NHS Ayrshire and Arran Assurance Board minutes: Meeting One: 2 April 2026

Attendees and apologies

Members

• (SG): Stephen Gallagher, Director of Assurance & Improvement – Chair, Scottish Government
• (FB): Fiona Bennett, Chief Finance Officer (FB), Scottish Government
• (AW): Angie Wood, Director Social Care and NCS, Scottish Government

 

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 IJB
• (VC): Vicki Campbell, Director of Acute Services
• (MI): Mark Inglis, Chief Officer – South Ayrshire IJB 
• (CM): Crawford McGuffie, Medical Director
• (BS): Brian Steven, Turnaround Director
• (DS): David Stonehouse, Director of Finance
• (JW): Jenni Wilson, Director of Nursing
• Scottish Government officials

Apologies 

• [redacted] Policy Official
• (CM): Craig McArthur, Chief Officer – East Ayrshire IJB

Items and actions

1. Welcome and introductions

SG welcomed members and attendees to meeting one of the assurance board and outlined the agenda. He thanked those who have contributed to the minutes of meeting 0 on 19 March 2026 and asked for any final comments. There were no further comments so the minutes are accepted and will be published following the election in May 2026.

2. Action Log

Glen Deakin provided an update on the action log:

Action	Update
update section 8 of the terms of reference to reflect wider support.	Amended section to read: Continued support from other NHS boards including but not limited to, NHS Lanarkshire and Golden Jubilee   Attendees are content with this amendment, the terms of reference are accepted and this action closed.   The terms of reference will be published alongside assurance board meeting minutes, after the election in May 2026.
AW and GJ to meet to explore more of the detail around involvement and partnership working between the health board and integration joint boards	GJ and AW met on 27 March and provided a brief update on their discussion. This action is closed   Whole system planning will be added to the agenda of a future AB meeting.
GJ to explore options around partnership working that will save money and provide better care, linked to the aims of the Safe Hospital Occupancy programme, and bring a paper back to the assurance board if further support will facilitate this.	To be discussed at a future meeting.   Open action
Add review of vacancy data to a future assurance board agenda	To be discussed at a future meeting   Open action
Grip and control measures to be included in the agenda for Meeting 01, scheduled for 02 April 2026	Action closed – addressed as item 3 in this meeting’s agenda.

 

3. Grip and Control Measures

BS spoke to his slides on grip and control. This included the measures already in place and those looking ahead to the new financial year. He confirmed that a presentation had been given to the NHS Ayrshire & Arran corporate management team and board in October 2025 covering the elements of stage 3 escalation relating to financial governance, financial management and control, and financial sustainability. Since the health board were moved to stage 4 of the NHS Scotland Support and Intervention Framework in February 2026, the focus of the approach is on strengthening leadership oversight, improving grip and control arrangements, and addressing the underlying drivers of the financial deficit to support long‑term sustainability. Key measures include tighter pay and non‑pay controls, improved budget setting and financial reporting, clearer accountability for budget holders, and embedding finance within a wider performance management framework.

It was noted that a number of grip and control measures are already established, including strengthened governance arrangements, a new organisation-wide performance management regime, zero-based budgeting analysis, refreshed standing financial instructions, and an inclusive approach to budget setting for 2026/27.

 

SG asked for an example of what has changed in terms of grip and control. BS described the vacancy request process whereby requests that have not been robust have been rejected and confirmed where additional data is required to support requests.

 

JW expanded on the vacancy controls covering 284 posts. Many have been converted to fixed-term posts. 39 have been rejected following scrutiny. A small number had been withdrawn. Other options such as vacancy redesign are being explored

SG requested that data on vacancies and vacancy control be brought to the assurance board at the end of the first quarter of 2026-27 for further assurance.

Action: Bring vacancy control data to the assurance board for discussion at the end of Q1 (June 2026)

BS also noted actions currently in progress, including consultant job planning reviews, tighter controls on supplementary staffing and waiting list initiatives, refreshed workforce policies, enhanced procurement and non‑pay controls, and increased financial focus within divisional performance management. Future plans include the roll out of e‑rostering, further development of divisional performance management with a focus on productivity metrics, improved compliance with financial governance requirements, and enhanced financial reporting and dashboarding to support sustained financial recovery. SBARs are currently being used as a proxy for business cases, though it was noted that business case criteria will be issued in the near future, including further clarification on the timeline and current approval thresholds.

FB queried whether there is a risk that the approach could lead to an excess level of grip and control, and how it could be ensured that staff felt empowered where possible.

 

DS commented that there is a materiality level for items, noting that only a small number of cases require review by the panel where they are genuinely discretionary and above the set threshold. DS also referred to the budget setting process, highlighting that a significant level of scrutiny and activity takes place within the virement process.

 

BS noted that the tightened approach is an indicator to the system that things have changed with regard to scrutiny, and grip and control. GJ confirmed that the delegated approval limit had reduced from £4million to £1million.

 

JW explained that the tighter controls allow for escalation to happen more quickly when needed.

 

SG invited further comment and questions from the board.

 

FB commented on the savings plan, noting the importance of it becoming more embedded as business as usual, with a stronger focus on delivery and implementation.

 

AW questioned how assurance would be gained that an appropriate balance is being struck between oversight and micro‑management, and how the additional control steps in place would be monitored and evidenced.

 

GJ reflected on the grip and control approach, highlighting the need to empower staff while reinforcing accountability. He noted the monthly finance newsletter and acknowledged that further work is required to strengthen communication and engagement in this area.

 

VC commented it has been challenging, but the change has been required and it is getting better as it progressing. It is making individuals have more control on performance management.

 

The assurance board note this update and the work that is in progress. There are some points to come back to including vacancy control and handling of discretionary spend – the assurance board would like to hear more about this in due course. The assurance board acknowledge the importance of grip and control arrangements, while also recognising the potential impacts these measures, if applied in an extreme way or indefinitely, can have on staff. The assurance board also note recent changes to delegated approval limits and the work underway to strengthen business case processes, including addressing and preventing issues that have previously arisen, and draw some assurance from this work.

 

4. Best Value Programme and lessons learned from consultancy

 

BS provided an update on the establishment of an in-house Programme Management Office (PMO) to support transformation and best value delivery. Senior programme roles have been consolidated, with key leadership posts appointed from February 2026 and wider recruitment completed by March, with staggered start dates through to June. The corporate management team have approved the business case for the PMO model, including role design, accelerated HR processes, vacancy control approval and recruitment activity undertaken between October 2025 and March 2026.

SG noted the progress and asked for some further information on timescales, including any potential to expedite filling remaining vacancies. BS explained that some interim gaps are being managed within existing resources and extended from the work with Viridian.

Action: update on filling the HR post within the programme management office at the next assurance board meeting

FB asked about the scope for PMO, what is the key remit and the scope. GJ confirmed the key element is a best value programme, as well as two elements of delivering “Caring for Ayrshire” in 2026: the urgent care model, and a general surgery model.

CM commented on clinical reform. GJ advised that PMO arrangements will continue to be reviewed and refined, with the potential need for external support identified. There are opportunities to learn from other health boards and GJ continue to engage with NHS Grampian to understand their ways of working and report back to the NHS Ayrshire & Arran Board.

GJ commented on the challenges and NHS Ayrshire & Arran’s approach to staff, stakeholder and partner engagement, with a particular focus on financial recovery and transformation.

DS updated on how wider engagement is supported through the “Daring to Succeed” newsletter, which shares progress, learning and success stories linked to the Caring for Ayrshire strategy, alongside regular briefings at internal governance forums, area partnership forum, external partnership boards, and with the Scottish Government through quarterly reviews. Engagement with MPs and MSPs is also maintained via the chief executive.

SG requested examples and feedback from staff, including comments that have been received to date.

JW commented on discussions held with the nurse directorate in relation to the move to stage 4, noting that she had brought teams together to explore what this means for them and to share understanding and reflections.

VC commented particularly from an acute perspective, highlighting that the grip and control processes and performance management structures have provided a constructive framework for two‑way engagement with staff.

FB noted that Forth Valley health board have good financial comms and offered to share further information on this.

action: Fiona Bennett to share information/contact relating to the Forth Valley approach to communications.

LB updated on engagement with the health board. She noted that the board are well-sighted on issues, and ask the right questions. They show some nervousness around delivery, although have more confidence than in previous years and a positive first quarter will provide some reassurance. The PMO structure is new so evidence of delivery from this will also provide reassurance.

SG requested an update on communications, specifically how the health board and the wider organisation are being informed and how NHS Ayrshire & Arran is signalling the scale of the financial challenge, alongside the approach being taken to address it, seeking evidence and assurance that the board and staff recognise the seriousness of being at stage 4.

action: NHS A&A to bring a paper on communications to the assurance board in mid-May.

DS presented on the best value plan dashboard which sets out the programme‑level approach to delivering financial sustainability through a structured portfolio of savings and transformation projects. In relation to the RAG slides, the emphasis will be on moving projects from red to amber, and from amber to green. Plans-on-a-page are being developed.

 

FB asked what it means to be a ‘director sponsor’ – what do they do and how are they held to account. DS confirmed that director sponsors will intervene if projects are not on track, and escalate issues to address blockers. GJ explained that role descriptions have been defined. CM gave an example from the prescribing group, explaining that the director sponsor for this goes through spend line-by-line.

 

GJ noted the need to enhance the unscheduled care/flow programme, reflecting on the conversation in the previous assurance board meeting and the action agreed therein.

 

action: Gordon James to bring a proposal on transfer of care to the assurance board in May (confirmation of action from meeting 0)

 

SG noted that it is important that the assurance board have confidence in the best value plan. He invited FB to conduct a deep-dive into finances to ensure robust content and assumptions, and suggested that NHS Grampian could support a deep dive into the PMO set up and reporting. Taken together this could provide some valuable challenge and support at this stage of the financial year.

 

action: Fiona Bennett to arrange for a deep dive on finances focussing on the content and substance of the savings plans.

 

DS suggested including the PMO in the deep dive, or having a separate session to review the best value plan from the PMO perspective. SG agreed to work up a plan for this.

 

action: Fiona Bennett to arrange a deep dive into the PMO approach to best value.

 

FB asked colleagues to consider what the finance team going forward needs to look like, reflecting that data plays a key role, and asking whether there is sufficient existing capacity for this. She offered support from the Scottish Government Finance Delivery Unit.

 

SG asked whether the £500,000 support funding could be used here, and whether consideration had been given yet to how to use this. GJ confirmed that the corporate management team still need to consider this, but would bring a proposal back to the assurance board.

 

action: Gordon James to develop a proposal for using the £500,000 support and bring a proposal to the assurance board in May.

 

GJ noted that workforce analytics may be worthy of further discussion. SG suggested taking this off-table initially and exploring with workforce colleagues in Scottish Government.

 

action:  Assurance board to discuss workforce analytics with Scottish Government workforce colleagues.

 

7. Any Other Business

 

MI reflected that members of integration joint boards have a shared understanding of the move to stage 4 and the impact of this. They have an important part to play in improving whole-system flow.

 

 

Next Meeting

The next meeting (Meeting Two) had been scheduled for Tuesday 14 April from 0900 to 1100. However, as this falls within the Easter holiday period and only six working days after Meeting One, it was agreed to reschedule this. Meeting Two will now take place on Thursday 30 April between 1300 and 1500. By this time it is expected that the deep dives will also have been undertaken.

 

____

 

 

Summary of Actions

 

April

• Update on filling the HR post within the programme management office at the next assurance board meeting (Thursday 30 April)
• Fiona Bennett to share information/contact relating to the Forth Valley approach to communications.
• Fiona Bennett to arrange for a deep dive on finances
• Fiona Bennett to arrange a deep dive into the PMO approach to best value
• Assurance board to discuss workforce analytics with Scottish Government workforce colleagues

 

May

• NHS A&A to bring a paper on communications to the assurance board in mid-May
• Gordon James to develop a proposal for using the £500,000 support and bring to the assurance board in May.
• Gordon James to bring a proposal on transfer of care to the assurance board in May (confirmation of action from meeting 0)

 

June

• Bring vacancy control data to the assurance board for discussion at the end of Q1.