Two health boards required multimillion-pound loans to break even, figures show

Two health boards needed large loans from the Scottish Government to break even in the last financial year, figures show.

Audit Scotland said NHS Grampian and NHS Ayrshire & Arran both received multimillion-pound loans.

NHS Grampian received £65.2 million in 2024-25 and is projecting a £68 million overspend in 2025-26.

In May, the health board was escalated to stage four of NHS Scotland’s support and intervention framework due to concerns about financial sustainability, leadership and governance, and service performance.

Stephen Boyle, Auditor General for Scotland, said NHS Grampian will need a “significant redesign” of its health and social care system.

He 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.”

NHS Ayrshire & Arran needed a £51.4 million loan in 2024-25 to break even. It now has outstanding loans totalling £129.9 million – the highest amount across the NHS in Scotland.

The board is forecasting a deficit of £33.1 million in 2025-26.

Mr Boyle continued: “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.

“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.”

Laura Skaife-Knight, NHS Grampian chief executive, said: “Section 22 reports are a constructive way to reflect on our challenges and identify where we need to improve. I welcome this opportunity for learning, alongside all other means of support the organisation is receiving to see the improvements that are necessary for our patients, community, and staff, and we will fully engage with the parliamentary review process.

“Our focus remains delivering the improvements we have committed to, including those related to leadership, governance, the timeliness of planned and emergency care for our patients, and our financial performance.

“We’ve already begun a programme of improvement, shaped further by the recently published KPMG diagnostic report and other external input, including learning from other health boards.

“We’re developing an improvement plan in close collaboration with our staff and partners, building on work already under way recognising this is how we will meet the challenges we face and that lie ahead.

“This improvement plan will come to our public board meeting in December 2025 for approval, for transparency, and regular progress updates will be shared with our community, partners and staff.

“The continued commitment of our staff to delivering safe and compassionate care to the communities we serve across Grampian is deeply valued and remains at the heart of everything we do, for which I would like to thank them.”

Gordon James, chief executive of NHS Ayrshire & Arran, said: “We are aware of the Auditor General for Scotland’s Section 22 report, published today, 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 into 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.

“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.”

The Scottish Government have been approached for comment.