difficulties from 2019 to 2022 Figure 2: The increased demand for CAMHS services from 2019 to 2022 comparing referrals for ND difficulties to other referrals. Figure 3 the proportion of referrals to CAMHS with ND difficulties with and without mental health difficulties. 314
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2.13 A telephone contact service has also been established to provide information and assist children and their families who are currently waiting for a diagnostic assessment. The specialist N-CAMHS team have completed 75 assessments for ND difficulties from November 2022 to February 2023. In January 2022 with Scottish Government recovery and renewal funding external provision was secured to assist with reducing the waiting time for a neurodevelopment diagnosis and CAMHS has subsequently commissioned two external providers: Purple House and Helios to manage the backlog of referrals. 180 young people were referred to Helios with 176 accepted in the year to February 2023. The contract with Purple House has been secured for review of 3 complex referrals per month. In the period January 2022 to end of February 2023, 44 young people were referred. The current waiting list holds non-Mental Health referrals of around 700 young people with a referral/waiting list management plan which will take 22 months to complete if the current use of external providers is maintained and the CAMHS specification is fully implemented immediately. The longer CAMHS continues to accept these referrals the greater the length of time required to address the long waits. 2.14 To fully deliver CAMHS in alignment with the National service specification planning requires to taken forward at pace to facilitate the signposting of referrals to alternative pathways for those young people who do not meet the service specification access criteria. This is required to ensure safe service sustainability and to enable the critical CAMHS resources to be allocated to young people with mental health needs in alignment with the CAMHS pathways developed by the Extreme Team reform work. The alternatives to this approach would compromise: Core CAMHS Delivery: Young people with moderate to severe mental health disorder such as depression, Anorexia nervosa and psychosis may not receive treatment. Without responsive treatment young people’s mental health may deteriorate, and long term prognosis will be impacted in some disorders such as psychosis. Increased risk of young people requiring hospital admission or OOH support as they are not receiving regular and effective support. A larger burden will fall on other services such as OOH services, ED, Police and other services such as school counselling and voluntary sector organisations. The RRT will increase and NHS Ayrshire and Arran CAMHS will no longer reach 90% compliance Unscheduled Care CAMHS Young people who have presented and been admitted to paediatrics or ED may not receive a mental health assessment from CAMHS. As young people have not received assessment including risk assessments there will be increased risk of a completed suicide or significant act of self-harm leading to life changing physical health difficulties such as liver transplant. A larger burden will fall on other services such as OOH services, ED, Police, and other services such as school counselling and voluntary sector organisations. 315
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Comprising either of these core CAMHS pathways carries an unacceptable level of risk for young people in Ayrshire and Arran. To fully operationalise the CAMHS specification ensuring appropriately deployed CAMHS resources and safe service delivery from the 1 August 2023 the CAMHS service will focus on delivering the CAMHS service specification as prescribed nationally. The CAMHS will continue to screen all referrals directed into the service to ensure that young people that are appropriate for CAMHS are accepted. CAMHS will continue to accept young people with a comorbid or existing mental health difficult along with their ND difficulties, supported by the N- CAMHS team. Neurodevelopmental Pathways 2.15 To fully operationalise the CAMHS specification ensuring appropriately deployed CAMHS resources and safe service delivery from the 1 August 2023 the CAMHS service will focus on delivering the CAMHS service specification as prescribed nationally and resourced locally. The CAMHS will continue to screen all referrals directed into the service to ensure that young people that are appropriate for CAMHS are accepted. CAMHS will continue to accept young people with a comorbid or existing mental health difficult along with their ND difficulties, supported by the N-CAMHS team.. 2.16 Together with the three HSCPs in Ayrshire and Arran plans require to be developed at pace with partners to progress whole system plan(s) to meet the National Neurodevelopment Specification. Specific outputs include: Communication plan to be developed to inform stakeholders about the change in provision and new service models Whole system development of alternative service or community wellbeing solutions for young people building on the good practice already being commissioned by Education and Children’s services across the whole system. Continue to deliver NEST as a universal life course service offer with whole system with whole system partner consideration to be given to build on this key service development and early intervention solution. Whole system consideration of the outcomes and recommendations of the Ayrshire Neurodevelopment Glasgow University event held early in 2023 to build on local good practice and a partnership approach to develop a comprehensive range of alternative provision. Neurodevelopmental Empowerment and Strategy Team (NEST) NEST is a new and first in Scotland service jointly funded by East, South and North HSCP’s in Ayrshire and Arran. This newly launched service provides co- ordination and development of pathways of empowerment for the large number of children and adults directly and indirectly affected by neurodevelopmental diversity across the three Ayrshire partnership areas which will deliver on three critical outcomes. Whilst not directly managed or within the CAMHS service provision, NEST complements the service redesign and aspirations that are outlined for CAMHS Neurodevelopmental services and there will be a natural synergy 316
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between the core service and this new emerging model, the core outcomes and benefits of which are noted below: Information access – Up to date, relevant and accessible information will be freely available for the neurodivergent community and professionals across Ayrshire. Individuals and families will have a good understanding of what a diagnosis means for them and will be able to make informed decisions. Empowerment Programme – Individuals and families/carers will have a better understanding of their neurodivergent differences and through the opportunity to learn, develop strategies and networks will be empowered to live as full a life as possible. The NSET team, in partnership with individuals, families and neurodevelopmental professionals will design and deliver a systematic pan Ayrshire, needs based empowerment programme. Existing communities and groups will be supported to increase their scope and reach across their area. Community/Services - Communities across Ayrshire will be more tolerant and understanding of the needs of neurodivergent individuals. This tolerance and understanding will provide a marked improvement in access and opportunity for neurodivergent individuals and families. Local services will be aware of the needs of our neurodivergent community and will systematically incorporate solutions to these needs into their service delivery. These core critical outcomes are being delivered through collaborative working with neurodivergent individuals, their families, clinicians, third sector and services across Ayrshire. This is a unique life span population wide universal service and an examplar across the rest of Scotland in building a cohesive lifespan pathway of supports to people with neurdivergent needs. The NEST service provides the building blocks and foundation in Ayrshire and Arran to taking forward the full implementation of the Neurological Specification. 3. Recommendation 3.1 IJB are asked to: Note the successful implementation in Ayrshire and Arran to meet the National CAMHS Specification, noting the ongoing demands and risks placed on the service of accepting referrals for young people that do not meet the national criteria and specification. Through the 3 HSCPs in Ayrshire and Arran take forward work at pace with partners to progress whole system plan(s) to meet the National Neurodevelopment Specification, noting approval that referrals not meeting the CAMHS specification will cease to be accepted by CAMHS from 1 August 2023. 317
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3.2 Anticipated Outcomes IJB has assurance that risks are identified and managed appropriately to ensure the safe and sustainable delivery of the National CAMHS Specification. Ayrshire and Arran will have a sustainable and world class CAMHS service that meets the needs of young people that require support under the national CAMHS service specification. Full alignment and compliance with the national CAMHS service specification with improved Children and Young People’s Mental health and wellbeing outcomes, timely access to services and support to Children, young people, and their families at a locality level in alignment with the CAMHS extreme team reform question. The positive delivery of a whole system Neuro-developmental Service in Ayrshire and Arran. CAMHS will be able to progress through the current Neurodevelopmental list more timeously and be able to offer more therapeutic interventions. Young people coming through N-CAMHS will be seen by the right person, in the right place at the right time. Opportunity for whole system partnership approach to developing alternative service or community wellbeing solutions for young people that do not need a CAMHS referral and building on the good practice already being commissioned by Education and Children’s services across the whole system. 3.3 Measuring Impact CAMHS can monitor the number of referrals that come to the N-CAMHS service and the referrals that are meaningfully redirected to more appropriate Partner Services. Benson Wintere has been commissioned since 2020 and is able to produce locality and school level information on referral activity, work force modelling, capacity, and demand with live dashboards to reflect service activity. This information is utilised to continue to inform service planning and workforce development. An engagement officer has been recruited by the service to facilitate young people in service design and inform service improvements. KIDSCREEN has been implemented with a digital approach to capturing quality of life and experience information. A follow up report will be presented to the IJB with progress and details of plans from a whole systems perspective across Ayrshire and Arran and also locally in our own HSCP/Local Authority area. 4. IMPLICATIONS 4.1 Financial Creating a Neuro-developmental Service for Children and Young People who do not meet the CAMHS Specification will require financial investment from system partners, as the model and pathways are designed and developed the financial implications will be quantified. 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic 318
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None 4.5 Risk Reputational and operational risk of CAMHS being able to safely meet demand if the Specification is not implemented. Risk implications of other functions that CAMHS would be unable to sustain are detailed in the report. There is a significant risk to the North Ayrshire CAMHS service of continuing to accept referrals until August, it is likely that national performance targets for CAMHS waiting times will be breached as the service continue to accept referrals over the period required for the Neuro specification to be implemented. 4.6 Community Wealth Building None 4.7 Key Priorities Meets Caring for Ayrshire, GIRFEC, The Promise, HSCP strategic objectives, Ayrshire conversation Mental Health priorities, Mental Health and wellbeing strategy. Delivery of a fully resourced and compliant CAMHS service in alignment with the national specification is a key national and local HSCP strategic priority. This will enable full realisation of investment for Children and Young people’s Mental health in Ayrshire and Arran, improving mental health and wellbeing and enabling timely access for young people and their families to the right service or support in the right place and the right time. It is a key priority of all Partners across the whole system to ensure that there are fully developed wellbeing services and supports for Children, young people, and their families and to enhance current models of best practice in relation to neurodevelopment diagnostic and support provision. This is evidenced by the initial investments by the three HSCP’s in the NEST service and Autism support Ayrshire which provide information, training and community supports at a population wide universal level. 5. CONSULTATION The work developed by the CAMHS Extreme Team and more latterly the CAMHS implementation group has been fully consulted as part of the programme of Whole systems Reform. There has been an event for all stakeholders on 16th February with Glasgow University and world experts to try and understand the alternatives for young people who would fall under the ND service specification. The proposals as outlined are supported by the three HSCPs and will be presented to all three IJBs. Caroline Cameron, Director, NAHSCP Thelma Bowers, Head of Service, Mental Health, thelmabowers@north-ayrshire.gov.uk, 01294 317849 Appendices None 319
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Appendix 2 Redesign work in CAMHS & CEDS 2021 – 2025 Introduction NHS A&A CAMHS have redesigned the entire service since 2021-2025 including creating pathways and distinct teams to ensure that young people are seen in the right place, by the right person at the right time. Workforce redesign and innovation has seen the creation of new posts to help alleviate the shortages of clinicians able to prescribe with the creation of Clinical Nurse Specialists and Pharmacy prescribers. The creation of CUAIT the unscheduled team with CAMHS means that there is a 7 day a week service 8am – 8pm which did not previously exist. (Appendix – Redesign work in CAMHS). A CAMHS Participation Officer was employed to ensure that young people family/carers are fully involved in the redesign of services and have their voices heard in terms of making improvements. Community CAMHS Team – 18 week Referral To Treatment NHS A&A CAMHS have continued to meet the 18 week RTT since 2022 and are one of the only health boards in Scotland to sustain this. Even in 2023 when the CAMHS National Specification was implemented the service increased the number of assessment appointments and continued to meet the target. The Community Team continue to use the data to stay ahead and inform us of future concerns. The appointment of a Data/Information Analyst is key to this as information is sent to the team leader on a bi-weekly basis. In October 2025 the Community Team streamlined the Nurse-led Medication clinics to ensure the regular monitoring of young people prescribed medication through the Community CAMHS Team. 320
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Driver Diagram above of the Nurse-led Medication Clinics CUAIT (CAMHS Urgent Assessment Intensive Treatment) Team In June 2022 the CUAIT became operational creating their criteria, setting up Care Partner forms and combining the mental health and CARAS risk assessments. There was an expansion of response to include Ayr Hospital ED, CAU Ayr and Crosshouse hospital 16- 18th birthday. Collaboration with health partners in AMHS, paediatrics and Arran/Cumbrae (pathways, response, sops). Collaboration with HSCP partners in East Ayrshire (WSA, CYJ). Between October 2023 and February 2024 the first recruitment of CUAIT’s first band 5 took place along with further band 6 recruitment (introduction of learning disability nurse in team). A duty escalation pathway was developed and the expansion of weekend role to include urgent review/follow up for known patients. During the period February 2024 and October 2025 a student nursing placement audit was carried out and the team were identified as a placement area. PREVENT training and right-wing ideologies training was rolled out across the team and a 12 hour shift pilot 8am- 8pm 7 days, closing referral gap between daytime and overnight services. The NHS24 pathway for up to 18th birthday supported by ICPNT was put in place and the ESMHP pathway supported by Psychiatric Liaison and MHANP. CUAIT Psychiatry 0.5 WTE was set up to work alongside the rest of the CUAIT team adding another complementary workforce skill mix element to the service. The CUAIT NDV pathway (under review as per PDSA cycle). ADASTRA training is planned and access to complete NHS24 process in its entirety. N-CAMHS • Workforce & Recruitment • Training & Skill Development • CYP Engagement Sessions with Participation Officer (Team Name and Logo) • Information Packs for CYP and Families • Prioritisation Criteria 321
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• Pathways of Care (e.g. ASD, ADHD, Multiple Presentation, Medication) • Documentation Review (e.g. Neurodevelopmental History, Screening Tools) • Transition Planning: Primary to Secondary Check-Ins • Waiting List Initiatives to Support Lengthy Waits: North Ayrshire School Project and East Ayrshire Clinic Model (Caring for Ayrshire: Providing the Right Support at The Right Time Close to Home) • Use of External Providers • Complaints and Enquiries • Development of West Road (September 2024) • Supporting Multi-Agency Neurodevelopmental Implementation Groups (Pan- Ayrshire) • Introduction of Care Co-ordinator Roles • Development of 18+ Years Assessment Clinic • Waiting List Wellbeing Check-In • Neuro-Affirming Reports Templates • MDT Diagnostic Case Discussions • LD Diagnostic Clinics • Psychology Consult Appointments CEDS CEDS commissioned a Review of Community Eating Disorders in 2021-22 through Main Street Consulting to consider the improvements that would be anticipated in the National Review. A CEDS Stakeholder Event in January 2024 explored these and highlighted where they can help to bridge the gaps. From the event it was decided that the development of an Extreme Team would be paramount in service development. It was about this time that it became apparent that CEDS had no allocated budget and has been funded for years by the CAMHS underspend as far back as 2012. A Business case is being developed and an SBAR prepared for PSMT. The CEDS referral form was updated which contains information on the MEED Risk Assessment (formally Marsipan) and CEDS Referral Guidelines have been developed and approved at Clinical Governance. At present AN & BN (BED 2024). A Severe and Enduring Service (SEED) has been established and patients identified. In March/April 2025 CEDS moved from Kiln Walk to a newly renovated building which has much more clinic space and be appropriate to carry out groups and physical health checks. CEDS Participation Officer has been involved with patients who are interested in being involved in service redesign workshops. A QR code has been developed for patients who have been discharged from the service, resulting in valuable feedback – qualitative and quantitative. A MAUDSLEY model for carers is currently being developed by CEDS clinicians. The lack of dedicated Psychiatry for Adults is the most pressing clinical risk to the service. Quality Improvement & Data The Service has used Improvement methodology and tools to capture qualitative and quantitative data to inform service redesign and PDSA’s tests of change to small scale changes before larger scale redesign. DCAQ (Demand, Capacity & Queue) to ensure that the workforce capacity can meet demand and highlight areas where alternative solutions for gaps in workforce recruitment (Pharmacy Prescribers, Nurse Prescribers, Allied Health Professionals). Taking risks around new posts like the Quality Improvement Advisor, Participation and Data/Information Analysts posts. Redesign and improvement work in CAMHS and CEDS A&A that it is recognised nationally 322
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19th June 2023 – Spotlight Presentation at the NHS Scotland Event – Redesigning CAMHS in A&A 2020-2023 21st June 2022 – Winner of the Integrated Care Poster at the NHS Scotland Conference, Aberdeen for the CAMHS Leisure Project in Partnership with 3 Leisure Services across Ayrshire CAMHS Benson Wintere Data Model This PowerBI model was designed by CAMHS with the assistance of an external contractor as there was not the expertise with NHS A&A. This information is highly sought after by other boards and is of particular interest to Scottish Government who have seen the data. We are the only board that can see at a glance a dashboard of CAMHS data including the RTT and compliance and we know the numbers of referrals we are ‘meaningfully redirecting’. School cluster level of detail in the Benson Model 323
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We are able to look at the data and split it into North/South and East Ayrshire and we are then able to look at the secondary school and cluster primary schools in terms of reason for referral to the service. Inbuilt in the model is the school roll numbers to enable us to see the percentage referral rate for each school and the SIMD (Scottish Index of Multiple Deprivation) giving us information in terms of the referrals and the deprivation categories for all those referred in. This information has been shared with colleagues across Ayrshire in terms of Children’s Services and presented to elected members across Ayrshire. CAMHS Participation Officer The CAMHS Participation has been involved in so much of the redesign work within CAMHS ensuring that young people and family stories are heard. Much of the work is around engaging with key stakeholders which included care experienced young people and young carers. The Participation Officer has also done lots of collaborative working with NEST (Neurodevelopmental Empowerment & Strategy Team) and the Bairns Hoose work with Scottish Government. 324
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The Participation Officer has also been instrumental in testing the Mindlog app with young people in the service who use the app to do twice daily checkins that are then uploaded and sent to CAMHS clinical mailbox for discussion with the young person at their next appointment. Ready for Anything was a collaborative project with Adventure Carrick - an outdoor education centre specialising in water sports. Our aim was to develop a groupwork opportunity for young people (YP) to learn to manage their symptoms of anxiety. The role of the Participation Officer was instrumental in the successful running of this project. Other work the Participation Officer has been involved in is the Children In Scotland Engagement which is Engagement with patients around their experiences and what support has worked / hasn’t worked in the past. This would influence CIS updating Essential CAMHS training toolkit. Psychology Provision Psychology within CAMHS deliver NES packages re: Anxiety – delivery and also training to wider staff group – NHS and community. Group work is undertaken by CAAPS – early intervention and peer support. Psychology input to the CUAIT Team for delivery IPT-A C. There are a few challenges for psychology including; filling vacancies, need to expand provision to cover roles/responsibilities, overall increase in referrals to CAMHS and concerns regarding C&YP Mental Health – increase in both numbers and complexity and significant demands in relation to Neurodevelopmental concerns and assessment. Pharmacy Pharmacy have been instrumental in helping the medication clinics develop and really helped the service manage medication during the shortages of ADHD medication. They have contributed to the training and development of other staff and are a point of contact for medication advice from other members of the team. They also have a very important patient facing role and see many young people starting on medication. 325
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Psychiatry The role of Psychiatry has grown in the last 2 years from a position of virtually having no psychiatry. Psychiatry is involved with all aspects of CAMHS and CEDS. Most recently Psychiatry has been leading on the potential for an LD CAMHS Service in Ayrshire and Arran. Prevalence rate of mental health difficulties is 31- 41% for children and adolescents with learning disabilities - significantly higher than the general population The needs of young people with learning disabilities and mental health difficulties are not currently well served by existing services in many areas of the UK including Ayrshire, where there are disjointed services and gaps in provision. A Business Case is being discussed with CAMHS and the LD Service in Ayrshire and Arran. Admin is a critical part of the service and essential to the smooth running of the service. By centralising the management of CAMHS and CEDS this has really helped in SSTS, procurement, reduction in clinical mailboxes and a robust process for ensuring that all new staff are added to Trakcare. Admin have been integral in suggesting improvements in processes and ensuring that standardised letters and the text reminders go out timeously. 326
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The Admin Manager also sits on the Management and Leadership Team for CAMHS and CEDS and is integral to the decision making for process change. Sleep Pathway Development A specific sleep pathway has been developed in CAMHS to ensure that there is an initial appointment with the young person, family/carer to issue Sleep Diaries and explain height and weight and physical apt as well as using a screening tool. Previously, families requested melatonin straight away for sleep issues and sleep diaries were not returned. This allows a discussion about how and why sleep diaries need to be completed and when they are returned another appointment is scheduled and potential intervention for 4-6 sessions is agreed. This ensures that all sleep hygiene is carried out before medication is offered as per guidelines. New Accommodation for N-CAMHS and CEDS 2025 327
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The new facility at West Road for N-CAMHS (Neuro CAMHS) and CEDS (Community Eating Disorder Service) has resulted in an improved environment to carry out physical examinations and improved the wellbeing for patients and staff in the facility. Previously physical examinations were being carried out in environments which were must less suitable. The newly refurbished facility will enable a much safer and hygienic environment which the workforce have been involved in designing. West Road N-CAMHS (Neuro CAMHS) and CEDS (Community Eating Disorder Service) opened to staff March/April 2025 and first patients were seen 22nd April 2025. The Official Opening was on the 22nd of May 2025 with the Leader of the Council and the Provost carrying out these duties. 328
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Appendix 3 Health, Social Care and Sport Committee ADHD and ASD pathways and support The Health, Social Care and Sport Committee is undertaking an inquiry into Attention Deficit and Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) pathways and support. 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. Question “Please tell us your views on the aims of the inquiry, in relation to the people you support, and describe any opportunities for improvement you have identified.” 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. To understand why waiting times for diagnosis and management of ADHD and ASD are long and increasing you must look at both societal and structural/operational factors that have combined to form a perfect storm of increasing demand and decreasing capacity. Public awareness and understanding of ADHD and ASD have increased at a rate no one predicted or planned for. Across Scotland and the UK there is a significant increase in children, young people and adults seeking information, support, assessment and treatment for neurodevelopmental conditions (including ADHD and ASD). The lack of national accompanying investment in neurodevelopmental services has funnelled this increase in demand through Mental Health services that had no additional capacity to cope with even the smallest of increase in referrals. Our Neuro-CAMHS service received a small investment, however this was insufficient in comparison to the extra pressure on the service. Our adult services have had no additional funding. Many health boards and HSCP’s have traditionally supported neurodevelopmental assessment and treatment via their mental health pathways through services such as CAMHS and local CMHT’s. This has been a natural development due to professional expertise required being available in these services. Over the past 4-5 years, locally we have been overwhelmed when met with an estimated increase in demand of 20-30% for neurodevelopmental assessment and treatment. The consequence of which means the core business of these services to assess and treat people with acute mental health conditions has become increasingly difficult to deliver, presenting mental health services with an unexpected and continuing crisis and an unacceptable level of risk leading to difficult operational and clinical decisions. In addition to this increase in demand and the lack of specialist neurodevelopmental services, there is a national workforce shortage in many areas associated with the assessment and support of neurodivergent people. Difficulty in recruiting and retaining professionals in disciplines such as SLT, OT, Psychology and Psychiatry is a significant factor in the service delivery issues faced across Ayrshire. Our Community Paediatric services provide assessment and treatment for our pre-school children and children with cooccurring developmental and physical health conditions. They face the same demand/capacity and workforce challenges as CAMHS and CMHT’s. They are also working at maximum capacity with no additional resources. The circumstances detailed above have left two main scenarios across Ayrshire. 329
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During the early stages of this increase in demand, mental health services and community paediatrics continued to receive referrals for neurodevelopmental assessment with no additional national or local resource to strengthen teams or create separate specialist neurodevelopmental services. Consequently, the increase in waiting list numbers and waiting times has increased exponentially. This increase has not always been visible in reported RTT due to lack of reporting the ND demand within services or the national mandated requirement for this in RTT targets. In order to deliver and maintain their legislative requirements, CAMHS must work in line with the Scottish Government CAMHS Specification and can therefore only accept neurodevelopmental referrals as part of wider assessment of a cooccurring moderate to significant mental health condition. This action has meant a slowdown in the growth of waiting lists. However, this doesn’t address in any timely manner, the individuals who were already on a waiting list. This has also created a scenario where it is impossible to accurately track the demand for children and young people who do not meet the mental health referral criteria but require a Neurodevelopmental assessment and/or support. Similarly, within the adult CMHT’s, neurodevelopmental assessment is only available as part of a wider mental health assessment where criteria for the service is met. Due to all the reasons outlined above, there are no options for assessment and treatment for children, young people and adults in Ayrshire who have a suspected neurodevelopmental profile but do not meet criteria to access a mental health service. Our citizens who are seeking neurodevelopmental assessment and do not meet criteria for the existing mental health services are informed about our local Neurodevelopmental advice and guidance service. No diagnosis is needed to access this service and individuals can contact the service directly with no clinical or referral pathway. Despite some limited national work and significant local work to evaluate and address shortage in assessment and treatment, individuals and families can still feel lost and unsure as to where to turn without a diagnosis. Many individuals, families and professionals believe the absence of a neurodevelopmental diagnostic pathway as part of the wider support network, is unacceptable and national resource must be provided to assist local areas with meaningful resources to fulfil their duty in this area. This demand is particularly stark where impacting or limiting access to medication and treatment. Understand the impact of delays on individuals To understand the impact of these delays and lack of specialist neurodevelopmental services out with our mental health provision, the three Ayrshire HSCP’s have been engaging with local people in different ways over the past five years. This engagement has increased over the past two years with the introduction of local multi agency implementation teams tasked with scoping out opportunities to operationalise many of the National Neurodevelopmental Specification principals and standards (for children/young people and families). The development of our local Neurodevelopmental Empowerment & Strategy Team (NEST) has provided a vehicle through which each partnerships engagement team can reach our neurodivergent citizens and their families. The majority of engagement has been aimed at families and carers. We have also engaged specifically with adults who are diagnosed or suspected to have ADHD. Similar themes are evident throughout Ayrshire, across age groups and individuals and families. It must be noted that the continuous work carried out by the implementation teams, health, education and NEST to specifically address the needs of diagnosed or undiagnosed neurodivergent individuals and families was highlighted in a positive way through many of the stories and experiences shared in the latest round of engagement events. However, to address the question posed in the aims of this enquiry, there are themes that strongly link to the difficulties in accessing assessment or the long waiting periods people have if they are offered assessment. 330
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Themes such as isolation, desperation, family crisis, lack of opportunity, not being listened to, lack of validation, lost in the system, hopelessness and a real sense of frustration are evident throughout all engagement carried out. It is well evidenced and documented that statistically, individuals who have a neurodivergent profile and do not receive supportive intervention at an early stage have significantly lower chances of positive health and social economic outcomes. Higher rates of isolation, educational difficulties, challenges in the workplace, unemployment, relationship challenges, financial challenges, poor mental health, mental illness, addiction and suicide are consistently reported. The testimony of local citizens across all areas of Scotland and the published national and international data on life outcomes must be at the forefront of decisions relating to allocation of resource, strategic workforce planning and service redesign. explore solutions to improve capacity of services, referral pathways and support. Locally we are dedicating significant time looking at potential pathways of support and assessment. There is recognition that the assessment and support of neurodevelopmental conditions is very complex and often does not come alone as a single issue that is easily diagnosed and supported. Taking a holistic and trauma informed approach in ND assessments is going to be essential to ensure safe and helpful diagnostics and formulation of a person’s presentation. Individuals who present with potential neurodivergent profiles can have multiple associated health/mental health difficulties, as well as complex social and environmental backgrounds. Recognising the complexity of people’s lives is essential in the wider assessment/treatment and support pathways offered. When assessment and support pathways are being developed, they must be cognizant of the above and designed with the whole person in mind. Multiagency/disciplinary pathways are essential if the right support, at the right time is to be achieved. Community based support in Ayrshire is increasing with investment in our NHS service Neurodevelopmental Empowerment & Strategy Team (NEST) and the commissioned National Autistic Society service, Autism Support Ayrshire. Relationships between health, education, social work, third sector and our neurodivergent citizens is becoming stronger and better joined up, however there is still some way to go to establish truly integrated multidisciplinary pathways for assessment and support. Support regardless of a diagnosis and at the earliest opportunity has been increasingly the ethos and direction services are taking across Ayrshire. This principle is also at the heart of potential pathways being designed. Scottish Government and its local partners must recognise the importance of planning and investment in support services and diagnostic services equally. Our community supports such as NEST and Autism Support Ayrshire are having a demonstrable positive impact on our neurodivergent individuals and families. Both services are available at the point of need and no diagnosis is required to access these. These services are focused on advice, guidance, and empowerment. Through the NEST model, we are successfully creating one central space in Ayrshire where individuals, families and professionals can access advice, guidance and connections. Online and in person education, workshops and one to one advice and guidance are now available for all diagnosed or suspected neurodivergent citizens and their families across Ayrshire. NEST have also built essential partnerships with their partners in both Health and Education as well as the Third Sector and Peer Led supports. These supports have been designed in close partnership with neurodivergent people. The “Nothing about us without us” principle should be adopted when models of support are being designed and implemented. These services are in place and bringing positive change. However, they are under increasing pressure due to an increase of general awareness but also the demand for help 331
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created through the lack of an assessment pathway for the majority of our citizens. Demonstrating that support alone is not always going to be enough for people who require further clarification, validation and potential clinical treatment only made available through a formal diagnosis. However, despite the need for a diagnostic pathway to be available, these services are an essential part of the neurodevelopmental support structure in Ayrshire. These are not clinical services and demonstrate that non-clinical supports can work very well when co-designed with the people who use them. This also demonstrates that wider capacity and a more holistic offering can be achieved through the recruitment of individuals from a non-clinical background. Solving some of the forementioned difficulties within the system caused through a shortage in clinical workforce. Submitted 18th August 2025 332
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Integration Joint Board 13th November 2025 Subject: 2025-26 – Month 6 Financial Performance Purpose: To provide an overview of the IJB’s financial performance as at Month 6 (September). 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 £4.957m reducing to £1.604m after planned recovery actions; (b) notes the progress with delivery of agreed savings; (c) approves the actions which are being taken to progress financial recovery and that an updated recovery plan will be presented to the next IJB; and (d) notes the remaining financial risks for 2025-26. Direction Required to Council, Health Board or Both Direction to: - 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership MH Mental Health MDT Child & Adolescent Mental Health Services BRAG Blue, Red, Amber, Green UNPACS UNPACS, (UNPlanned Activities) – Extra Contractual Referrals NRAC NHS Resource Allocation Committee PAC Performance and Audit Committee MHOF Mental Health Outcome Framework MDT Multi-Disciplinary Team 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 Agenda Item 8 333
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relevant budget holders and services. It should be noted that, although this report refers to the position at the end of September 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 £4.957m (1.5%) reduced to £1.604m 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 @ mth6 4.957 1.245 3.712 Financial Recovery Plan Projections (3.353) (1.244) (2.109) Residual Risk 1.604 0.001 1.603 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 The movement in the projected outturn position for the 2025-26 financial year is illustrated in the graph below: 334
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This illustrates the movement in the gross and net projected overspend and the residual overspend or risk split between NHS and LA funding partners. 1.4 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. The main areas of movement from Period 4 to Period 6 are: • Updated assessment of the vacancy savings projection with lower level than anticipated for social care, primarily due to a number of posts which have been removed as recurring savings. • Increase in Learning Disability care packages due to a small number of high cost packages. • Increase in supplementary staffing in Woodland View due to a short term IPC incident and associated staff cover costs. • Under-recovery of anticipated income following new charging policy. 1.5 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. 1.6 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. 335
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• 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 6 At month 6 against the full-year budget of £340.767m there is a projected year-end overspend of £4.957m (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 £3.924m in social care services and a projected overspend of £1.245m 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. Appendix F provides information on the costs of bank and agency staff. 2.3 Health and Community Care Services Against the full-year budget of £100.020m there is a projected overspend of £4.167m (4.2%) which is a favourable movement of £0.1638m and the main variances are: a) Care home placements – net projected overspend of £0.565m (£0.010m favourable). This includes an overspend on placements of £1.115m (£0.160m favourable) 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 budgeted number of permanent placements was 765 and at month 6 there were 807 placements resulting in a projected overspend of £1.140m. 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 and gross funded placements which is projected to be £0.550m over recovered 336
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(£0.150m adverse). 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 and access to the funds or estate of service users. b) Care at home is projected to be £1.689m overspent (£0.017m 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 £0.486m (£0.057m adverse) split as follows: £0.958m over in residential placements, £0.296m under in direct payments and £0.176m under in community care packages. d) Integrated Island Services is projected to overspend by £0.507m (£0.196m adverse). The most significant variance is a projected overspend at Montrose House of £0.283m 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. One of the main adverse movements relates to an income under recovery at Montrose House and a write off of aged debt. The Arran Patient Transfer contract is projected to overspend by £0.040m. e) Specialist Rehab wards – projected overspend of £0.175m (£0.015m favourable) (Redburn ward £0.203m overspend and Douglas Grant £0.028m underspend). The overspend is due to cover costs for vacancies as well as supplementary staffing for patients who require one to one support. f) Wards 1 and 2 – Projected overspend of £0.774m (£0.009m 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. 2.4 Mental Health Services Against the full-year budget of £118.496m there is a projected overspend of £1.218m (1%) which is an adverse movement of £0.613m 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 £1.036m (£0.416m adverse). The adverse movement is mainly due to one new high-cost care LD package £0.126m, a projected under recovery of income £0.153m and an adverse movement in children with a disability packages of £0.076m. • Community Mental Health services are projected to underspend by £0.060m (£0.094m adverse movement). The adverse movement is mainly due to an 337
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adverse movement of £0.041m in residential packages. 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. • The Lead Partnership for Mental Health is projected to be £0.687m overspent (£0.201m adverse) and the main variances are as follows: • Adult Inpatients – projected overspend by £0.954m (£0.315m 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. The month 5 and 6 costs were materially higher than the month 1 – 4 average, this was due to high levels of staff cover required to respond to an IPC incident at Woodland View. The projection assumes that £0.338m of costs are recharged 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 £1.054m (£0.299m favourable) based on current placements. Since month 4 there has been the transfer of two packages. 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, the projected position includes provision for any new placements approved. 338
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• Learning Disability Services – projected to overspend by £0.349m (£0.293m adverse). This adverse movement relates to the delay in achieving the saving from Ward 7A. Whilst the ward closed there are still legacy costs as the staff are still being redeployed. • Elderly Inpatients – projected overspend of £0.117m (£0.016m 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. • Eating Disorders – projected to overspend by £0.135m (£0.008m adverse 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 (no movement). 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 £0.321m (£0.029m 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 £0.156m (£0.120m adverse). The overspend is less than projected 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 £0.279m (£0.050m 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 underspend. The projected underspend is after considering the legacy costs from the 2024/25 review of funding. Innovation Fund – projected underspend of £0.021m (£0.004m adverse 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 £0.972m 339
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(favourable movement of £0.444m) in 2025-26. Further information is included in the table below: Vacancy Savings Target (£1.160m) Projected to March 2026 £2.132m Over/(Under) Achievement £0.972m 2.5 Children and Justice Services Against the full-year budget of £42.224m there is a projected overspend of £1.636m (3.9%) which is an adverse movement of £0.030m and the main variances are: a) Care Experienced Children and Young People is projected to overspend by £1.996m (£0.081m adverse). 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 £2.714m (£0.024m adverse) based 33 placements in month 6. This demonstrates an increase of 4 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. 340
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• Looked After and Accommodated Children (fostering, adoption, kinship etc) is projected to be £0.937m (£0.032m favourable) underspent. • Residential respite – placements are overspent by £0.071m (£0.002m fav 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 £0.170m (£0.099m adverse movement), largely due to staffing levels in the children’s houses and regrading of posts. • Care Leavers – projected underspend of £0.058m (£0.013m adverse movement) in rent costs. • Section 29 Payments (Throughcare Team) are projected to overspend by £0.049m (£0.015m favourable movement). b) Head of Service – is projected to underspend by £0.562m (£0.006m adverse). This consists of a projected overspend of £0.158m in relation to the previous staff reconfiguration saving 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 £0.777m and which contributes to costs incurred across a number of C&F service areas. c) C&F Health Team – is projected to overspend by £0.082m (£0.062m favourable) 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. The favourable movement is due to ongoing work by the senior manager to reduce the overspend. 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 £0.185m (£0.019m adverse). 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. 341
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2.8 MANAGEMENT AND SUPPORT Management and Support Services are projected to underspend by £1.685m (£0.659m favourable) and the main areas of variance are: • There is projected slippage on the LD and MH transition funding of £0.473m (£0.210m 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. • There is also a balance of overachieved savings of £0.137m (£0.076m favourable) 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. • The funding for the Reduced Working Week (non-Lead Partnership element) is coded to Management and Support pending final confirming of the allocation. It is projected to underspend by £0.293m as the overspends in relation to these costs are shown on other lines outwith Management and Support. • An over-recovery of payroll turnover of £0.600m (£0.500m adverse) for social care services and an over-recovery of £0.308m (£0.006m favourable) 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 £4.000m £1.877m Over/(Under) Achievement £0.600m £0.308m 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 342
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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 The approved 2025-26 budget included £4.019m of savings. BRAG Status Position at Budget Approval £m Position at Month 6 £m Red - - Amber 2.984 2.027 Green 1.035 0.200 Blue - 1.792 TOTAL 4.019 4.019 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 North MDT funding to Arran Medical Group (Virement 11) (0.043) 2 Budget transferred to Capital for INV-3395435821 (0.006) 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. 343
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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 6 the MH lead partnership is projected to overspend by £0.687m (£0.225m NRAC share for East and £0.196m for South). South HSCP (month 6 info) – projected overspend of £0.282m (£0.148m adverse) of which £0.104m (£0.054m adverse) will be allocated to North. The variance is mainly due to an overspend of £0.131m in the community store. This includes the costs of replacing mattresses, repairs and maintenance contract and equipment costs. The adverse movement is due to the purchase of additional mattresses when the wash bay was temporarily closed, and this impacted on the recycling of mattresses. There is also a projected overspend of £0.087m 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 6 info) - projected overspend of £0.104m (£0.326m favourable) of which £0.038m will be allocated to North - £0.121m favourable movement). The main variances are: Allied Health Professions (Lead Partnership) There is a projected underspend of £0.420m on AHPs services which mainly relates to staffing savings. An increase in overall supplies expenditure has seen a small adverse movement from month 4 projected underspend £0.445m. Primary Care and Out of Hours Services (Lead Partnership) The Primary Care and Out of Hours Services £139.701m budget is projected to overspend by £0.416m, which is a small favourable movement of £0.206m from month 4. There are projected additional costs within Primary Care Contracting and Support £0.402m (£0.493m overspend month 4), due to a number of variances, including new Office 365 licence costs, as well as additional spend related to the GP’s Sub- Committee and staffing costs. Primary Medical Services are projected to overspend by £0.643m (£0.686m at month 4), largely due to increased pension and sickness cover costs. Primary Medical Services payments also show an overspend and IT continues to overspend. These projected additional costs are being partially offset by a projected underspend £0.309m (£0.170m at month 4) against Ayrshire Urgent Care Services based on average of month 1 to 6 expenditure and cross charges based on 2024/25 trends (and is after building-in an allowance for public holiday cover in the remainder of the financial year). Funding has been allocated to partially offset Urgent Care Pathway costs £0.823m (projected to outturn £0.248m over allocated funding). Funding has also been allocated to Covid-19 Therapeutics of £0.274m, with costs projected at £0.229m. There is a projected underspend of £0.555m (£0.304m at month 4) in Dental services that reflects that staffing numbers are running at less than establishment, alongside 344
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reduced equipment costs. The financial recovery plan includes anticipated reduced spend on Dental equipment £0.035m. Prison and Police Healthcare (Lead Partnership) The projected overspend of £0.013m at month 6 (£0.106m overspend month 4) is largely due to reduced staffing costs. Due to extended periods of vacancy, there has been a favourable movement of £0.119m, however this is partially offset by additional prescribing costs. Prison prescribing was highlighted as a budget pressure as part of the 2025/26 budget. Both East Ayrshire 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 possible that the Prison and Police Healthcare projected overspend highlighted in this report can be reduced as a consequence of this work. Other Services (Lead Partnership) The £0.095m projected overspend (£0.146m overspend month 4) is due to increased Area Wide Evening Services and Palliative Care Services costs. This is mainly due to additional staffing costs including high use of bank staff to meet service demands which are expected to reduce when vacancies are filled. As part of the recovery plan, recovery actions will be undertaken to reduce costs by an estimated £0.069m in the remainder of the financial year within Area Wide Evening Services: • Caseload and rota review to ensure prioritisation of essential criteria for overnight interventions. • Reviewing skills mix and reducing teams from eight to seven. • Reducing bank usage by ensuring optimum recruitment to vacancies and maximising attendance at work Palliative Care Services budgets continue to be closely monitored and reviewed; however increased costs largely reflect demand for provision of services. This pressure will require to be considered on a pan-Ayrshire basis, as part of the 2026/27 budget-setting process. Alongside financial recovery plan actions, it is anticipated that the prison prescribing pressure can be considered through forthcoming pan- Ayrshire discussions. East Ayrshire Financial Recovery Plan (approved on 29th October 2025) A financial recovery plan will be presented to the IJB on 29 October 2025 for consideration and approval (and presented to North and South Ayrshire IJBs for approval). The initial hosted services financial recovery plan assumes that costs can be contained at month 6 projected outturn position levels overall, with specific savings highlighted in the table below to achieve overall financial balance in 2025/26. 345
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Service Division Proposed Saving 2025/26 £m Primary Care – Dental equipment balance (revenue) 0.035 Area Wide Evening Services – Staff Cost Reductions 0.069 TOTAL 0.104 Set Aside: - Work has been undertaken with partnerships to progress and develop set aside arrangements to fully implement the legislative requirement. This includes arrangements in relation to the use of Directions, Joint Commissioning Plans and overall progression towards fair share allocations of resources. Further work has been undertaken through the Ayrshire Finance Leads group to establish baseline resources for each partnership and how these compare to the NRAC “fair share” of resources. Ayrshire Finance Leads have now agreed a baseline methodology for set aside budgets which involves using the four full years prior to the pandemic, 2016/17 – 2019/20 inclusive. The HSCPs require to agree their final share of the baseline with each other, however the aggregate will remain unchanged. The table below shows the cost of the historic baseline at 2024/25 prices. The 2025/26 actual usage information is not known until later in the year. IJB Baseline at 2024/25 prices (£) East 31.870 North 39.966 South 34.488 Total 106.324 The annual budget for Acute Services is £488.0million. The directorate is overspent by £17.2 million after 6 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 wards contributed an overspend of £3.6m after 6 months. Within the overall £17.2 million overspend Medicine are over by £6.8 million, Emergency Care by £5.4 million, Surgery by £1.9 million, Labs and Diagnostics by £1.8 million and Women and Children by £1.2 million. Legacy CRES and underspends on other budgets make up the difference. 346
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There is a material underlying deficit caused by: • Length of Stay (LoS) and emergency admission rates in NHS Ayrshire and Arran acute hospitals are above the Scottish average. • High expenditure on medical and nursing agency staff, high rates of absence and vacancies causing service pressure. • Delayed transfers of care and high acuity of patients. The IJBs and the Health Board work closely in partnership to maintain service and improve performance. In respect of Lead Partnership Services, the 3 Chief Officers and CFOs have met to consider improvements in the reporting and visibility of financial and operational performance for those services which we lead or are led by another HSCP. Actions have been agreed to develop more regular shared information to be shared across all 3 IJBs with an intention to incorporate this further detail into future financial monitoring reports during 2025/26. 2.12 FINANCIAL RISKS There are a number of financial risk areas that impact or may impact on the financial position. • Current overspend areas, especially in low volume / high-cost services e.g. Children’s residential placements, UNPACs, and supplementary staffing across community, mental health and learning disability wards. • Growing demand for services. • Staff recruitment and retention challenges across a number of service areas. • The expectation that performance will continue to be maintained or improved despite the significant resource challenges. • Ongoing delivery costs of Scottish Government policy directives, particularly where these are not fully funded or inflation proofed. • 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. 347
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• Removal of brokerage for NHS Boards, NHS AA have been asked by Scottish Government to deliver further financial improvement beyond their Board approved financial plan. • The overall sustainability of commissioned care providers, with eNICs compounding historic challenges re financial sustainability, there is a heightened risk of provider failure leading to handing back of care and contracts. • The ongoing ability to source packages of care for service users. • Progress with the work to develop set aside arrangements and the risk sharing arrangements agreed as part of this. • The recurring underlying levels of overspend which may impact on the Partnership’s ability to continue to sustain service levels in the future. • The use of supplementary staffing for enhanced observations across a number of service areas and the use of high-cost agency staff to support frontline service delivery in areas where there are recruitment challenges. • Agenda for Change Pay Reform programme – including Nursing Band 5-6 re- grade, protected learning time and reduction to the working week. • Scot Excel inflationary increases for children’s 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. • Risk related to NHS Reform investment being allocated by Scottish Government on a payment by results basis and in arrears. • Local Government Settlement and Distribution Group (SDG) – The SDG periodically review existing distributions to ensure that they remain fit for purpose. The impact of this in future years is not yet known but it is a significant quantum of the overall funding. 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. 348
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2.14 Financial Recovery Plan The IJB set a balanced budget for 2025/26 on 20th March 2025. This did not include any draw on reserves but did include the approval of £4.019m of savings to achieve financial balance. Services will continue to work towards implementing the recovery plan to deliver cost reduction targets while carefully managing the level of risk. This will include the preparation of equality impact assessments. The management actions and governance framework outlined below which were agreed in 2024/25 will continue throughout 2025/26: MANAGEMENT ACTIONS/CONTROLS AGREED IN 2024/25 • 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 and SEPTEMBER 2025) • Recruitment delay – there will be a recruitment drag with vacancy scrutiny approved vacancies being held for four weeks before they are advertised to 349
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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. • 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 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 6 UPDATE • The updated recovery action is outlined in Appendix E. This includes the proposals agreed at month 3 and 4 and updated progress at month 6 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 residual risk 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 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 • At month 6 this has deteriorated to: TOTAL Health/ NHS AA Social Care/NAC Projected Overspend @ mth6 4.957 1.245 3.712 Financial Recovery Plan Projections (3.353) (1.244) (2.109) Residual Risk 1.604 0.001 1.603 350
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• This plan will be reviewed each month and further recovery actions will be presented to the IJB for approval. Services are working on further recovery actions to come to IJB in December – these will impact further on waits and service performance. PROPOSALS 3.1 Anticipated Outcomes Continuing to closely monitor the financial position will allow the IJB to take corrective action where required to deliver services in 2025-26 from within the available resource, thereby limiting the financial risk to the funding partners. The transformational change programme will have the greatest impact on the financial sustainability of the partnership, the IJB require to have a clear understanding of progress with the delivery of the transformation plan. 3.3 Measuring Impact Ongoing updates to the financial position will be reported to the IJB throughout 2025- 26. 4. IMPLICATIONS 4.1 Financial The outturn is an overall year-end overspend of £4.957m (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. 351
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The ‘financial viability of the HSCP’ risk on our strategic risk register. 4.6 Community Wealth Building None. 4.7 Key Priorities The ability to deliver on our strategic priorities may be compromised due to the greater financial risk faced in 2025-26 and the increased focus required on financial rather than service improvement. This will be kept under close scrutiny throughout 2025-26. If we are unable to successfully develop a financial recovery plan to achieve financial balance, consideration may be given to revising the strategic commissioning plan. 5. CONSULTATION 5.1 This report has been produced in consultation with relevant budget holders and the Partnership Senior Management Team. 5.2 The IJB financial monitoring report is shared with the NHS Ayrshire and Arran Director of Finance and North Ayrshire Council’s Head of Finance after the report has been finalised for the IJB. Caroline Cameron, Director Author – Eleanor Currie, Chief Finance Officer [eleanorcurrie@north-ayrshire.gov.uk] 352
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PUBLIC INFORMATION 2025-26 Budget Monitoring Report–Objective Summary as at 30th September 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 79,033 81,988 2,955 20,987 22,199 1,212 100,020 104,187 4,167 4,330 (163) : Locality Services 32,974 33,962 988 5,900 5,899 (1) 38,874 39,861 987 1,206 (219) : Community Care Service Delivery 41,771 43,382 1,611 0 41,771 43,382 1,611 1,745 (134) : Rehabilitation and Reablement 2,136 2,176 40 0 2,136 2,176 40 10 30 : Long Term Conditions 896 946 50 10,633 11,609 976 11,529 12,555 1,026 1,063 (37) : Community Link Workers 374 370 (4) 0 0 0 374 370 (4) (5) 1 : Integrated Island Services 882 1,152 270 4,454 4,691 237 5,336 5,843 507 311 196 MENTAL HEALTH SERVICES 41,075 41,960 885 77,421 77,754 333 118,496 119,714 1,218 605 613 : Learning Disabilities 31,938 32,974 1,036 738 738 0 32,676 33,712 1,036 620 416 : Community Mental Health 7,112 6,955 (157) 1,812 1,812 0 8,924 8,767 (157) (154) (3) : Addictions 2,025 2,031 6 1,901 1,900 (1) 3,926 3,931 5 7 (2) : HBCCC 0 0 0 353 0 (353) 353 0 (353) (353) 0 : Lead Partnership Mental Health NHS Area Wide 0 0 0 72,617 73,304 687 72,617 73,304 687 485 202 CHILDREN & JUSTICE SERVICES 36,349 37,921 1,572 5,875 5,939 64 42,224 43,860 1,636 1,606 30 : Irvine, Kilwinning and Three Towns 3,259 3,344 85 0 0 0 3,259 3,344 85 62 23 : Garnock Valley, North Coast and Arran 3,619 3,687 68 0 0 0 3,619 3,687 68 57 11 :Intervention Services 1,827 1,836 9 0 0 0 1,827 1,836 9 5 4 : Care Experienced Children & Young people 22,749 24,745 1,996 0 0 0 22,749 24,745 1,996 1,915 81 : Head of Service - Children & Families 1,363 801 (562) 0 0 0 1,363 801 (562) (567) 5 : Justice Services 3,101 3,101 0 0 0 0 3,101 3,101 0 0 0 : C&F Health Team 431 407 (24) 4,995 5,101 106 5,426 5,508 82 118 (36) : Lead Partnership NHS Children's Services 0 0 0 880 838 (42) 880 838 (42) 16 (58) CHIEF SOCIAL WORK OFFICER 1,983 1,798 (185) 0 0 0 1,983 1,798 (185) (204) 19 PRIMARY CARE 0 0 0 54,721 54,805 84 54,721 54,805 84 36 48 ALLIED HEALTH PROFESSIONALS 0 11,504 11,505 1 11,504 11,505 1 1 0 MANAGEMENT AND SUPPORT COSTS 8,172 6,657 (1,515) 3,647 3,477 (170) 11,819 10,134 (1,685) (1,026) (659) OUTTURN ON A MANAGED BASIS 166,612 170,324 3,712 174,155 175,679 1,524 340,767 346,003 5,236 5,348 (112) Return Hosted Over/Underspends to East 0 0 0 0 (225) (225) 0 (225) (225) (159) (66) Return Hosted Over/Underspends to South 0 0 0 0 (196) (196) 0 (196) (196) (139) (57) Receive Hosted Over/Underspends South 0 0 0 0 104 104 0 104 104 50 54 Receive Hosted Over/Underspends East 0 0 0 0 38 38 0 38 38 159 (121) OUTTURN ON AN IJB BASIS 166,612 170,324 3,712 174,155 175,400 1,245 340,767 345,724 4,957 5,259 (302) Over/ (Under) Spend Variance at Period 4 Movement in variance from Period 4 TOTAL Partnership Budget - Objective Summary Council Health 2025/26 Budget 353
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2025-26 Savings Tracker Appendix B Social Care: Ref Description Deliverability Status at budget setting Deliverability Month 6 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 Amber 1.000 Community Care & Health 6 Review of Day Care provision Amber Blue 0.107 7 Care at Home Amber Blue 0.500 8 Care Package Review (all services) Amber Green 0.200 9 Deletion of vacant posts Green Blue 0.056 10 Increase to charging Green Amber 0.186 11 Admin Post Savings Green Blue 0.114 12 Financial Inclusion Green Blue 0.357 TOTAL SOCIAL CARE SAVINGS 2.903 Cross Service 354
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Health: Ref Description Deliverability Status at budget setting Deliverability Month 6 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 4.019 355
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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 25.504 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) 166.612Social Care Budget Reported at Month 4 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 (25.504) 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 0.174 356
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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 (communitystore) 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 Training Grade Adjustment (Dean Funding) - August 5 0.129 Budget transferred to Capital for INV-3395435821 5 (0.006) Transfer from South - ANP contribution 5 0.030 Primary Care Prescribing Budgets reworked 5 0.130 HD157 3% pay award ADP North 5 0.057 North MDT funding to Arran Medical Group (Virement 11) 5 (0.043) Training Grade Adjustment (Dean Funding) - September 6 0.018 ANTICIPATED BUDGETS INCL HERE (NOT IN LEDGER) 6 (1.104) Roundings 0.001 174.155 TOTAL COMBINED BUDGET 340.767 Health Budget Reported at Month 6 357
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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 3,161 358
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Financial Recovery Action Plan Appendix E £m Projected Overspend at Month 6 4,957 SERVICE AREA Target at Month 6 Achieved at Month 6 Still to be achieved Target set (IJB Date) Comment a) Care home placements (568) (59) (509) 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) 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) (39) (36) August 2025 - month 3 report Based on planned action developed by the senior manager. d) Wards 1 and 2 (275) (53) (222) August 2025 - month 3 report Based on planned action developed by the senior manager. e) Care at Home (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 (1,218) (151) (1,067) Mental Health Services Revised Target at Month 6 Achieved at Month 6 Still to be achieved Target set (IJB Date) Comment a) Learning Disabilities 0 0 0 August 2025 - month 3 report b) Community Mental Health services 0 0 0 August 2025 - month 3 report c) Lead Partnership for Mental Health : - Adult Inpatients (150) 0 (150) August 2025 - month 3 report Inpatient Review being undertaken - Elderly Inpatients (150) (66) (84) August 2025 - month 3 report Inpatient Review being undertaken - Psychiatry (150) 0 (150) August 2025 - month 3 report Junior doctor rota still to be revised. - Action 15 Reserves (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) 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% (603) (455) (148) August 2025 - month 3 report TOTAL (603) (455) (148) 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. 359
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SERVICE AREA Revised Target at Month 6 Achieved at Month 6 Still to be achieved Target set (IJB Date) Comment Children and Justice Services Target set (IJB Date) Comment a) Residential Placements (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) 0 (1,000) Revised Target at Month 6 Achieved at Month 6 Still to be achieved Target set (IJB Date) Comment ALLIED HEALTH PROFESSIONALS 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 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) 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) 0 August 2025 - month 3 report Based on historic slippage. c) Contractual inflation (100) (100) 0 August 2025 - month 3 report d) Service Redesign Fund (100) (100) November 2025 - moth 6 report TOTAL (500) (200) (300) OTHER AREAS b) Agenda for Change - assume fully funded (838) 0 (838) August 2025 - month 3 report Based on 100% cost of the half hour reduction in working week being funded. (838) 0 (838) TOTAL RECOVERY ACTION (4,159) (806) (3,353) Remaining projected overspend 1,604 360
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Bank and Agency Costs to Month 6 Appendix F 1) NHS 4863 (Registered) 4864 (Unregistered) 4853 (Registered) 4854 (Unregistered) TOTAL Average per month AAC074 North Core Slt Adult 3,098 3,098 516 AAC403 Ward 1 Woodlands View 23,100 173,772 196,872 32,812 AAC406 Ward 2 Woodlands View 15,431 230,267 245,698 40,950 AAC410 Ach Redburn Rehab Ward Nrs 17,929 110,872 128,801 21,467 AAC412 Ach Douglas Grant Rehab Wd Nrs 15,320 29,379 44,699 7,450 AAD401 Ward 3 Woodlands View Nursing 5,472 223,152 228,624 38,104 AAD402 Ward 4 Woodlands View Nursing 870 22,234 23,104 3,851 AAH047 New Clonbeith Nursing(jura) 60,239 65,250 125,489 20,915 AAH415 Wview The Glen Ect 3,133 4,013 7,146 1,191 AAH417 Wview Ward 10 Acute Mh Nrs 2,991 192,253 195,244 32,541 AAH423 Wview Ward 8 Acute Mh Nrs 13,583 510,635 524,218 87,370 AAH460 Ward 5 Woodlands View 1,821 9,955 11,776 1,963 AAH466 Wview Ward 7b Rehab Mh Nrs 2,302 2,302 384 AAH492 New Dunure Nursing(clonbeith) 21,653 94,990 116,643 19,441 AAH494 Mh Bed Management 16,565 16,565 2,761 AAT001 Trindlemoss 37,950 147,097 185,047 30,841 AAW047 Arran Hospital Nursing 40,072 32,879 72,951 12,159 ACA405 Camhs Management 1,944 1,944 324 ACA412 Camhs Unscheduled Care 801 801 134 ACF001 Early Yrs-c/f Team 1 923 923 154 ACF003 Early Yrs-c/f Team 3 974 974 162 ACF051 Immunisation Nursing 5,751 867 6,618 1,103 ACN047 Arran Dn 13,607 13,607 2,268 ACN012 Package Of Care (p) - Amg 80,863 80,863 13,477 ACN013 Package Of Care (p) - Lmo 312 312 52 ACP002 Nc Poc Team 2 990 990 165 ACP003 Nc Poc Team 3 3,271 3,271 545 ADN000 Three Towns Dn -101 -101 -17 ADN033 Irvine Dn 16,516 16,516 2,753 ADN042 North West Coast Dn 25,545 25,545 4,258 ADN075 Garnock Valley Dn 40,739 40,739 6,790 AHM154 North Ahp Management Team 7,329 7,329 1,222 ALA047 Lady Margaret Nursing 7,662 3,543 11,205 1,868 AMA408 Prevention + Services Spt Team 2,397 2,397 400 AML146 Ld Health Checks 12,238 12,238 2,040 AML392 North Cldt 5,777 164 5,941 990 AML402 Lds Management 2,286 2,286 381 AML429 Mhanps Mh Unscheduled Care 1,931 57 1,988 331 AML500 Mhs Inpatient Mgt 13,288 210 13,498 2,250 AMN412 Cmht Nursing-north Ayrshire 2,988 2,988 498 AMN415 Wview Ward 7c Forensic Rehab N 6,593 88,175 94,768 15,795 AMN425 Intensive Community Nursing Team 24,761 1,556 26,317 4,386 AMN431 Adult Mental Health Liasion Team 21,271 21,271 3,545 AMN433 Pcmht North 1,798 1,798 300 AMN446 Wview Ward 6 Low Secure Nrs 25,182 88,548 113,730 18,955 AMN454 Warrix Ave 56,387 52,694 109,081 18,180 ANU632 Icfn - Community Phlebotomy 6,278 6,278 1,046 AMN468 Action 15 - Adult Liaison 0 0 AMY415 Forensic Psychology 3,248 3,248 541 ASC001 Child Health Admin 1,083 1,083 181 AWV438 Wview Ward 7a Ld A+t Nrs 25,610 425,962 1,804 14,532 467,908 77,985 AXC407 Wview Ward 9 Acute Mh Nrs 13,199 199,604 226 213,029 35,505 AXC418 Wview Ward 11 Acute Mh Nrs 21,540 126,730 148,270 24,712 630,298 2,941,070 2,030 14,532 3,587,930 2) SOCIAL CARE £ 217,700 271,857 108,382 597,939 Bank Agency Montrose House LD - Asessment and Care Management MH - Asessment and Care Management 361
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Integration Joint Board 13 November 2025 Subject : Meeting Dates 2026 Purpose : To advise members of the proposed timetable for meetings of the IJB, PAC and SPG for 2026. This report is for approval. Recommendation : That IJB agree the dates for meetings of the Integration Joint Board, Performance and Audit Committee and Strategic Planning Group for 2026. 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 Integration Joint Board PAC Performance and Audit Committee 1. EXECUTIVE SUMMARY 1.1 The schedule of meetings for the Integration Joint Board (IJB) and Performance and Audit Committee (PAC) is required for the forthcoming year. 2. BACKGROUND 2.1 The IJB in agreed in September 2021 to reduce to 8 meetings during 2022 to avoid the council recess periods and the period of purdah during the local government elections in May 2022. 3. PROPOSALS 3.1 IJB The number of IJB meetings for 2023 was reinstated to 9 meetings per year, with ad hoc private sessions arranged as and when required. In 2025 the number of meetings was reduced to 7 to align with budget reporting timetables, 2026 will be the same as 2025. 3.2 Performance and Audit Committee The Performance and Audit Committee will continue to meet on a quarterly basis. Agenda Item 9 363
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3.3 Strategic Planning Group As in 2025, the Strategic Planning Group meetings will take place quarterly, reducing to 4 meetings per year. 3.4 As in previous years, the timing of all meetings has taken budget reporting and performance schedules into consideration and the timetable has been created to avoid clashes with key NHS and Council meetings, avoiding some recess periods of the Council. 3.5 The proposed dates for IJB, SPG and PAC meetings are detailed below. The schedule of meetings is attached in Appendix 1. Integration Joint Board Performance and Audit Committee 12th February 2026 13th March 2026 19th March 2026 26th June 2026 30th April 2026 25th September 2026 25th June 2026 27th November 2026 20th August 2026 1st October 2026 12th November 2026 10th December 2026 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 Consultation has taken place with the Chair and Vice Chair, IJB and Chair, PAC as well as other relevant officers on the proposed timetable. Caroline Cameron, Director For further information please contact Karen Andrews, Team Manager (Governance) on (01294) 317725 or kandrews@north-ayrshire.gov.uk 364
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Appendix 1 NORTH AYSHIRE HEALTH AND SOCIAL CARE PARTNESHIP MEETING SCHEDULE 2026 INTEGRATION JOINT BOARD / PERFORMANCE AND AUDIT COMMITTEE Integration Joint Board (10.00 a.m.) Performance and Audit Committee (10.00 a.m.) 12th February 2026 13th March 2026 19th March 2026 26th June 2026 30th April 2026 25th September 2026 25th June 2026 27th November 2026 20th August 2026 Strategic Planning Group 1st October 2026 To be confirmed. 12th November 2026 10th December 2026 365
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together Minutes of North Ayrshire Strategic Planning Group Meeting Held on Wednesday 04 June 2025, 10:00am Virtually via MS Teams Present: Councillor Margaret Johnson (Chair) Councillor Anthea Dickson, Provost, NAC Alison Mcallister, Library & Information Services Manager, NAC Dominic Jarrett, AA Learning Disability Service Fiona Comrie, KA Leisure Katie Bell, Team Manager, Housing, NAC Kerry Logan, Head of Service, Health & Community Care Michelle Sutherland, Partnership Facilitator, NA HSCP Lee Ballantyne, Senior Manager, Strategic Planning & Transformation Lisa Davidson, Assistant Director Public Health, NHS Rebecca Black, Partnership Engagement Officer, HSCP Seony Ross, Team Manager, Strategic Planning & Equalities Sharon Hackney, Senior Manager, Allied Health Professions Peter McArthur, Senior Manager, Mental Health - Addiction Services Apologies Received: Joyce White, Vice Chair Caroline Cameron, Director, NAHSCP Betty Saunders, Senior Manager, NAHSCP Billy Brotherston, Independent Chair, NA ADP Darren Fullarton, Associate Nurse Director, NAHSCP Debbie Browne, Depute Medical Director, NHS Elizabeth Stewart, Head of Service, NAHSCP Gillian Arnold, Assistant Director, Planning & Commissioning, NHS Iain Jamieson, Clinical Director, North Ayrshire HSCP Jennifer McGhee, Policy & Community Planning Officer, NAC Michael McLennan, Lead Officer, ADP Nicola Teager, Communication & Engagement Officer, NAHSCP Scott Hunter, Chief Social Work Officer Thelma Bowers, Head of Service, NAHSCP Agenda Item 10 367
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together Item Item Action 1. Welcome and Introductions 2.1 Update from Chair Cllr Johnson, Chair, thanked Joyce White for her tenure as Chair, and acknowledged that Joyce will now take over as Chair of the IJB. Cllr Johnson highlighted that the final Partnership Performance report will be presented to IJB on 19th June and will outline 2024/25 financial position. The Partnership is awaiting the final confirmation from NHS, and final Council position is an overspend of £2.03million, which is an improvement on previously reported position. Yesterday’s Cabinet meeting approved a non-recurring budget transfer of £2.03million, which will go some way to supporting the future sustainability of Social Care services in North Ayrshire. 3. Minutes of Meeting held March 2025 3.1 The minutes of the meeting held March 2025 were agreed as an accurate reflection of discussion. Focus on: Strategic Planning 4. Strategic Plan Progress Update Seony Ross provided an update on how the Strategic Plan is progressing, and shared a table with a timeline of progress to date. An evaluation of the current plan was undertaken in December 2024, to understand what needed to be changed, continued or removed in the updated version of the plan, based on what has been achieved between 2022 – 2025. Seony highlighted a number of things that were achieved during this time, including service advances such as change to the Carers Support Model through Carers Gateway, increased support for children with guardians with substance issues, and embedding of Money Smart services with GPs; also evidence of improved service performance such as improved occupational therapy wait times and reductions in delayed discharges on Arran. This also identified improvements to be made for next iteration of the plan, to make outcome delivery more robust, including links between enabling plans published such as Transformation and Digital Plans and links with Housing which have progressed through work with the Housing Strategy Team. The current plan is also focussed on service delivery, considering how better to measure outcomes and how service delivery is influencing communities. 368
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together There are ten chapters is the Strategic Needs assessment outlined in the attached report, but Seony noted that due to the volume of information being analysed completion date has moved to June 2025. This will be shared later in the summer once complete. Seony advised that this exercise has highlighted the key issues in each topic area, and provided some examples of the key issues, outlined in the attached slides: The Engagement analysis was completed in May 2025, and the report is currently being finalised by Rebecca Black. Data from the last two years is being analysed including 47 different engagement pieces, consisting of input from over 2,800 people. Key themes are being identified and broken down to different services; and have highlighted concerns about accessing information to services; digital exclusion, and isolation of parents of children with additional needs. A review of local and national policy was also completed in May 2025 and is being analysed into similar categories. This has meant reviewing national polices such as GIRFEC and the Promise, and local plans such as Children’s Services and Child Poverty plans; ensuring the golden thread between national and local policies. A process of Service Mapping is also in progress to better understand how the HSCP operates and how priorities are being met. Seony highlighted that this will be helpful when looking at service reviews, or opportunities for transformation change as part of the transformation programme. A key part of this is also to gather feedback from individual service on what they want to see from the Strategic Plan. All information is currently being analysed and priorities identified for the plan by the end of June; following this work will be undertaken with SMTs and partner organisation with the plan being collated through the summer and a draft plan prepared by August 2025. The group acknowledge the amount of work that has been undertaken and the volume of data already gathered; Seony highlighted that much of the analysis is already in progress or completed, therefore it should be achievable to have the draft report prepared by August. It was also highlighted that there is a significant change in priorities post pandemic, and enquired whether the collated data will be accessible, as this will be beneficial in other areas of service delivery in terms of highlighting pressures and where resources and support should be focussed. Seony advised that the engagement has built on work already done and has focussed on specific targeted groups, This has meant results are more in depth than simply a specific survey for the Strategic Plan which would only ask general questions. Seony noted that there is also a Locality Survey 369
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together which is out for the full year and information is being pulled form this throughout the year, so a constant stream of information is being collated. The group thanked Seony for the work being doing and look forward to an update on the results at the next meeting. 5. HSCP Equality Outcomes 2025 – 29 Seony provided an update on the new Equality Outcomes which were developed between September 2024 and February 2025; beginning with locality planning engagement in September which was carried out with community groups and used for Equality Outcomes as well as Locality Planning, as discussed at previous meetings. Paragraph 2.2 and appendix 2 of the attached paper outlines how the outcomes were reached. The public sector equality duty – to advance equality of opportunity and eliminate discrimination of protected characteristics; and the purpose of the equality outcomes is to further equality duty within services. Each new outcome has a detailed section in the plan outlining why the aims were chosen, where we are now, and where we want to get to; and this is summarised in section 3 of the report. These outcomes were approved by IJB on 1st May, so are now in place. A progress report is required every two years, however an interim update will be presented to the SPG after one year to ensure progress is being made throughout the four year period towards achieving outcomes. The group were encouraged to become familiar with the outcomes and consider how they may be embedded within services, and circulated across teams. Cllr Dickson highlighted concerns that this could be one of the more difficult reports to include within the Strategic Plan, and will be much more open to scrutiny and questioning. The group discussed that with changes in society and more vocal people being less tolerant, trying to narrow gaps, this likely to be queried and more difficult to deliver; but highlighted that this progress and will result in improvements. Members highlighted the rich diversity of partners working across the HSCP in North Ayrshire, particularly those in community organisations, and how this will be of benefit to them. The group agreed that they are looking forward to a further update on the work being done and the input of this work to the overall strategic plan. Focus on: Service Planning 370
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together 6. Learning Disability Service Learning Plan Dominic Jarrett provided a presentation to the SPG regarding the Learning Disability Service Learning Plan. The last strategy was published in 2017 and ran for 3 years, and in recent years there has been a refreshed consideration of the relevance of a strategic document around Learning Disabilities. Dominic highlighted that there is a constantly changing landscape of challenges and opportunities and therefore the LD transformation board agreed a different approach to the LD strategic plan, that was less about demonstrating actions to be pursued, and more about committing to an ongoing process of communication and collaboration, with the intention of becoming better at listening, sharing information and working alongside people. As a result, two different documents have been produced – one fully accessible document that came out of engagement work with clients, carers and provider partners; and along with this a more complex document that describes data and more detail about what is happening in the service. It is anticipated that these will engage slightly different audiences, and gives people the choice on what they want to engage with. Dominic noted that this is currently going through a process of review and signing off before being more widely published; and the service are confident that this is going to be successful. The ambition is for a yearly update to be provided, with ongoing communications throughout the year. Dominic highlighted that unfortunately the service have recently lost an Engagement Officer post, however are hopeful of engaging with service and third sector partners across North Ayrshire to help realise ambitions with co- designing engagement activity. Dominic gave an example of recent work being done with Public Health Scotland around the health needs of the identified Learning Disability population of North Ayrshire, with the ambition of undertaking this information gathering annually; with the aim that over time this will allow the service to demonstrate and understand the changing needs of the local population. Both documents have been shared with the Strategic Planning Group and members are encouraged to review and engage with both. 7. Interface Guidance: Co-occurring Mental Health and Substance Use Peter McArthur, Senior Manager provided an update regarding work being undertaken across Mental Health and associated services including alcohol and drug services, looking at the pathway for providing support for individuals with co-occurring mental health and drug misuse. The focus of this work is on the role of leadership and the impact this has on developing support. The service has set up secondary care alcohol and drug services, primarily NADARS which include MH practitioners, RMNs, OT, psychiatry, psychology, and integrated social care and community mental health services, and has 371
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together been widened out to include elderly mental health, Learning disability services, and inpatient services including Ward 5. The desire was to update the interface guidance to make the pathway and journey for individuals accessing support easier and simpler. The aim has been to provide quick, non complicated, no barrier access to support, designed to be complementary to support provided via community based services. The service felt it important to seek views and guidance of service user, family members and other stakeholders; at all stages; and a national operation group was established to review current guidance. Guidance was reviewed locally by senior managers team managers, team leads, and later sought wider national review which was approved and implements. A new senior steering group was created, chaired by Thelma Bowers, involving, senior managers, professional leads, lived experience and digital service support functions; who reviewed and implement guidance. Peter advised that staff awareness sessions have been delivered, attended by over 200 members of staff over 7 sessions, with further sessions planned later in the year. Implementation began in November 2024, and is currently in a ‘sustaining’ phase; and currently the service is gathering more experience-based feedback, from service users, family members and carers; and are currently being supported by the Alcohol and Drug Partnership team who are also gathering feedback for implementation of other drug and alcohol strategies such as medication assisted treatment standards. Peter provided the attached matrix chart which breaks down mental health conditions from most severe to less severe, coupled with less to more severe alcohol and drug misuse; this also highlights community based responses and specialist secondary care responses; who would lead or what areas would jointly work. The interface then outlines what services should work together, who should lead on what different type of scenario. This new pathway has now been adopted across the service, and feedback has been positive from staff and service users with further information being gathered over the next few months. This has also been used by services in East and South Ayrshire who have adopted a similar approach. Work is also underway with Health Improvement Scotland which is influencing national guidance and pathways. The service have been asked to present at national meetings ang groups and the interface and case studies have been used nationally as an example of good practice. The pathway and guidance behind this interface can be shared with members of the group. Staff are using this protocol and feedback both locally and nationally is being gathered, which can be updated to the group at a later date. 372
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NORTH AYRSHIRE Health and Social Care Partnership Delivering care together AOCB 8. Collaboration for Health Equity in Scotland Michelle Sutherland joined the meeting to provide an update around the CHES work being undertaken following the previous meeting. Michelle noted that the Steering Group has held its first meeting and will be meeting again this afternoon to consider the options around setting priorities for the Marmott Principles. An analysis exercise has been undertaken at locality level around social determinants in North Ayrshire, for example Child Poverty levels, employability, and health. At this stage, the Marmott Principles that have the most evidence attached are around giving every child the best start in life, creating fair employment and strengthening the role of health prevention. The Steering Group will also look this afternoon at what engagement with communities will look like – Michelle noted that there is a good foundation of people working together across North Ayrshire – and this will be brought forward into informing the Strategic Plan. Michelle advised that an update around the principles and priorities of the work of the Steering Group will be brought to a future Strategic Planning Group, which will hopefully also include an engagement plan. - There was no other business to be discussed and the meeting was closed. Note from the chair that the next meeting will take place in person, Wednesday 3rd September, 10am – 12pm; at Fullarton Connexions, Irvine. 9. Date of Meetings – 2025 - Wednesday 3rd September, 10am – 12pm; Fullarton Connexions - Wednesday 26th November, 10am – 12pm; via MS Teams 373
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