NHS Grampian Assurance Board minutes: 07 May 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, Board Chair
• (LSK) Laura Skaife-Knight, Chief Executive
• (JB) June Brown, Executive Nurse Director
• (SD) Sarah Duncan, Health Board Secretary
• (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 Integration Joint Board
• (FM) Fiona Mitchelhill, Chief Officer, Aberdeen City Integration Joint Board (item 5)
• (JP) Judith Proctor – Chief Officer, Moray Integration Joint Board (item 5)
• (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
• (LB) [redacted], Policy officer

• (GD) [redacted], Assurance & Improvement Unit
• (HM) [redacted], Policy officer (notetaker)

 

Items and actions

Welcome and Apologies

SG welcomed members and attendees to the nineteenth meeting of the assurance board, noted apologies and outlined the agenda. He reflected on the walkthrough at ARI this morning by members and thanked staff for their time in facilitating this and its usefulness, engaging with the teams in flow navigation, integrated care hub, emergency department, and medicine/frailty.

Michael Dickson, chief executive Scottish Ambulance Service had been invited to attend for the unscheduled care item, however he is unavailable and will be invited to a future meeting.

Actions/Updates from previous meetings

SG confirmed publication of minutes will commence again from week commencing 11 May 2026 following the election period.

GD provided an update on the action log:

There is one action outstanding from meeting 17 – Phil Tydeman to share a copy of the integrated impact assessment on value and sustainability with assurance board.

Update – this will be an agenda item for assurance board on 02 June 2026.

 

There is one action that was carried forward from meeting 19 - Convene Unscheduled Care (USC) Subgroup to have a deep dive on performance and variation at Dr Gray’s Hospital – this can be closed as the meeting took place on 05 May 2026, and an update from this will be provided during the unscheduled care item on this agenda.

 

There is one action outstanding from meeting 19 - De-escalation criteria on planned and USC performance to be included on a June agenda. – This will be an agenda item in June 2026.

 

Unscheduled Care

LJ outlined the current challenges and the mitigations being put in place. Over recent weeks, there has been some improvement in achieving safer flow. A key point is the need to better understand the underlying drivers behind the headline figures, particularly in relation to variance. Challenges remain despite improved flow conditions. The system continues to be dominated by bed availability and discharge flow issues. Continuous improvement is required.

SG asked what learning is there from other organisations that could be taken on board and what further assets are available nationally and locally, for example access to improvement advisers.

GE noted that ambulance waits and overall occupancy are showing improvement and trending downwards. However, further detail is needed regarding 12-hour waits. He also highlighted that performance on non-admitted pathways should be stronger, as there are no clear barriers preventing improvement in this area.

DB reflected positively on the site visit this morning. She emphasised the decision-making process, particularly how staff ideas are identified, tested, and implemented and suggested the health board could benefit from accelerating its test-and-learn approach to roll-out improvements more quickly.

HFB acknowledged the positive changes observed during the visit today, particularly in the minor's area and the new waiting area in Rapid Assessment And Care (RAAC). He noted the positive impact these developments are having on long ambulance waits and emphasised that both initiatives were generated and delivered by clinical teams.

LSK welcomed the discussion, noting it was helpful to hear these insights. She highlighted the importance of whole hospital improvement and stressed that the contribution of staff ideas to driving positive change should not be underestimated. She also welcomed the continued socialisation of ideas across the organisation to support wider improvement. Organisational development support will likely be necessary to support the changing culture piece.

SG commented on the significant effort and engagement across the organisation, noting a positive shift in culture. There is now greater discipline within the unscheduled care programme. He also welcomed the stronger connection now being envisaged between the other NHSG improvement plan activities on people and culture, clinical governance, and unscheduled care. He posed the question of how to take things further, to create a critical mass of people empowered to make change, recognising the need to have focus and parameters around this. The assurance board would be happy to facilitate a conversation around this with national improvement partners, if helpful.

In relation to performance metrics, SG noted that four-hour performance across NHS Grampian as a whole  not, in isolation, a particularly useful measure. Data should be broken down by individual site to better understand what constitutes meaningful performance change in each. He asked that reports to the assurance board are based on site-by-site metrics in future. Pan-Grampian performance should be a footnote and not the headline.

For the Scottish Ambulance Service, it was highlighted that maximum waiting times and the number of hours lost per week are more powerful when considered together, rather than as standalone metrics.

SG asked for the components of the programme which would enable the discharge without delay and the volumes going through that. LJ provided an update on the multi-disciplinary approach to discharge.

DB commented that the integrated flow hub was impressive and sought further clarity on how it is operating in practice. In particular, she queried how the links work into and out of the integrated flow hub, and how it connects to wider decision-making processes and the integrated flow hub.

LJ confirmed that there is significant work underway to further improve integrated working across services. This includes strengthening pathways, to support and ensure clarity around expectations across partners to improve MDT communication and working. While there has been progress, there remains an ongoing challenge to sustain continuous improvement.

It was noted that social workers are present within the system and are monitoring delays; however, they need to be involved at an earlier stage in the process to have maximum impact.

A programme of work relating to the flow hub is being progressed through the unscheduled care improvement board, including the development of key performance indicators (KPIs).

JB reflected on the role of the nursing team in the discharges process and whether there was a need to consider this further. She agreed to take an action to clarify the role of discharge co-ordinators.

Action:  June Brown to consider the role nurses are playing in the discharge process and clarify the role of discharge co-ordinators.

TS reflected on the process pre-covid when planned dates of discharge would be set early, and whether that was what could be strengthened. JB agreed.

LSK provided a verbal update on the work done by the executive team to strengthen understanding of the unscheduled care landscape. She described the collective corporate responsibility and shared what that looks like on a weekly basis. At executive team meetings on a Tuesday there is a standing agenda item around weekly data and performance that week, including the national benchmarking. She described specific agenda items in recent months have included agreeing a timeline for the frailty bed reconfiguration and building strengthened relationships with the Scottish Ambulance Service by working more closely together on improvements for patients.

Next week the executive team will concentrate its discussions on culture and scaling up engagement across the organisations. LSK emphasised the importance of the executive team not cutting across the work of the unscheduled care improvement board. She described the importance of individual roles as well as collective responsibility and that the executive team were getting much better at knowing where they needed to be. She noted the plans around improved visibility and strategic relationships and how this is communicated across the organisation.

SG reflected on the need for the executive team to have visibility and connection with front line, he referenced for example LSK working a night shift to get a sense of what it feels like on site out of hours and how that shows staff that senior leaders are visible and able to understand the complexities teams are dealing with. This is particularly key when implementing a change on this scale.

AE provided a verbal update on changes that have been implemented by the NHS board on unscheduled care data. She advised that since October 2025 the NHS board have been receiving unscheduled care papers about “where we are” to have the focus. They have been looking at KPIs and performance data. This enables board members to concentrate on areas for concern. She advised that there are limitations to the system as the NHS Grampian board only meets every two months and the data they are considering may not be current. She described ongoing work to recognise and overcome these limitations, including increasing benchmarking national data.

AE went on to describe how there were more closed board meetings, where data was discussed and the importance of getting the balance right about having things in a closed space but also maintaining the transparency for members of the public. There will another NHS board seminar next Thursday where some of this will be teased out.

 

SG noted that AE had asked some questions of the assurance board regarding good practice from other NHS boards in regard to   scrutiny of performance reporting and use of data. RK would provide some information and signposts by 15 May.

 

Action: RK to write to Alison Evison on good practice and use of data by other NHS boards.

 

TS asked whether the NHS Grampian board has access to the whole system dashboard. AE replied that they were considering the balance of getting the right amount of information and they would consider this. A discussion was held on what was appropriate to share from other boards. TS will give some thought and feedback.

 

Action: Tracy Slater to consider what information from other boards is appropriate to share to NHS Grampian board members.

 

Dr Gray's Hospital - deep dive and improvement proposals

GF presented a deep dive on performance at Dr Gray’s Hospital, outlining the unique challenges associated with its rural and geographically isolated context, rising demand from an ageing population, workforce fragility, and constraints in bed capacity and physical estate. These factors have contributed to an imbalance between demand and capacity, high occupancy, delays in flow, and ongoing impact on patient experience and 4-hour performance. A programme of improvements is underway, focused on reducing unnecessary admissions, improving patient flow and discharge processes, and strengthening operational grip across the system. The review highlighted the need for clearer daily goals, stronger alignment between the emergency department and wider hospital flow, and more consistent discharge management, alongside a set of practical recommendations to improve flow, reduce delays, and support more reliable performance.

GF described the presentation includes information from RS who spent a week at Dr Gray’s and his external view was helpful. Performance variation can occur from day to day. There are useful recommendations that can help that.

GF highlighted that the Moray model of discharge-to-assess was expanding across all areas and was working well. There is a clinical assessment unit where part of the emergency unit is protected for use of minors and non-admitted patients. There are some staffing and cultural issues that need to be addressed to ensure consistent approach and focus on discharging.

GE asked about consultant cover and HFB provided an update on recruitment.

DB provided an update from the unscheduled care subgroup discussion on the variability and the lack of consistency, and the need for routes into hospital and are links agreed. She thanked the team responsible for the work and report and reflected on its insightful view.

SG asked about next steps. GF replied from the deep dive there are 13 recommendations, some implemented, some have a short-term window, and some long-term and an action plan will be formed. GF reflected on the need for ownership but that teams are open for the change.

JB stressed the need to link this to the next agenda item on clinical governance and to quality and safety and the longer-term plans.

HFB described about the challenges that come with a strong reliance on locum staff resulting from long-standing recruitment challenges at Dr Gray’s Hospital, though summarised some promising developments regarding potential substantive recruitment to medical posts.

LSK explained that much work is being undertaken to further improve quality and safety in the immediate term, and said the scope of the Healthcare Improvement Scotland diagnostic review that will soon get underway has been signed off and the output of this work will help with medium to longer-term improvements.

There was a discussion about how some of this work would be linked into sub-national developments.

GE requested a future assurance board be held at Dr Gray’s Hospital to provide the Assurance Board with familiarisation of the hospital and the flow.

 

Action: The chair and Laura Skaife-Knight to discuss holding a meeting at Dr Gray’s Hospital.

 

Governance

Clinical Governance

JB described how there have been four inspections by Healthcare Improvement Scotland (HIS) in the last week and three letters from HIS in the last month. HIS will provide a diagnostic of clinical governance at Dr Gray’s Hospital in its entirety. A quality and safety improvement board will be set up by NHS Grampian, taking a programme management approach and linking closely to the wider culture work.

SG advised he has been copied into the HIS correspondence and responses from the NHS Board

GE reflected on the letter from HIS, observing parallels with the issues previously identified at Aberdeen Royal Infirmary, which suggested that learning had not been effectively transferred across sites. He raised concerns that the organisation lacked the same level of control and oversight in clinical governance as it was now demonstrating in financial management. 

JB responded that a seminar on governance was scheduled for the following week. She explained that the post-COVID changes to governance had not been fully implemented and were in place in some areas but not consistently across the organisation.

HFB described some of the background that led to the input from HIS which was because of the NHS Board’s proactive engagement with HIS.  Shared learning was not embedded yet and that would be the role of the new Clinical Quality and Safety Improvement Board.

A discussion took place on improving quality and safety and developing the systems at all levels whilst balancing priorities. 

GE asked whether there was a resource issue; JB replied that they needed time to test that theory as part of the strengthened oversight.

LSK provided feedback that they have been clear to HIS that following the diagnostic NHS Grampian will need ongoing external support to support implementations of the prioritised recommendations that will follow There will be future discussions with HIS about what that looks like.

It was noted the first meeting of the Clinical Quality and Safety Improvement Board will be 13 May 2026. This will be a ‘meeting zero’ style about establishing terms of reference for the improvement board and establishing methods of working. Feedback on the improvement board will be brought to the assurance board.

Outputs of NHS Board seminar.

AE provided a verbal update on the outputs of the health board seminar, highlighting a number of  emerging themes focused on strengthening governance arrangements. These included improving transparency, openness, and culture within the health board discussions, enhancing the quality and alignment of agendas and reporting, and learning from best practice across other health boards. There was also a strong emphasis on increasing the visibility of patient voice, clarifying the health board’s authority and levers, and improving committee structures and reporting processes. Consideration was also given to resourcing requirements to support these improvements.

AE went on to describe some of the work ongoing including links to other NHS boards as described above, and work with public delivery services Scotland. She went on to explain the NHS Board meeting earlier today to discuss recent HIS correspondence and the organisation’s response. Vice-chairs will be invited to business meetings as there will changes to chairs in October and January. Future board seminars will focus on operational governance and the recommendations of the HIS diagnostic review. She stressed there is a strong appetite to support this improvement work

SD described the work that will take place over the summer where there will be a review of all the terms of reference of the committees. These will consider the findings of next week’s seminar. There will a public board in October. Strategic risk deep dive reports will be made public.

SG said it would be helpful to have a consolidated output followed by a discussion at a future assurance board meeting to identify any further support that can be offered as the Board moves to implementation of the actions described today.

Action: NHS Grampian board to produce a paper on consolidated outputs from board seminars on governance and ways of working for a future assurance board meeting.

DB asked if the NHS board are confident, they are moving towards having the right structures in place for governance. AE replied that they were working towards that, and they know where they want to be.

 

Value and Sustainability

AS provided an overview of the Quarter-4 position, noting that NHS Grampian achieved a year-end deficit of £34.7 million, within the agreed funding envelope, supported by delivery of savings above plan and improved financial performance across both delegated and non-delegated services. Progress has been made in strengthening governance, implementing the single improvement plan, and improving the financial position of integration joint boards, with reserves now held in two of the three integration joint boards. Looking ahead the 2026/27 plan requires delivery of £40 million in savings, underpinned by the Value and Sustainability programme, alongside continued focus on operational improvement, particularly in planned and unscheduled care. Key risks include workforce pressures, delivery of savings, integration joint board funding assumptions, and wider system demand, with ongoing work through the North-East Transformation Group to support longer-term sustainability and system-wide reform.

JG agreed that the Quarter-4 review was more positive and that next week sees the one-year anniversary since escalation and it is good to now see sustained financial improvement.

FM noted an underspend in Aberdeen City which they have put into reserve funding. They have £14 million savings plan for 2026/27 which will be challenging. Continuing to work on this but mindful of the impact on quality of savings. The integration joint board has no further financial ask of partners this year.

JP advised that the situation in Moray was escalated early in the year due to demands on services, particularly children’s services. Overspend is within the parameters set. Savings programme will be reliant on help from partners. The position remains challenging but did improve at year-end.

LJ reported a small overspend in Aberdeenshire and noted that a three year saving rolling plan is in place to support the delivery of sustainable services.

The three chief officers confirmed that multi-year plans are in place across all three integration joint boards.

PT provided an update on progress with the 2026/27 Value and Sustainability Programme, noting that detailed work is underway to confirm the phasing and deliverability of savings, with overall confidence that the full programme will be achieved. Quality Impact Assessment panel activity has progressed well, with the majority of schemes approved and a small number requiring further development or rejected on quality grounds. Ongoing work is focused on maintaining delivery momentum, strengthening monitoring, and tracking arrangements, and finalising governance processes, alongside preparation for future phases of the programme and alignment with wider system transformation activity.

 

The Assurance Board noted this update and the level of confidence in the 26/27 Value & Sustainability Programme.

 

AOB

Due to time constraints, SG asked NHS Grampian to provide correspondence updates on CDU and recent media articles on complaints handling.

SG thanked LSK and her team for arranging a tour of ARI for board members that morning, noting that this was a productive and helpful visit. The assurance board noted particular thanks to those NHS Grampian colleagues who had taken the time to speak to assurance board members and show them around the facilities.

Next meeting: Meeting 20 is scheduled for Tuesday 19 May @ 1pm