NHS Ayrshire and Arran Assurance Board minutes 03 September 2026

Attendees and apologies

Members Scottish Government

• (SG): Stephen Gallagher, Director of Assurance & Improvement – Chair
• (FB): Fiona Bennett, Chief Finance Officer
• (FH): Fiona Hogg, Chief People Officer

 

Attendees – NHS Ayrshire and Arran

• (LB): Lesley Bowie, Chair of NHS Ayrshire and Arran
• (GJ): Gordon James, Chief Executive
• (CC): Caroline Cameron, Chief Officer, North Ayrshire Integration Joint Board
• (VC): Vicki Campbell, Director of Acute Services
• (KD): Kirstin Dickson, Director of Transformation & Sustainability
• (MI): Mark Inglis, Chief Officer, South Ayrshire Integration Joint Board
• (DS): David Stonehouse, Director of Finance
• (ES): Erik Sutherland, Chief Officer, East Ayrshire Integration Joint
• (PT): Phil Tydeman, Turnaround Director
• (JW): Jenny Wilson, Director of Nursing

 

Attendees – Scottish Government/other

• [redacted], Unit Head
• (CN): Colin Neil, Professional Advisor to NHS Ayrshire & Arran Assurance Board

 

Apologies 

• (CM): Crawford McGuffie, Medical Director
• (AW): Angie Wood, Director Mental Health, Social Care and NCS

Items and actions

Item 1. Welcome and introductions

SG welcomed members and attendees to meeting seven of the assurance board. He reflected on the national discussion on NHS reconfiguration but reinforced that NHS Ayrshire and Arran's current improvement and accountability duties remain unchanged and invited comments on the last meeting’s minutes.

Item 2. Action Log

Most outstanding actions are complete, with two being carried forward to the next meeting’s agenda.

Item 3: 2026-27 M4 review

DS reported that the financial position remains broadly in line with plan, with the year-end forecast unchanged. While there has been no significant deterioration, the position remains challenging and vulnerable to further pressures, particularly within acute services where savings delivery is behind expectations.

Members emphasised the importance of improving performance where possible to strengthen the organisation’s overall financial position and support recovery from escalation.

FB stressed that the permitted deficit should be treated as the maximum position, with any opportunity to improve beyond that seen as important for coming out of escalation and reducing next year's challenge.

CN sought greater assurance on the detail on medical spend, noting that medical pay remains the largest pay overspend. The current papers do not yet provide a sufficiently complete narrative on agency use, locum spend, establishment growth, cost drivers, mitigation and the route to improvement. SG concluded that this scrutiny should take place before the next Assurance Board meeting.

Action- Hold a focused workforce deep dive covering medical spend and the nursing workforce position within the next fortnight, and use it to report learning back to the next assurance board.

JW set out that nursing teams are reviewing bank and agency use every week, introducing daily senior sign-off for one-to-one duties and tightening roster control ward by ward. Additional context was provided that some establishment growth relates to vaccination and care home support functions. The next workforce discussion is expected to show both the operational changes and how those changes are affecting spend and delivery against savings assumptions

 The assurance board recognised stronger recurring delivery than in month 3 and noted that full-year effect savings are materially better than the in-year number alone suggests, even though the overall financial position remains under pressure.

 DS emphasised the need to maintain a strong focus on length of stay, bed utilisation and patient flow, which remain the most significant areas of challenge and the greatest opportunity to improve financial sustainability.

Item 4: Better value programme update

PT reported continued progress in the delivery of the savings programme, supported by regular validation and executive oversight. While members welcomed the progress made, they noted further conversion required regarding the amber and red schemes that could move into delivery over the next two months.  Members also noted that a significant gap remains to the overall savings ambition and that further opportunities will need to be identified and delivered during the year.

CN highlighted the programme's full-year effect once recurrent impact is included, and urged NHS Ayrshire and Arran to make that more visible. FB noted that Ayrshire and Arran appears to be on track to deliver more than 3% recurrent savings in 2026–27, which compares well with a number of other boards. Greater visibility of recurrent impact would provide a clearer picture of underlying progress. The assurance board stressed the importance of highlighting full-year effect and recurrent savings more clearly.

PT then outlined a 20-week development programme aimed at producing a draft savings plan for 2027-28 before the end of December 2026. The approach includes bottom-up development, a weekly executive-led steering group and a clearer programme structure intended to support both transactional and transformational opportunities.

FB said it is increasingly unlikely that a Carrick Glen sale will support the 2026–27 position, and that the building may instead create ongoing cost pressure if a decision is delayed further. The issue was framed less as a savings assumption and more as an emerging risk requiring quicker resolution. Ongoing holding costs and delay now appear more significant than any short-term benefit assumption.

The assurance board stressed that work on 2026–27 must continue in parallel rather than being treated as complete.

Item 5: Transfer of care update

VC reported early progress against the first October milestone in reducing bed capacity and improving patient flow across acute sites, with lower occupancy levels and reduced escalation pressures. While some operational variability remains, weekly oversight arrangements are being used to manage planned bed reductions. Members noted improved occupancy levels, with UHC at 88% and Ayr at around 92% occupancy, and greater capacity across acute sites, providing increased resilience to manage day-to-day operational pressures.

CC, ES and MI all reported that their local transfer-of-care actions are on or close to trajectory, including funded care home moves, discharge-to-assess capacity, recruitment for care at home and additional community hospital capacity. South Ayrshire was reported as slightly behind trajectory because of recruitment and approval timing, but recovery actions are under way. Improvement is being achieved through linked movement across multiple sites rather than through a simple one-patient-to-one-bed formula.

CN asked for clearer visibility of what has been invested in transfer-of-care changes and what financial benefit is being released. The chief officers confirmed that dedicated budget lines and monthly billing arrangements are now in place so social care investment can be tracked alongside operational and financial impact. The assurance board made clear that the programme should be judged through patient flow and care improvement as well as finance.

 Item 6: Next meeting focus and agenda

GJ asked for separate space to discuss future front door models and broader service transformation issues.

Action -  Arrange a separate discussion on wider transformation.

GJ flagged the permanent recruitment of a director of finance as a risk in the context of stage 4 escalation and wider national changes. The point was raised as a governance and leadership concern rather than an administrative issue. SG and FB agreed to take that issue away after the meeting for further discussion.

Action- Stephen Gallagher and Fiona Bennett to have a separate discussion on executive finance leadership.

Item 7: AOB

No other items of business were raised.