NHS Ayrshire and Arran Assurance Board minutes: Meeting Five: 25 June 2026

Attendees and apologies

 

Members, Scottish Government 

• (SG): Stephen Gallagher, Director of Assurance & Improvement
• (JG): Jack Gillespie, Deputy Director of Finance
• (FH): Fiona Hogg, Chief People Officer
• (AW): Angie Wood, Director Mental Health, Social Care and NCS

 

Attendees – NHS Ayrshire and Arran

• (LB): Lesley Bowie, Chair of NHS Ayrshire and Arran
• (GJ): Gordon James, Chief Executive
• (VC): Vicki Campbell, Director of Acute Services
• (RK): Roisin Kavanagh, Director of Pharmacy
• (CM): Crawford McGuffie, Medical Director
• (BS): Brian Steven, Turnaround Director
• (DS): David Stonehouse, Director of Finance
• (KD): Kirstin Dickson, Director of Transformation & Sustainability
• (JW) Jenny Wilson, Director of Nursing

 

Attendees – Scottish Government/other

• (GD): Glen Deakin, Unit Head
• (AG): Ally Grant, Finance Delivery Unit
• (HM): Hayley McMinn (note taker)
• (CN): Colin Neil, Professional Advisor to NHS Ayrshire & Arran Assurance Board
• (TS): Tracy Slater, Head of Assurance & Performance

 

Apologies 

• (FB): Fiona Bennett, Chief Finance Officer
• (CC): Caroline Cameron, Chief Officer, North Ayrshire Integration Joint Board
• (MI): Mark Inglis, Chief Officer, South Ayrshire Integration Joint Board
• (ES): Erik Sutherland, Chief Officer, East Ayrshire Integration Joint

Items and actions

1. Welcome and introductions

SG welcomed members and attendees to meeting five of the assurance board and outlined the agenda. He invited comments on the last meeting minutes. No further comments were received and the minutes are accepted.

2. Action Log

Progress against actions was noted. Key updates included:

• AB016: Meeting on service redesign to be scheduled.
• AB020: Update provided that risk registers will now be taken through Board governance processes; action effectively closed.
• AB021: SG to attend an NHS Ayrshire and Arran Board meeting – to be scheduled for September 2026.
• AB022: Staff engagement events ongoing; online event taking place on 29 May 2026 with further face-to-face meetings to be arranged.
• AB023: Meeting between FH/SG and Employee Director completed (took place 22 June 2026).

 

Item 3: 2026-27 M2 review

 

BRAVE

DS provided an overview of the BRAVE report (Bank, Recruitment, Agency, Absence, Vacancy, Establishment), noting this remains a work in progress, with data currently drawn from multiple systems and requiring further alignment.

Bank and agency usage remains elevated, driven by ongoing operational pressures which are offsetting reductions achieved compared to the previous year.

Medical budgets were reported as overspent by c£500k at Month 2, reflecting underlying service pressures not fully captured through the budget-setting process.

Overall workforce levels remain relatively stable when temporary staffing is included, although there is continued reliance on bank and agency staffing to maintain service delivery. Key drivers of bank usage were identified as: short-term sickness (~25%), vacancies (~24%), and additional beds (~22%)

Sickness absence remains broadly stable, with a slight reduction observed between April (6.18%) and May (6.04%).

Fill rates remain consistent (c.90–94%), indicating sustained demand for temporary staffing to maintain safe staffing levels.

The assurance board noted the update and the need for NHS Ayrshire & Arran to further develop and align workforce reporting, particularly across recruitment, establishment and absence metrics.

Savings Plan - 2026-27 Month 1 & 2 Review

DS presented the financial management report for the two months to 31 May 2026. The assurance board noted that the financial plan reflects a £45.0 million deficit, including £10.9 million of sustainability funding.

At Month 2, the health board is reporting a deficit of £8.1 million, around £0.55 million off plan. Health and social care partnerships reported an aggregate £1.4 million surplus; however, it was noted that these resources do not offset the health board financial position.

There was discussion around performance against Scottish Government targets, specifically the minimum recurring efficiency of 3% from the health board’s baseline budget, which is £32.8 million.  Recurring efficiency delivered by Month 2 was £3.9 million, excluding integration joint boards. Non-recurring efficiency was £2.0 million.

It was highlighted that acute budgets have been reset to 2025–26 levels, and that there remains a gap in the savings programme which requires to be addressed. It was emphasised that the organisation cannot rely on slippage in other areas to achieve financial balance.

The assurance board noted that, in line with other health boards, formal financial forecasting will be introduced from Month 3. Key risks to the financial position were identified, including, uncertainty in prescribing costs, new high-cost medicines, non-pay inflation pressures and unscheduled care demand, including winter-related pressures is also a risk. The risk of under-delivery against the best value programme. Workforce and policy-related cost is also a pressure.

Mitigating actions include continued delivery of best value measures, corporate underspends and strengthened grip and control arrangements.

The assurance board noted the financial position and associated risks at Month 2 and looked forward to a comprehensive discussion on Month 3 data.

 

Best Value Plan – June 2026

KD provided an update on the best value plan position as of June 2026.

The overall plan value has increased by £4.928 million since the previous update. This reflects an increase in high‑confidence (green) plans of £1.025 million, alongside a reduction in amber value and an increase in red (lower confidence) plans of £3.190 million, indicating further work is required to strengthen delivery confidence.

It was noted that additional savings opportunities have not yet been fully incorporated, including approximately £1.1 million of recurring savings in prescribing.

The assurance board also noted the expected full‑year effect of workforce initiatives, including nursing workforce savings estimated at £4 million, with further benefits anticipated from unscheduled care, transformation programmes and digitally enabled projects, although these are not yet fully quantified.

In relation to delivery requirements, the minimum 3% recurring savings target of £32.8 million remains in focus. Over 50% of this requirement is currently identified with high confidence, and over 80% is captured across all confidence levels.

A range of further opportunities continue to be explored, including workforce and structural changes, efficiency measures and service redesign initiatives

The assurance board noted the updated position and the requirement to increase the value of high confidence plans to support delivery.

 

Item 4: Operational Improvement Plan (OIP)/ Transfer of care

The assurance board received an update on phase 1 of the unscheduled care operational improvement plan for 2025-26, including performance against trajectories and progress in implementing delivery plans and winter readiness measures.

It was noted that NHS Ayrshire and Arran submitted an initial proposal in line with other health boards; however, due to funding constraints, revised priority proposals were subsequently agreed and approved by the corporate management team.

GJ described the process undertaken to develop the transfer of care paper and the collaborative approach with partners.  He advised that it has received pan-Ayrshire support and has been endorsed at the transformation board.  GJ also advised it would be tabled at their corporate management team meeting on 29 June and executive board on 30 June.

Delivery is being progressed through a series of pan‑Ayrshire workstreams, including frailty units operating seven days per week, integrated discharge teams, enhanced community capacity, and discharge to assess/home-first approaches to support improved patient flow.

Feedback from members acknowledged the work that went into developing the paper, but sought assurances around benefits realisation, and importantly, how do the health board provide assurance more broadly through governance, grip and control to ensure delivery of the transfer of funding and the closure of acute beds.  Trajectories and key performance indicators will be essential to measure successful delivery, but acknowledging the risks and opportunities.  GJ advised there will be a further discussion within the next week regarding the transfer of care, funding decisions, and the ask of Scottish Government.

Members also discussed the level of commitment from partners noting this was critical to ensuring a successful transfer of care and enhanced community provision. 

The assurance board noted progress against the operational improvement plan and transfer of care paper, and the ongoing implementation of initiatives to deliver performance improvements and winter preparedness and stood ready to engage further in between meetings.

Item 5: 15 box grid

CN presented the 15 box grid, setting out national analysis identifying key opportunities for financial improvement across NHS Ayrshire and Arran.

The 15 box grid has been refreshed for 2026–27 to align with national priorities, with a focus on four key areas: length of stay, polypharmacy, supplementary staffing and attendance promotion.

The assurance board noted that length of stay remains a significant challenge, with higher-than-average performance for both elective and emergency pathways. This continues to impact the health board’s ability to deliver planned bed-related savings, with previous savings largely non-recurring and shortfalls evident across recent years.

It was highlighted that there is a material opportunity to improve patient flow and release capacity, with potential to reduce avoidable bed days and associated costs. Delayed discharges were identified as a key driver of extended length of stay and sustained pressure on inpatient capacity.

In relation to prescribing, the assurance board noted that NHS Ayrshire and Arran have the highest rate of polypharmacy in Scotland, with review rates remaining comparatively low. While slides from the director of pharmacy highlighted that review rates/ activity is improving at a review rate above the Scottish average, there remains a clear opportunity to deliver financial benefits through targeted interventions.

The assurance board also noted a reduced but ongoing reliance on nurse agency staffing, reflecting ongoing workforce and capacity pressures, although performance in relation to medical locum usage is comparatively favourable against NHS Scotland.

Sickness absence was identified as an opportunity, with NHS Ayrshire and Arran rates in upper quartile performance. The rate was above the national target, contributing to additional costs and reliance on temporary staffing.

The assurance board acknowledged the scale of opportunity across these areas and the need to translate identified opportunities into deliverable and sustainable savings, supported by strengthened performance management and monitoring.

Item 6: Internal Audit

The assurance board received an update from DS on progress against the audit recommendations. It was noted that the majority of recommendations have been implemented.

Two key areas remain outstanding: Completion of the ‘plans on a page’ action, and implementation of more granular financial reporting, which is expected to be in place by July.

CN noted that there were 33 recommendations in total, and progress against these continues to be monitored.

KD confirmed that engagement with auditors is ongoing and that evidence has been submitted to support completed actions. It is anticipated that confirmation from auditors on the closure of actions will be received in advance of the next meeting.

In response to a query from SG, it was noted that the 2026–27 internal audit plan will focus on key areas including: Financial management and reporting, procurement and tendering, whistleblowing, delayed discharges and waiting list management, staffing, and wellbeing.

CN confirmed that the proposed audit plan avoids duplication and is aligned with key organisational risks.

The assurance board acknowledged that this would be BS’s final assurance board meeting and recorded its thanks for his contribution, noting his constructive challenge, expertise and support in establishing the assurance board.

The assurance board noted the update on internal audit progress and planned areas of focus.

Next Meeting

The next meeting was planned for Thursday 23rd July