Health boards reliant on loans and financially unsustainable

NHS Grampian and NHS Ayrshire and Arran both needed large loans from the Scottish Government to break even in the last financial year.

NHS Grampian 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.

NHS Ayrshire and 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 and does not have a clear plan for achieving financial sustainability.

Stephen Boyle, 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 and 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.