NHS Grampian Assurance Board: 02 June 2026

Attendees and apologies

Members

• (SG) Stephen Gallagher, Chair, Scottish Government
• (DB) Donna Bell, Director Mental Health & Social Care/NCS development, Scottish Government
• (GE) Graham Ellis, Deputy Chief Medical Officer for Scotland, Scottish Government
• (JG) Jack Gillespie, Deputy Director of Finance, Scottish Government
• (FH) Fiona Hogg, Chief People Officer, Scottish Government
• (RK) Robert Kirkwood, Head of People, Governance and Appointments Unit, Scottish Government
• (JM) Jess Milne, Policy Official, Unscheduled Care, Scottish Government

 

Attendees – NHS Grampian

• (AE) Alison Evison, Health Board Chair
• (LSK) Laura Skaife-Knight, Chief Executive
• (JB) June Brown, Executive Nurse Director
• (HFB) Hugh Farrow Bishop, Medical Director
• (GF) Geraldine Fraser, Chief Officer, Acute Services
• (SF) Stephen Friar, Deputy Medical Director, Unscheduled Care
• (LJ) Leigh Jolly, Chief Officer, Aberdeenshire IJB
• (SP) Shantini Paranjothy, Director of Public Health
• (AS) Alex Stephen, Director of Finance
• (RS) Rick Strang, Site Director ARI
• (PT) Phil Tydeman, Interim Director of Improvement

 

Attendees – SG/Other 

• (TS) Tracy Slater, Assurance & Improvement unit
• [redacted], Policy officer

• [redacted], Assurance & Improvement unit
• [redacted], Assurance & Improvement unit (notetaker)

 

Items and actions

1: Welcome and Apologies

SG welcomed members and attendees to the twenty first meeting of the assurance board, noted apologies and outlined the agenda.

2: Actions/Updates from previous meetings

GD provided an update on the action log. Two actions feature on the agenda and can be closed:

• Share a copy of the final quality impact assessment on value and sustainability with assurance board. Covered in item 7.
• Updated unscheduled care programme details to be shared with the assurance board. Covered in item 3.

Two actions have been addressed outwith the meeting and can be closed:

• The chair and Laura Skaife-Knight to discuss feasibility of holding an AB meeting at Dr Gray’s Hospital. Update under AOB. 
• Stephen Gallagher and Laura Skaife-Knight to meet offline to discuss the cadence of the assurance board meetings. Update under AOB. 

 

One final action remained outstanding:

• Consider the role nurses are playing in the discharge process and clarify the role of discharge coordinators. June Brown provided an update to confirm that this had been completed

 

All outstanding actions were therefore closed.

 

Item 3: Unscheduled Care

 

GF provided an update on unscheduled care performance. She confirmed performance remains challenging and largely flat. Four‑hour access performance has plateaued at 58.2%, with some week‑on‑week reduction in Aberdeen Royal Infirmary performance but stronger delivery in Dr Gray’s Hospital. Occupancy remains high but stable at 106%, and boarding pressures have increased, with 73 patients in Aberdeen Royal Infirmary, predominantly general medicine. Delayed discharges are broadly stable overall, with acute at 32 and non‑acute reducing slightly to 114.

 

Ambulance handover times continue to be challenging.. The number of patients waiting over 60 minutes at Aberdeen Royal Infirmary has increased to 225 from last week’s performance, and median turnaround times across NHS Grampian have worsened, rising from 69 to 79 minutes, driven by Aberdeen Royal Infirmary performance. Pressures at Dr Gray’s Hospital remain comparatively lower.

 

In summary, system flow remains constrained with sustained occupancy, increased boarding, and worsening ambulance turnaround times for the week in question, indicate continued pressure across urgent and unscheduled care pathways.

A query was raised regarding the sustained reduction in 12‑hour waits, noting concerns around current performance. Clarification was sought on the plans in place to address this and how trends are developing over time.

RS advised that there is a focused programme of work underway to reduce long delays.

He shared that some estates issues in cardiology relating towater ingress  have had some impact on system capacity. RS confirmed that work is ongoing and indicated this issue is expected to be progressed within the week.

A query was raised regarding the scope of the developing paper relating to bed reconfiguration, including whether it would support 7‑day working. It was noted that it has been approximately a month since the initial site visit, and further clarity was sought on how the case is progressing.

HFB advised that the work is potentially financially significant, with implications for service redesign and delivery models, and therefore requires careful development and good governance.

It was noted that the paper has undergone multiple iterations and is now approaching a more advanced draft stage. However, it is not yet at a point where it can be brought to the executive team, as further decisions and refinements are required prior to escalation.

GE welcomed the approach being taken, noting the importance of balancing current service delivery with longer‑term planning. Drawing on experience from other systems, he highlighted that while new models can bring significant benefits, they can take several years to fully mature and establish sustainable staffing. He emphasised that having a clear view of the end‑state model is sensible and provides reassurance.

DB asked questions regarding the frailty plans, including how decisions are being made and the pace at which they are progressing. She queried how the work being undertaken will be sustained over time and how it aligns with the wider system plan, as well as when implementation is expected.

Discussion also reflected on the time required to move from decision making to implementation, and whether additional support could help accelerate progress, or whether delivery is primarily dependent on specialist clinical expertise and leadership.

LSK advised that the executive team had met earlier that morning and agreed to return to this discussion on 16 June 2026 so there is a holistic discussion on unscheduled care plans, including the frailty proposal. It was noted that three key areas of work will be brought together to support this, including the emergency department staffing position, the frailty options appraisal, and the urgent and unscheduled care financial paper. She emphasised the importance of aligning these interdependent areas to provide clarity for decision making. LSK also welcomed ongoing engagement with the Scottish Government, noting that this should continue at the appropriate point in the process.

 

LJ confirmed the improvement programme is now moving into more structured delivery. For 2026/27, work is being taken forward through three operational groups focused on reducing admissions, length of stay, and delayed discharges, alongside key enablers such as the integrated flow hub, ‘Hospital at Home’ expansion, and development of community assessment hubs.

 

Looking ahead, there is a strong emphasis on planning and governance. The programme has established a clear cadence of weekly, fortnightly and quarterly oversight, with delivery boards and workstreams driving progress. Key priorities include agreeing key performance indicator trajectories, finalising funding and priority areas, strengthening reporting arrangements, and progressing winter planning.

She reflected on the role of the group, noting a significant and positive shift towards more effective partnership working. It was highlighted that relationships now feel more collective and collaborative, rather than operating as separate parts of the system.

It was also noted that engagement with the Scottish Ambulance Service has been particularly valuable, helping to better understand system challenges in more depth.

She emphasised a willingness to support ongoing discussions at the delivery board, recognising the importance of maintaining this collaborative approach to drive improvement.

In summary, the focus is on translating improvement priorities into coordinated operational delivery, supported by tighter governance, clearer accountability, and forward planning for system pressures, including winter.

 

GE commented that delayed discharges have reduced, noting this as an encouraging improvement. He queried whether this reflected a seasonal effect.

 

It was confirmed that the improvement is attributed to greater grip and control across the system, with a reduction in length of stay contributing to the positive trend.

 

JM raised a question regarding the culture change in emergency department performance, asking whether there are examples where this is already being demonstrated in practice.

 

In response, it was noted that culture change is being driven by bringing the right people together, with a clear focus on ownership and accountability across the system.

 

It was highlighted that there is a strong emphasis on the executive team and delivery board, with a clear line of accountability for performance and delivery, supporting a more coordinated and outcome‑focused approach.

LSK noted that, as work progresses on culture and governance, it would be helpful to share the updated terms of reference and membership of the unscheduled care delivery board with the assurance board.

LSK went on to say that it had been agreed to undertake a NHS Grampian board deep dive on unscheduled care on 9 July with the full NHS Grampian board, which was considered timely to reflect on learning to date and future improvement priorities.

GF provided an update on the frailty programme, noting good progress and rapid options appraisal.

Plans are being developed to create capacity in the green zone, including around 20 additional beds, with direct access from primary care, community services and Scottish Ambulance Service.

Clinical safety and risk are currently being assessed ahead of implementation.

An update on the package of USC proposals would be brought to the assurance board after the meeting on 16 June.

4: De-escalation

 

LSK provided a verbal update on de-escalation criteria, including the latest position on the planned and unscheduled care trajectories.

 

The assurance board heard that the criteria set out a clear framework for NHS Grampian to move from stage 4 to stage 3 escalation, developed in partnership with the health board and Scottish Government.

 

It was noted that the criteria align with NHS Grampian’s 2026/27 strategic priorities, bringing together improvement activity across finance, performance, and leadership and governance into a single, coherent framework. Good progress has been made in financial performance and reducing long waits, however unscheduled care remains a key challenge, particularly in relation to the four-hour emergency access standard, ambulance handovers and patient flow, and is a priority for the year ahead.

 

Seven defined improvement areas are now supported by clear metrics, providing a structured basis for tracking progress and demonstrating readiness for de-escalation. It was noted that some planned and unscheduled care trajectories remain under discussion with Scottish Government, with all other criteria agreed and delivery underway, supported by strengthened governance and reporting arrangements.

 

In summary, this represents an important milestone, providing clarity on expectations and a route towards potential de-escalation, at the earliest from January 2027, with progress to be reported regularly to the health board.

SG noted that some additional detail of the decision-making and approval process around de-escalation would be helpful to add clarity to this section on page 4 ahead of the paper going onward to the 11 June 2026 public health board meeting.

Action: Scottish Government will provide some wording to explain the role of the groups and boards involved in the decision-making and approval process around de‑escalation so this can be included in the paper going onward to the 11 June NHS Grampian public board meeting.

5: Single Improvement Plan

 

PT presented a paper providing an update on NHS Grampian’s single improvement plan, developed in response to the diagnostic report following escalation to stage 4.

 

He highlighted that the plan brings together improvement activity across finance, performance, and leadership and governance, supported by a strengthened governance framework with clear oversight through health board committees and programme structures.

 

Progress has been made in embedding robust governance arrangements, including standardised evidence templates, a central repository for assurance, and strengthened scrutiny and challenge at committee level.

 

A significant number of recommendations have now been endorsed for closure through the agreed governance route, with some extended where further time is required to demonstrate sustainable improvement.

 

In summary, the plan is now operating as a well‑governed programme, with clear evidence of progress and a continued focus on delivery and assurance to support future de‑escalation.

 

FH commented that the approach is well structured, and noted that the move away from taking a sample-based approach to reviews is positive in mitigating risks of bias. She also emphasised the need to understand how longer‑term, sustainable outcomes will continue to be monitored beyond the improvement plan.

 

AE highlighted that significant progress has been made, which has been recognised by the Performance Assurance, Finance and Infrastructure Committee. She noted that while a sampled approach may be sufficient going forward, it remains important to retain visibility of the detail and rationale behind decisions in order to provide assurance.

 

AS advised that further work is being undertaken on the financial elements of the improvement plan, and that a brief follow‑up paper will be brought back to the assurance board.

 

Action: Paper on finance elements of the improvement plan to be brought to future assurance board meeting

 

SG noted the course of action being taken, including the governance arrangements applied by the health board, and sought clarity on how evidence and progress will continue to be reported urging a proportionate approach focussing on key actions and risks to delivery.

 

6: Governance

​JB provided an update on NHS Grampian’s response to the Healthcare Improvement Scotland diagnostic, including arrangements for staff communication and ongoing health board oversight.

They outlined that NHS Grampian has proactively requested this support and has agreed a programme of responsive support with Healthcare Improvement Scotland, with an initial eight-week diagnostic review commencing in early June 2026, focused initially on Dr Gray’s Hospital while considering wider system pathways.

The diagnostic will provide an independent, evidence-based assessment of safety, quality, governance and organisational culture, helping to identify strengths, risks and priorities for improvement.

GE requested clarification on the timeline of key activities, noting the sequence of the diagnostic commencing on 8 June 2026 and the health board meeting on 11 June 2026, alongside two key components of work progressing.

SG highlighted the importance of understanding the timing of subsequent milestones, including the quality and safety review mid-June, the expected timing for the diagnostic findings to report, and broader timelines for Healthcare Improvement Scotland engagement and programme management office recruitment.

Action:  June Brown to bring back an update on the Healthcare Improvement Scotland diagnostic and programme management recruitment timeline.

AE provided an update on health board governance, highlighting recent engagement with colleagues in Lothian and Forth Valley, which were described as positive and constructive discussions.

It was noted that discussions with Lothian focused on data presentation and the type of information provided to the health board, resulting in the introduction of weekly updates from the chief executive team.

Engagement with Forth Valley was similarly positive, with a focus on sharing learning and shaping a collective way forward.

It was noted that a key learning has been the benefit of pausing and reflecting on changes at pace, to support more effective and informed decision‑making.

RK reflected on the need for a deliberate and structured approach to governance, noting the importance of returning to core principles and a clear understanding of systems, processes and capability across the organisation.

It was acknowledged that strengthening corporate governance will take time and should be supported through a formal improvement plan, which will be developed and brought back to the assurance board by the end of the summer.

It was further noted that this will provide a measurable improvement plan, with ongoing evidence and progress to be reported back to the assurance board, led by AE.

7: Value & Sustainability

JB provided an update on the quality impact assessment output and wider clinical care governance reporting.

They highlighted that a clinically-led quality impact assessment approach has been applied across the 2026/27 Value and Sustainability programme to ensure delivery of savings is balanced with maintaining patient safety, quality of care and staff wellbeing.

The panel reviewed 59 savings schemes across 14 workstreams, concluding that the majority are low risk and can be taken forward, subject to ongoing monitoring of key performance indicators and the ability to pause schemes if adverse impacts are identified.

 

They noted that a small number of schemes require further assurance or specific mitigating actions before implementation, and four schemes were not approved due to concerns regarding patient safety, workforce impact or service quality.

Alongside this, the integrated impact assessment process has provided assurance that equality, human rights and wider socio-economic impacts have been considered, with most schemes assessed as low risk and appropriate mitigations identified where needed.

In summary, robust clinical governance arrangements are now in place to support delivery of the savings programme, ensuring impacts are actively monitored and managed to protect patients, staff and service quality.

Action: Hugh Farrow Bishop to share the risk appetite paper with the assurance board.

IB commented that the paper was robust and well‑structured, highlighting that risks are appropriately escalated to a corporate level where required, particularly in relation to financial considerations, while noting the breadth of projects involved.

JB emphasised that risks have been identified and actively mitigated, noting that where schemes were considered too high risk, they were either not approved or subject to further work and assurance before progressing.

AS noted that there was limited additional update for finance at this stage, advising that the period-2 financial position is still being finalised and is expected to be available next week. He confirmed that this will be shared with the assurance board via a slide deck once complete.

8: AOB

Next meeting: 30 June 13:00 – 15:00.

A visit to Dr Gray’s Hospital is being planned for Summer 2026; the date will be confirmed in due course.

LSK updated board secretary interim recruitment to support governance improvement. Gail Woodcock, substantive director of strategy, transformation and performance is starting in post on Monday 8 June 2026.

SG thanked Phil Tydeman on the work that has been done for the NHS Grampian Assurance Board.