NHS Ayrshire and Arran Assurance Board minutes: Meeting Zero: 19 March 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
• Policy officials, Scottish Government 

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
• (CM): Crawford McGuffie, Medical Director
• (BS): Brian Steven, Turnaround Director
• (DS): David Stonehouse, Director of Finance
• (JW): Jenni Wilson, Director of Nursing

 

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Items and actions

1. Welcome and introductions

SG welcomed attendees to ‘meeting zero’ of the assurance board and invited attendees to introduce themselves

 

 

2. Escalation: Background and Introduction to Processes

SG provided an introduction and process for moving to stage 4 of the NHS Scotland Support and Intervention Framework for finance. On the role and process of the assurance board, he confirmed that the board would aim to meet fortnightly, hold deep dives into matters of interest, and aim to find evidence of improvements in financial grip and control to stabilise the position. The assurance board would then seek evidence of a robust value and sustainability programme that shows a trajectory towards financial sustainability in line with the 3-year financial assumptions previously communicated to the health board. On membership of the assurance board, this will start small and expand as required to bring in additional experience and advice. SG noted the support that is available to health boards at stage 4. On de-escalation criteria, he advised that these would be co-produced with the health board.

 

LB asked how long financial support is available for, noting the £0.5 million available in 2026-27. FB advised that this would be agreed each year however it could be assumed a similar value would be available in 2027-28 for planning purposes.

 

SG outlined the values of the assurance board:

• everybody speaks well of each other
• focus on outcomes
• deliver on commitments
• data and evidence are an important part of the process
• meeting in-person is important – will aim for every second meeting to be in-person.

 

GJ mentioned the recent visit from Caroline Lamb (Chief Executive of NHS Scotland and Director General for Health and Social Care). He also highlighted that the letter advising of the move to stage 4 noted that de-escalation criteria would be provided by 31 March. SG confirmed that these would be aligned to the criteria defined in the letter as reasons for moving to stage 4.

 

SG confirmed that minutes of assurance board meetings would be published on the Scottish Government website, although there would be a hiatus during the pre-election period as the majority of such publications are halted during this time.

 

3. Draft Terms of Reference

SG invited comment on the draft terms of reference that had been circulated with the meeting papers.

 

LB suggested that the support listed in section 8 was too narrow and that other partners would provide support. The assurance board accepted this and agreed to amend this element of the document.

 

Action: update section 8 of the terms of reference to reflect wider support.

 

DS asked what other types of support have been utilised. FB outlined some of the peer-to-peer support afforded to other boards at stage 2 and above of the framework.

 

BS noted some of the peer support he had experienced through the directors’ network, not just limited to directors of finance.

 

SG invited any further feedback on the draft terms of reference to be provided via correspondence, but for now – with the agreed amendment – these would be adopted.

 

4. Finance

i: Context

FB outlined the shift from brokerage to deficit support funding. Brokerage remains repayable when health boards return to financial balance, but the amounts will not change – any amounts provided from now on as deficit support funding are non-recurring and non-repayable. It is intended that deficit support funding being will reduce year-on-year, from £45 million in 2026-27 to zero by 2029-30.

 

It was recognised that not everything is a purely financial matter, and the summary of diagnostics that have been carried out in recent years is welcomed. The assurance board will now focus on actions.

 

FB welcomed the NHS Ayrshire and Arran financial plan for 2026-27. Delivering against the £45 million target for this year, identifying 3% recurring savings against total baseline funding, and a credible plan to deliver within the £30 million target for 2027-28 will all be critical evidence for de-escalation and sustainable improvement.

 

JW highlighted the importance of identifying slippage early. CM noted that some targets will be aligned to clinical reform, which would also be a mechanism for signalling slippage. FB agreed and noted some clinical changes would take more than 12 months, therefore the 3 year plan and beyond was also very important.

 

BS asked about sub-national planning and whether any savings might be identified through this process and count towards the 3% recurring target. FB confirmed that there is no separate sub-national financial planning, and while it was anticipated through working together additional opportunities may arise, savings must come from the NHS Ayrshire and Arran ledger.

 

GJ advised that the deficit support funding mechanism has been outlined to the health board. LB confirmed that a workshop on this had been helpful and the health board have high confidence in the work being undertaken to improve the financial position, albeit looking for more pace in delivery.

 

SG asked about the amount of baseline funding that is transferred to integration joint boards. LB and DS said this was around 40% and if GJ could describe his engagement with local authority partners.

 

GJ confirmed that he meets with local authority chief executives every 3-4 weeks. The Ayrshire transformation board also comprises the four chief executives along with other key system leaders such as medical directors, operational directors and chief social workers. There are five programmes of work being taken forward by the transformation board:

• Safe Hospital Occupancy
• Adults With Incapacity
• Shared Services
• Digital (with emphasis on digital integration)
• Communications (driving consistent communication with the public)

 

AW asked how the process works for communications between the health board and the integration joint boards on decision making. LB confirmed that the chairs of integration joint boards attend meetings of the health board and committee meetings. Members of the health board also sit on integration joint boards.

 

AW noted that there were no integration joint board representatives in the room. SG cited the example of a recent and positive assurance board meeting in NHS Grampian which included discussion of joint planning and included the chief officers of local integration joint boards and local authority chief executives. GJ confirmed that after discussion with SG the invitee list to this ‘meeting zero’ of the Ayrshire and Arran assurance board was kept small, but would be happy to expand and bring integration joint board representatives into future meetings. SG confirmed that it is within the gift of the Ayrshire and Arran chair/chief executive to decide who to invite to the assurance board meetings and so would welcome this.

 

Action: AW and GJ to meet to explore more of the detail around involvement and partnership working between the health board and integration joint boards.

 

ii: Performance and Planning

DS ran through a slide pack that outlined NHS Ayrshire and Arran’s financial performance and projections. At month 11 the deficit is £24.4 million, with a projected year-end deficit of £25 million.

 

GJ confirmed that this would be scrutinised by the corporate management team on Monday [23 March 2026]. The underlying position is driven by a range of factors, the most significant being acute overspends and pharmacy. Risks associated with health elements (ie prescribing) within the integration joint boards sit with the health board and the risks associated with social care sit with the respective local authority.

 

VC confirmed that the bed base consists of 64 beds. JW noted that care is being provided for some high length-of-stay cases. DS advised that the highest cost areas will be reviewed for any options to deliver care differently and look at step down options alongside the integration joint boards to ensure care is delivered in the best possible setting for the patient as well as reducing the acute bed base.

 

Action: VC to explore options around partnership working that will provide value for 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.

 

FB advised that there is a degree of inconsistency between boards when it comes to defining savings as recurrent or not. It would be worth revisiting savings plans with this in mind. JW noted this is helpful and cited the example of reduction in agency staff being classified as non-recurring.

 

SG asked about the impact of the savings target for 2026-27. GJ confirmed that this is very significant with regard to recurring savings, with the current plan delivering more than in prior years. VC agreed that this is challenging for the management team, with more data-driven work behind decisions.

 

CM linked this to the reform narrative over three years, with year-one focus on greater grip and control, year-two establishing centres of excellence, and year-three aligning with the ‘Caring for Ayrshire’ strategy.

 

JW highlighted the impact on recruitment with tighter controls on job proposals. Not all posts are getting approved. However, the quality of those coming through are higher. SG requested bringing related data to a future meeting of the assurance board.

 

Action: add review of vacancy data to a future assurance board agenda

 

SG highlighted the recommendation in the Viridian diagnostic around the establishment of a programme management office and pressed for an update on this, noting that the financial year is nearly at an end and this function will be critical to realise the ambition of plans for the coming year.

 

BS noted that an operational delivery unit has been created, with some posts filled through redeployment from across the organisation and some posts yet to be filled. GJ acknowledged that this needs to be progressed and there is a need to bring in some additional specific expertise.

 

SG advised that the assurance board would continue to scrutinise this.

 

SG asked how integration joint board budgets are monitored, and how this information is fed into the health board. DS advised that a finance report is prepared for the health board each month so that they are sighted on the numbers; a finance group for the integration joint boards meets each month which DS joins; and a quarterly financial review meeting takes place that includes the integration joint board finance leads along with DS and GJ.

 

LB advised that she has been in touch with the chair of NHS Grampian who has shared the integration joint board finance paper that was recently reviewed by the Grampian board.

 

SG referred to the slides outlining the best value plan, and asked about the requirement to move some of the elements from red to green, in particular the nursing and medical workforce plans.

 

JW advised that she was relatively confident in the nursing plan. Benchmarking on will take place at the end of the month. £1 million saving is linked to a reduced requirement for mental health nursing. Block recruitments are being carried out three times per year and agency spend is reduced, although there is some associated challenge around delays in the system. A bit more assurance around the establishment review will enhance confidence.

 

CM described the impact of supplementary medical spend and noted that the figures in the plan are approximate and will be updated in the coming weeks.

 

GJ advised that a digital plan will be going to the corporate management team on Monday [23 March 2026]. This is not yet in the best value plan savings to avoid double-counting.

 

GJ advised that the figure of £704k for early potential savings from Caring for Ayrshire service redesign options represented medical costs only. He referenced the clinical need and willingness to change.

 

AW noted that this needs to be driven by the right clinical practice, and getting communities behind this is critical. She sought assurance around the level of engagement in plans.

 

LB agreed that there are sensitivities and that the health board are developing careful messaging about their investment in services.

 

GJ advised that he is discussing engagement with the team at Healthcare Improvement Scotland (HIS). SG confirmed that HIS will set the benchmark for what appropriate engagement needs to be in place around redesign and service change.

 

5. Grip and Control Measures

This item was deferred to the next meeting to ensure sufficient time to discuss the detail.

 

Action :include this item in the agenda for Meeting 01, scheduled for 02 April 2026

 

6. Update from Public Audit Committee (PAC)

LB updated that the PAC appearance worked well with the combination of clinical and financial expertise on the panel. She noted that the health board has become finance-heavy, with 10 of the 14 members having a finance background, including 5 accountants. This has been a response to the historic financial challenges; moving forward, LB is looking to bring a balance of skills/experience onto the board, particularly in programme management and digital.

 

7. Any Other Business

GJ noted that the NHS Ayrshire and Arran Board would be meeting on 07 April 2026. He will provide that board with an update on this meeting.

 

 

Next Meeting

Thursday 02 April 2026, 10.30 – 12.30. SG will attend in person