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NHS Ayrshire & Arran owes nearly £130m and now tops the list of Scottish health boards with the largest amount of debt, says the Auditor General for Scotland. And the health board has been warned that its savings plan, aimed at reducing their crippling debt levels, is “overly optimistic” and they “may not be achievable.” The dire warning comes from Stephen Boyle, Auditor General for Scotland, who highlighted both NHS Ayrshire & Arran and NHS Grampian in a fresh financial report and said their positions are “the most pressing.” Indeed, Boyle even went as far as to describe the financial position at the Ayrshire health board as “unprecedented.” NHS Ayrshire and Arran needed a £51.4 million bail-out loan in 2024/25 to break even. It now has outstanding loans totalling £129.9 million, the highest amount across the NHS in Scotland. And while the board is forecasting a deficit of £33.1 million in 2025/26, the Auditor General claimed they ‘do not have a clear plan for achieving financial sustainability.’ In the case of NHS Grampian, they received a £65.2 million loan in 2024/25 and is projecting a £68 million overspend in 2025/26. In May 2025, Grampian was escalated to Stage 4 of NHS Scotland’s support and intervention framework due to “concerns” about “financial sustainability, leadership and governance, and service performance.” Stephen Boyle, the auditor general for Scotland, said: “These two health boards are not alone in finding it difficult to achieve financial balance, but their situations are currently the most pressing. “In the case of NHS Grampian, it won’t be possible for the board to return to financial balance without a significant redesign of its health and social care system. “The severity of the financial challenge facing NHS Ayrshire & Arran is unprecedented, and the board is relying on an overly optimistic savings plan that may not be achievable.” Stephen Boyle added: “For both health boards, effective leadership and close working with the Scottish Government and other partners will be vital to improving their financial sustainability and the delivery of services.” Now South Scotland Conservative List MSP, Sharon Dowey, has waded into the issue and savaged the SNP Scottish Government for their handling of the unfolding financial crisis. She said: “This report lays bare the shocking reality of NHS finances under the SNP. “Years of underfunding and short-term fixes have pushed NHS Ayrshire & Arran to the brink of collapse. “It is utterly unacceptable that frontline staff and patients are being left to pick up the pieces of SNP mismanagement.” Among the key messages the Auditor General’s report reveals: “ NHS Ayrshire & Arran is not in a financially sustainable position. “In 2024/25, the board required a £51.4 million loan from the Scottish Government to break even, and it now has the highest amount of outstanding loans across the NHS in Scotland, at £129.9 million. “The board relied on nonrecurring savings in 2024/25, which exacerbates future financial pressures. Service performance against national waiting times standards is mixed. Performance against the delivery plan is behind target. And the board continues to rely on temporary staffing at a high cost.” The report goes on: “The scale of the financial challenge facing the board is unprecedented. Despite the severity of its financial position, the board does not have a clear plan for achieving financial sustainability. “The board’s three-year financial plan from 2025/26 to 2027/28 projects a cumulative financial deficit of £112.1 million. “The Scottish Government has set a target of a £25 million deficit for 2025/26, but the board is forecasting a deficit of £33.1 million. It is also relying on overly optimistic savings plans that may not be achievable.” And the report warns new interim chief executive, Gordon James - who replaced previous incumbent Claire Burden earlier this summer - that ‘urgent action’ will need to be taken in order to implement a “realistic recovery plan.” The report adds: “As a matter of urgency, the board, with the leadership of the newly appointed interim Chief Executive, needs to set out a realistic recovery plan to address its forecast deficit for 2025/26. “It also needs to agree and implement an improvement plan with the Scottish Government to show how it can achieve break-even within five years. This should include clear and attainable milestones to track progress.” A statement from Gordon James, the interim chief executive of NHS Ayrshire & Arran, he said: “We are aware of the Auditor General for Scotland’s Section 22 report, following our 2024/25 audit. “The report reflects the considerable financial pressures we continue to face and highlights our overspend for 2024/25 and going in to 2025/26. “The report provides a valuable opportunity to reflect and improve. “We welcome this support and are fully committed to the parliamentary review process.” The statement continues: “NHS Ayrshire & Arran acknowledges the challenges we face but remain committed to delivering a plan to make improvements in our financial performance. We work closely with the Scottish Government and other partners to deliver sustainable transformation and change and will continue to do so to improve our position. “I would like to thank staff and partners for their continued commitment to the delivery of safe and effective care across the communities we serve.” On Monday, First Minister John Swinney announced an additional £25.5 million this year to allow health boards to deliver more planned care appointments and procedures to reduce long waits for patients. NHS Ayrshire & Arran is one of nine health boards to share the cash. Speaking during a visit to Queen Elizabeth University Hospital in Glasgow, the First Minister said: “The latest figures show our plan to support Scotland’s NHS is working, delivering real benefits for patients. “We have already provided £110 million of additional targeted funding this year to tackle the longest waits. Now we are providing a further boost to deliver more appointments and procedures, taking the total additional funding to £135.5 million for 2025-26.” But Sharon Dowey added: “John Swinney’s so-called funding boost will barely scratch the surface. Our health service is in permanent crisis and needs real reform, not rehashed plans and tinkering.”
