NHS Grampian Assurance Board minutes: 08 September 2026

Attendees and apologies

Members Scottish Government

• (SG) Stephen Gallagher, Chair
• (DB) Donna Bell, Director of Social Care & Mental Health
• (GE) Graham Ellis, Deputy Chief Medical Officer for Scotland
• (FH) Fiona Hogg, Chief People Officer
• (CP) Claire Pearce, Deputy Chief Nursing Officer
• (RK) Robert Kirkwood, Head of People, Governence and Appointments unit

Attendees – NHS Grampian & Partners

• (AE) Alison Evison, Health Board Chair
• (LSK) Laura Skaife-Knight, Chief Executive
• (PB) Paul Bachoo, Medical Director Acute
• (JB) June Brown, Executive Nurse Director
• (TF) Tara Fairley, Deputy Medical Director, Acute Clinical Governance
• (GF) Geraldine Fraser, Chief Officer, Acute Services
• (HFB) Hugh Farrow Bishop, Executive Medical Director
• (SL) Steven Lindsay, Employee Director
• (LM) Lucy McLeod, Dr Gray’s Hospital General Manager
• (JO’B), Jay O’Brien, Director of People and Culture
• (GW) Gail Woodcock, Director of Strategy, Transformation and Performance

 

In attendance

• (GD) Glen Deakin, Assurance & Improvement Unit
• (TS) Tracy Slater, Assurance & Improvement Unit
• (JMi) Jess Milne, Unscheduled Care Unit
• (RT) Rabina Tindale, Observer

Apologies

• (SF) Stephen Friar, Deputy Medical Director, Unscheduled Care
• (AS) Alex Stephen, Director of Finance
• (RS) Rick Strang, Unscheduled Care Improvement Director, NHS Grampian

Items and actions

1: Welcome and Apologies

The chair welcomed members and attendees to meeting twenty-four of the assurance board. He reflected on NHS reform that featured in the Programme for Government announcement of the previous week. He confirmed that NHS Grampian remains an escalated system and so the assurance board's remit will continue while NHS Grampian remains in escalation, with future national structural reform not altering the immediate requirement to improve patient care, safety, staff wellbeing and organisational control.

2.  Actions/update from meeting

The minute from meeting twenty-three was signed off. Of the three outstanding actions, two were effectively closed through agenda scheduling, while the work on quality and safety KPIs remains in progress. HFB said that draft KPIs had been shared separately and asked for the substantive item to come back once the work is more mature.

Action: Finalise the quality and safety KPI set, including the developing framework and measures, and return it to the assurance board as a substantive update.

3. Quality safety and improvement work in clinical governance

HFB talked through the slide pack that had been prepared. Opening comments described a system where reporting is happening, but the organisation cannot yet show that accountability, escalation and governance expectations are consistently understood across all services and partnerships. It is recognised that this is not an issue related to only specific areas but rather a more systemic issue that is organisation wide.   

It was noted that, while a number of governance arrangements are in place, the absence of a single organisation-wide clinical governance framework has led to some variation in roles, expectations, standards and performance measures.  NHS Grampian is therefore developing a formal framework, aligned to HIS clinical governance national standards and informed by learning from other Boards, to provide clearer governance arrangements, accountability and assurance processes. Implementation is planned by Autumn 2026.

Discussion highlighted the need to move at pace from planning to implementation. While staff engagement has been positive, governance arrangements have historically relied on local practice, resulting in inconsistent reporting, escalation and accountability. The Assurance Board emphasised the importance of embedding core governance fundamentals, including clear ownership, structured oversight, escalation processes and feedback mechanisms.

TF provided an update on clinical governance work with staff at Dr Gray’s Hospital, noting strong engagement and willingness to improve. However, there has been variation in governance expectations, reporting thresholds and escalation practices, reflecting locally developed arrangements rather than a fully standardised organisational approach. She also outlined the work underway to strengthen core governance arrangements, including clearer accountability, structured oversight, defined escalation processes and improved feedback mechanisms for staff.

The issues identified at Dr Gray’s Hospital were considered to highlight challenges that have relevance beyond the site itself.  The Assurance Board emphasised the importance of addressing both organisation-wide and site-specific factors.

HFB provided an update on outstanding Level 1 adverse event reviews, including work to review open cases, identify learning themes and consider whether any earlier reviews require further examination. He highlighted challenges affecting review timescales, including the need for appropriate oversight and experienced clinical capacity. The Assurance Board emphasised the importance of clear plans to support progress while maintaining review quality. LSK outlined work to identify additional support through the Scottish Government, Healthcare Improvement Scotland and the East Sub-National Planning Group, with further discussions planned.

Action: Laura Skaife-Knight to have further conversations with HIS, East regional colleagues and Stephen Gallagher around further support to address the backlog of reviews.

 An update on complaints performance followed. JB highlighted the number of complaints exceeding 80 days and outlined work underway to better understand the factors contributing to delays and to strengthen and standardise complaints processes. The Assurance Board emphasised the importance of clear ownership, effective oversight and timely progression of cases. It also noted the need to address any perceived culture of tolerance towards delays, ensuring greater focus on timely resolution and accountability.

LSK noted that complaints, adverse events, information governance and employee relations continue to experience backlog pressures, and that executive leaders have been asked to establish recovery trajectories and identify the resources required in each area. The discussion recognised that these workstreams are at different stages of recovery planning and implementation.

 HFB summarised the circumstances that led to changes in paediatric services at Dr Gray’s Hospital. He outlined the governance, oversight and assurance arrangements now in place, noting that surgical activity is currently subject to enhanced oversight, including specialist input and confirmation of training requirements.  Any resumption of surgical activity will require assurance on capability, training and specialist sign-off.  The Assurance Board highlighted the importance of strengthening governance arrangements, training oversight and communication processes, recognising that key controls and information flows had not operated consistently across all relevant teams. 

HFB stated that NHS Grampian will strengthen arrangements for communicating urgent pathway changes, following learning from the paediatric surgery restrictions regarding the dissemination of key information.

 Throughout the session, NHS Grampian was challenged to build on its understanding of the issues by demonstrating tangible delivery of improvement, supported by clear trajectories, effective executive oversight and strong ownership of recovery activity. SG and GE emphasised the importance of evidencing how planned changes are translating into improvements in frontline practice.

The chair summarised the discussion by noting that the Assurance Board can see intent, effort and planning but cannot yet be assured that the organisation is converting these plans and intentions into consistent action and asked for culture and organisational dysfunction to be explored more deeply at the next meeting.

 

4. Leadership and Culture Programme update 

In view of the previous discussion and the time spent discussing clinical governance in detail, this item was deferred to the next meeting to allow sufficient time to consider the details.

Action: Add an update on the leadership and culture programme to the agenda for the next assurance board meeting.

5. AOB

There was no further business.

 

Date of next meeting – 22 September 2026