BOSSES at a health board which was given a £23 million bailout from the Scottish Government said they do not expect to begin repaying the loan for at least three years.

The chief executive of NHS Ayrshire and Arran, John Burns, told MSPs that the health board was unlikely to balance its books until 2021 and would require additional brokerage over the next two years – including an estimated £20m before the end of 2018/19.

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Mr Burns blamed a spike in A&E admissions and an increase in consultant vacancies which had to be plugged by more expensive locum doctors for the deterioration in the health board's finances.

NHS Ayrshire and Arran requested the cash boost from the Scottish Government in March when it became clear that it was facing a £23m budget shortfall for the 2017/18 financial year.

It is the first time that the health board has required brokerage – effectively interest-free taxpayer loans.

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It is also the largest single amount dished out to date. NHS Highland was allocated £15m in 2017/18 and NHS Tayside has received a total of £45m in brokerage since 2012.

Giving evidence to the Scottish Parliament's Health and Sport Committee, Mr Burns said: "In 2016/17, we started to see some pressures in our system in relation to increasing demand for unscheduled care and we also started to see increasing difficulty in recruiting to some of our key medical posts. Those two elements demonstrated pressure in our system."

He said they were now trying to cut costs by reviewing the estate, procurement processes, prescribing and reducing reliance on locum and agency staff.

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However, Mr Burns added that on current projections, NHS Ayrshire and Arran would not deliver a balanced budget for another three years and only then would be in a position to discuss repaying the loan.

Asked whether this meant the health board would require further brokerage in the meantime, Mr Burns said: "Regrettably, I believe that would be the case."

Derek Lindsay, the health board's director of finance, said they projected a shortfall of £20m in 2018/19, but stressed this could change depending on the value of NHS pay awards agreed by the Scottish Government.

NHS Ayrshire and Arran has come under fire over proposals to axe cancer services at Ayr Hospital, meaning that patients would have to travel to Crosshouse Hospital in Kilmarnock for chemotherapy.

Brian Whittle, Conservative MSP for South Scotland, said this would result in a three-hour round trip by public transport for a patient from Ballantrae and that even for patients making the journey by car, parking at the site was "inadequate".

Asked by Mr Whittle whether the move was financially motivated, Mr Burns insisted that no final decision had been taken.

He added: "I can say absolutely the drive for this is not about saving money – it's about delivering the right care and the best care to patients in Ayrshire."

Mr Burns said there was a possibility that some chemotherapy services which Ayrshire patients currently undergo in Glasgow might be "repatriated to Ayrshire" in future.

Asked by SNP MSP Emma Harper whether there was any research available on the impact of travel times on mortality from cancer, Mr Burns said: "It's not something I've looked at."

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Meanwhile, representatives from Scotland's island health boards – NHS Shetland, Orkney and the Western Isles – laid bare the demographic pressures facing remote healthcare.

MSPs heard that a third of NHS Orkneys's workforce is aged over 50 while all four of the Western Isles' consultant anaesthetists are Polish, raising concerns over the potential impact of a hard Brexit.

Chris Anne Campbell, chief operating officer and nurse director at NHS Western Isles, said: "If they all left at the same time we would be in significant trouble."

Ralph Roberts, chief executive of NHS Shetland, added that the UK "hasn't trained doctors to work in rural areas" and this was something they had called on the General Medical Council to address.

He added that pupils from rural areas could be given help to study medicine.

Mr Roberts said: "All the evidence from across the world is that if you come from a rural area, you're much more likely to go back and work in a rural area.

"Within 'Access to Medical Schools' there's been quite a lot of work around kids from deprived areas being given support to get into medical school, quite rightly, but I would certainly look for that to be rolled out into rural areas."