Review summary
I am Sally Campbell, a biologist with some practical experience in organising care in the community in my earlier life. Like many who attended the recent meeting about the future of Montrose House on Arran, I came away realising that I was confused about priorities, did not fully understand the systems in place and the extent of issues related to staffing, budgets, and had no appreciation of statistics behind health and social care in our region. I have also recently had considerable interface with the healthcare community as a consequence of a series of unplanned events in my family life. Since our meeting I have sat down and worked my way through what has turned out to be an incredibly complex structure incorporating a largely successful integration of health and social care in our community but constrained as ever by financial and staffing resources. All this is set against demographic statistics that point to continuing increase in demand within an ever-tightening means of funding. Without even a modest understanding of how this complex service of care in our community is funded and supported it is impossible to grasp the dilemmas in sustaining the future of Montrose House without simply reverting to the emotional response that such a facility must surely be needed to provide residential support for our elderly and infirm. I have tried to move on from this perfectly understandable view to see how health and care support works structurally in our community, where the pressures are, and basically how to ask the right questions of those who are charged with supplying these services. I have worked my way through the acronyms for a start then I have set out a simplified description of the professional roles of specialist organisations who provide these services and summarised the pressures they are under as described in publicly available reporting. I make no claim here to put forward any personal opinion but simply try to set out issues and identify those who are in positions whether groupings or individuals in making future decisions based on the best use of resources. The integration of health and social care has long been recognised and being beneficial across the country and impressive progress has been made in our region. However, with longer life expectancy, growing extent of infirmity in older age, more-older, more resource dependent people than younger working members of our society, all trends projected to continue into the future, we are going to need some more imaginative ways to provide the resources to meet our expectations. I have tried to set the scene here to enable our Arran community to see ways forward for our future health and social care needs.
My Review
I attended the consultation at Montrose House on Tuesday, 22 July 2025 and really did not gain insight from it as there was little in the way of data to help those there to understand the dilemma of North Ayrshire Council. The only fact I heard, without financial data, was that the cost of agency care staff was high. As you can imagine, there was a lot of emotional investment in what will happen to this island facility. I think I also heard that Montrose House is the only care home owned by North Ayrshire as part of the Integration Joint Board, even whilst NAC had use of 30 homes, but I may have heard that incorrectly. If Montrose House is the last one owned and run by NAC is there a strategic wish to sell on?
How can we on Arran make thoughtful and realistic argument for retaining Montrose House with a full complement of residents and qualified staff if we are not given the whole picture? What we really needed was the annual cost of running the facility over say the past 4 years, both in fixed costs and variable costs. What fees do residents pay? A simple outline would assist us all in facing the reality when those figures can be compared to costs of such facilities on the mainland.
Other data which was not given needs to be included and explained to islanders:
• What is the total of waiting list for residential accommodation on Arran? Is there indeed a waiting list, or is that not encouraged? Is the only route into Montrose House via Arran War Memorial Hospital (AWMH)?
• What percentage of beds in AWMH are effectively “blocking beds” there for lack of full-time residential accommodation on Arran or effective social care in their home to enable them to continue to live independently?
• Similarly, are there figures of long-term patients in Crosshouse and other major hospitals that are effectively preventing more efficient use of acute beds for want of home care services on Arran?
• Cost of agency staff at Montrose House (agency cost per hour per person, other costs including travel and accommodation). What is the flexibility for shift patterns when public transport is poor on Arran? 12-hour shifts are ridiculous. (For example, the no.11 bus from Ardrossan to Kilmarnock via Crosshouse Hospital runs every 15-20 minutes so 12-hour shifts are more viable if without own transport). Shorter shift patterns would enable carers to combine family responsibilities with care in the community.
• A new admissions policy, who will that exclude/include?
• Few people think about the complexity of health care services. But like many complex systems everything affects everything. Until we recognise that, we will go on complaining and not coming forward with strategic options for Arran and elderly health care on and off the island. How it is managed must also be discussed.
The Wider Health Picture on Arran
Over the past few years, residents have witnessed cutbacks on overall health care facilities on Arran as could be expected with the 12 years of general cutting back in many community facilities and our reducing resident population. That included the closure of Cooriedoon Care Home Ltd due to the North Ayrshire Health and Social Care Partnership (HSCP) terminating its contract with the home, citing “concerns over a significant period of time in relation to various aspects of care and support”. This decision was made after the HSCP determined that the care provided at Cooriedoon was not meeting the required standards. Craigielea Care home was sold and became a private dwelling some years ago. As finances tighten across health and social services, I do wonder what else may be at risk. Our AWMH (Arran War Memorial Hospital) is a vital link and hub in health services, especially for Accident and Emergency. So, an understanding of the costs in running such a wonderful service, the ambulances, the helicopter emergency service, dental practice must be in the equation; and all the ancillary services on the hospital site, the clinics, dentist etc. discussed. What is the strategic long-term plan for AWMH in Lamlash?
In the 2022 census the resident population of Arran was 4,618, a drop of 8.2% drop since 2001 census. Proportions of the population on Arran: 12.2% 0-15 years, 53.5% 16-64 years; Arran has a higher population of aged 65 and over (34.2%) compared to North Ayrshire (23.2%) and Scotland as a whole (20%). By 2026 50% of Arran’s projected population will be 65 and over. Just for comparison the Arran population peaked in the first half of the 19th century with highest ever population 6,600 in 1821 with much lower life expectancy.
The Emotional/Feelings at Montrose House Consultation Meeting:
• Feelings of “being informed” so not a consultation. Anger and even resignation.
• “I pay full council tax, live here all the year, vote here, why am I not important to be heard?”
• Many wondering if they are considered islanders? One person asked me if she qualified as she had lived here for 5 years. I smiled and said that many times I have been told, or implied I am not an islander, after all I was not born here, or my grandparents, even if I have lived here 21 years, much longer than I have ever lived anywhere. What is the admissions policy? The Consultation form was almost discriminatory or prejudicial.
• What other options are there if full residential care is needed? What type of care will not be suitable in this Montrose House? Where else does NAC suggest?
• How can the lower number of beds be viable? Why did NAC not keep the “old” Montrose House as accommodation for care staff? Was it just financial pressure that led to it being sold off for Auchrannie staff accommodation? No strategic forethought by NAC. Poor management was also muttered. Arran needs one-bed flats for carers to rent whilst full-time here. Somewhat like the elderly Glen apartments on Auchrannie Road. Would also be suitable for trainee doctors/ nurses/teachers here renting for a short time. But no hot-bedding.
• What would I want for my loved one? Preferably, stay at home with support. If the only option is care off the island, so be it. For myself, I would want to be supported wherever I am, good staff I know, not a continuous agency care worker. Building some sort of relationship. And a chair in my room for visitors. Dementia is a challenge of a very different order!
• Knowing people who I have visited off the island, in care, they were happy, content and just initially so relieved to be cared for. Yes, the ferry is a hurdle, and the journey is long but in reality, not so far. Perhaps it is for the partners of those in care on the mainland and their fears of being marooned in one “over there” that keep us from thinking through practical and realistic financial options for Arran.
• The way we need to deal with these is to have valid data, projected and real costs etc. Evidence of reality facing the choices of NAC (North Ayrshire Council) and NAIJB (North Ayrshire Integration Joint Board).
Our personal recent experience:
We, John and I, have had a lot to do with NAIJB this year and we have the highest praise for all the staff we encountered. Our GPs, AWMH, Crosshouse Outpatients and Inpatients departments, after surgery care, quality of the surgical team, everyone we encountered caring, professional, and worked as teams. Then, back home a superb local district nurse team, providing great support and encouragement. GPs too. So, I feel personally that I know this strategic thinking is with the view to the future as well as now. To lose the NAIJB would be a huge mistake: short termism at its worse. We need to think creatively outside the box of simply demanding as entitlement. Let us understand the problems of NAIJB. Sadly, extra ££millions do not grow on trees. We are the “expensive generation”, living longer with more health and mobility problems, requiring more interventions and care. 50% of over 70’s die through incurable cancer
I am trying to understand how we are where we are:
I have attempted to find out more about the whole picture in NAC Accounts for 2024-2025 and the North Ayrshire Integration Joint Board Accounts (NAIJB) to 31 March 2025. In the strategic thinking in both these documents, the figures are interesting which could be affecting decision making in the near-term strategic plans; some of these I will list below as significant in any longer-term review of services. Arran is after all part of the wider Ayrshire and Arran NHS Integration Joint Board. I have highlighted some figures in bold.
• North Ayrshire is home to 2.43% of Scotland’s population but a higher proportion of older residents making increased service demands. Residents aged 66 and over number 30,289, 23% of the population.
• NAC report higher levels of worklessness (24.7%) and lower levels of economic activity (67%) than the Scottish average (17.4% and 77% respectively).
• Health and Social Care Partnership revised budget £ million for 2024-2025 was £135.243m and an Adjustment of £4.373m to £139.616m. Total expenditure of NAC of £455.788m. This also included £15.813m from reserves.
• The financial performance of the Health and Social Care Partnership reflecting the historic challenges and financial risks presented by the delivery of these services showed in net expenditure of £139.616m needing an accounting adjustment of £4.373 million.
• Just for comparison Education in NAC had a revised budget of £175.108million and Net Expenditure in the Accounts £196.062 million.
Medium Term Financial Sustainability of the Health and Social Care Partnership
• Resources have not kept pace with demand for and cost of social care services with significant ongoing challenges across the medium term
• North Ayrshire’s overall population is forecast to reduce by 4.2% over the period with the number of children and working age adults being offset by a projected 17.1% increase in number of older people. This will negatively impact on anticipated funding levels while resulting in increased demand for services
• The percentage of adults claiming out of work benefits is 32% higher than the Scottish average and 26.9% of North Ayrshire’s Scottish Index of Multiple Deprivation data zones are within the 15% most deprived in Scotland, resulting in increased demand for cost-of-living supports such as Council Tax Reduction benefits
• North Ayrshire Council will become increasingly reliant on income from Council Tax and internal reserves to fund service delivery.
Much of this information is drawn from public Information of NAC: These are on the NAC website as North Ayrshire Accounts: Unaudited Accounts 2024-25
Health Integration Joint Boards:
An Integration Joint Board (IJB) is a legally separate entity responsible for planning and commissioning health and social care services within a specific area. It brings together representatives from the local council and the National Health Service (NHS) to oversee the integration of health and social care services. The IJB’s primary goal is to ensure that these services are planned and delivered effectively to meet the needs of the local population.
The Health Integration Joint Boards (IJBs) in Ayrshire are partnerships between NHS Ayrshire & Arran and the three local councils (North, East, and South Ayrshire) responsible for integrating health and social care services. Each IJB is a legal body that provides strategic direction and oversees the efficient and effective operation of their respective Health and Social Care Partnerships.
North Ayrshire Integration Joint Board Annual Accounts to 31 March 2025:
North Ayrshire is home to an estimated total population of 133,570 (NRS, 2023). The local area covers approximately 885 square kilometres and has a population density of c.151 persons per square kilometre. The National Records of Scotland (NRS) estimated that by 2043 North Ayrshire’s population will fall to 122,334, a further decrease of 8.4% from 2023, or an almost 11% decrease over the 30-year period. Not only is the overall population projected to change, but the demographic spread is also projected to change over time with a steady reduction in the working age population.
Current population estimates show that 60% of the population is aged 16-64 which is projected to decrease to 54.1% in 2043. Conversely, the 65+ population is currently 24.2% and is expected to rise to 30.7% in 2043 (NRS*). This demographic change has significant implications for local funding and spending as the number of working aged people paying taxes is decreasing, while the number of dependents, and therefore pressure on our health and care services, is increasing.
(* NRS figures generally refer to data published by the National Records of Scotland NRS). These include population estimates, migration statistics, and information about households. The NRS also handles the registration of births, deaths, marriages, and other vital events in Scotland.
Currently, 29.1% of local people are known to have some form of long-term condition. It is recognised that the prevalence of people with a chronic long-term condition increases by age. For example, 1.7 people in every 10 under the age of 65 has a long-term condition, whereas 8.7 people in every 10 over the age of 85 has a limiting condition.
What about Overspends? Health and Community Care in NAIJB – overspend of £5.632m mainly relates to overspends in care at home, agency costs within integrated Island Services, supplementary staffing in wards and district nursing staffing costs and care packages for people with a physical disability.
Overall position: It is essential that the IJB operates within the delegated budget and commissions services from the Council and Health Board on that basis. The 2024-2025 outturn has depleted the general reserves and additional funding was made available from North Ayrshire Council and NHS Ayrshire & Arran.
The improvement from the 2024-2025 position to the opening projected overspend for 2025-2026 is predicated on maintaining Financial Recovery Plan Controls, and includes:
• Removing the care home overspend and managing the number of placements in line with the budgeted level
• Reduce agency costs at Montrose House on Arran
There are a number of ongoing financial risk areas that may impact on the 2025-2026 budget during the year, these include:
• Current over-spend areas, especially in low volume / high-cost services e.g. Children’s residential placements, UNPACs (referrals outside the area), 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 Local Government and NHS pay awards are not settled for 2025-2026; as outlined in the report, a 3% increase has been assumed for the social care workforce and for NHS it is anticipated that additional funding will be allocated once the pay award has been settled. If the pay awards are not fully funded, then this will present an in-year cost pressure.
• Unearmarked reserves are depleted, there is no scope to absorb in-year variances, with any overspends requiring additional funding from partners.
• 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 annual budget for Acute Services is £462.6million. The directorate overspent by £36.9 million in the 12 months to 31 March 2025. This was caused by overspends on agency medical and nursing staff, together with medicines expenditure, equipment and supplies.
Going forward, we will continue to ensure local people are supported to get the right care in the right place, developing clear health and care pathways for the people of North Ayrshire. To achieve its vision, the Partnership recognises it cannot work in isolation. The Partnership will continue to strengthen relationships with colleagues within the Community Planning Partnership to ensure a joint approach to improving the lives of local people.
Conclusion: 2024-2025 has been an extremely challenging year for the partnership financially, driven by the cost of delivering services to meet demand across the system. There has been a requirement to draw on the remaining unearmarked reserves and also seek additional funding from North Ayrshire Council and NHS Ayrshire & Arran. This is not a sustainable approach.
Our health and social care services should reflect and respond to the needs of local people. To support this, we will help to build greater capacity in our communities and provide more ways for service users and local people to share their views with us to help shape services. We are fully committed to planning and designing services together with local people, our staff and our key partners including acute health services, housing, community planning and the third and independent sectors.
The decision has been made re. Montrose House with 10 beds. Just now reported. It is important that now there is an island meeting as soon as possible with concerned resident islanders to explain the why’s, and how combined health and community services will work together with islanders to give service to the community that meets the needs of older people; and an understanding of the financial pressures NAIJB is facing in difficult financial constraints. We all need to work together to make these decisions work well.
Sally Campbell 30 August 2025. Abridged paper for voiceforarran.com
Short Appendix of Terms used:
NAC North Ayrshire Council:
North Ayrshire covers an area of around 886 square kilometres with over 50% of our land area cover being islands including Arran and Cumbraes. The main settlements are Irvine, Kilwinning, Ardrossan, Saltcoats, Stevenson, Beith, Dalry, Kilbirnie, Dreghorn, Springside, West Kilbride, Seamill, Fairlie, Skelmorlie, Brodick and Millport.
NHS Ayrshire and Arran:
Run by a Board and area covered is North, East and South Ayrshire and is one of the fourteen regions of NHS Scotland. It was formed on 1 April 2004. It has a responsibility to provide health and social care to almost 400,000 people.
Services: The health board has almost 6,000 staff working in their hospitals, and almost 2,500 staff working in the community/ It is also responsible for the care provided by:
- general practitioners and their teams
- community pharmacies
- dentists
- ophthalmic practices
Hospitals include Arran War Memorial Hospital, University Hospital Crosshouse, University Hospital Ayr and Ayrshire Central Hospital.
Integration Joint Board IJB:
The IJB is a requirement in the Public Bodies (Joint Working) Scotland Act 2014 that states that health boards and local authorities must integrate their adult health and social care services.
The IJB replaced the Community Health Partnerships. So, for NHS Ayrshire and Arran each Partnership area (North, South and East Ayrshire) is overseen by a dedicated Integrated Joint Board (IJB) which is an independent legal body. Integration Joint Boards are responsible for the strategic direction of the partnerships, and make sure they are operating efficiently and effectively.
North Ayrshire IJB is the constituted legal governing body of North Ayrshire Health and Social Care Partnership. It is responsible for the strategic direction, effectiveness, and efficiency of the Partnership. This is a similar partnership to those IJPs established in East Ayrshire and South Ayrshire. Health and Social Care Partnerships. There are three Health and Social Care Partnerships (HSCP) in Ayrshire and Arran NHS Trust area, which are responsible for community-based care and social services for children, adults and older people. These are based in North, East and South Ayrshire. The Partnerships were established in April 2015 as part of the Public Bodies (Joint Working) (Scotland) Act. The act sets out requirements for health boards and local authorities to integrate their services, resulting in more joined-up, seamless health and social; care provision that will improve people’s lives. The Health and Social Care Partnerships work closely together along with health, community, third and independent sectors to improve people’s experience of services; and to give them the support they need to live safe and healthy lives in their own communities.
Featured image shows entrance road to Montrose House, Brodick, accessed at arranonline.com