NHS Grampian Assurance Board minutes 10 March 2026

Attendees and apologies

• Stephen Gallagher, Chair, Scottish Government
• Professor Graham Ellis, Deputy Chief Medical Officer for Scotland, Scottish Government
• Jack Gillespie, Deputy Chief Finance Officer, Scottish Government
• Tracy Slater, Head of Performance and Delivery, Scottish Government
• Donna Bell, Director Social Care & NCS, Scottish Government
• Alison Evison, NHS Grampian Board Chair
• Laura Skaife-Knight, Chief Executive, NHS Grampian
• Geraldine Fraser, Chief Officer, Acute Services, NHS Grampian
• Stephen Friar, Deputy Medical Director, Unscheduled Care, NHS Grampian
• Rick Strang, Site Director ARI, NHS Grampian
• Phil Tydeman, Interim Director of Improvement, NHS Grampian
• [redacted], Policy officer (notetaker)
• [redacted], Policy officer
• [redacted], Head of Unit
• [redacted], Unscheduled care policy lead
• Jonathan Belford - Aberdeen City Chief Finance Officer IJB
• Deborah O'Shea - Moray Chief Finance Officer IJB
• Mary Beattie - Aberdeenshire Chief Finance Officer IJB
• Leigh Jolly - Chief Officer Aberdeenshire IJB
• Judith Proctor - Chief Officer Moray IJB
• Angela Scott - Chief Executive Aberdeen City Council
• Jim Savege - Chief Executive Aberdeenshire Council
• Karen Greaves - Chief Executive Moray Council
• June Barnard (as deputy for June Brown) - Nurse Director for Acute, NHS Grampian
• Sarah Irvine (Deputy for Alex Stephen) - Deputy Director of Finance, NHS Grampian
• Fiona Mitchelhill - Chief Officer Aberdeen City IJB
• Meeting Apologies
• Irene Barkby, Associate Chief Nursing Officer, NHS Grampian
• June Brown, Executive Nurse Director, NHS Grampian
• Fiona Hogg, Chief People Officer, NHS Grampian
• Alex Stephen, Director of Finance, NHS Grampian
• Robert Kirkwood, Head of People, Governance and Appointments Unit

Items and actions

Welcome and Apologies

The Chair welcomed members and attendees to the sixteenth meeting of the Assurance Board, noted apologies and outlined the agenda.

Actions/Updates from previous meetings

The Chair provided an update on the action log:

There are 4 open actions and 2 actions now closed:

Closed

• Add an update on system discussions to a meeting agenda after 13 February 2026 and invite relevant partners to join a future AB meeting.

Update: This is covered in today’s meeting and the action is closed.

• Laura Skaife-Knight, Hugh Farrow Bishop, Graham Ellis and the Chair to meet offline to explore what support may be needed/offered regarding the work in hand.

Update: This meeting took place on 4 March so the action is closed.

Open

Four actions remain open but will be closed in subsequent meetings of the assurance board.

• NHS Grampian to reconsider the composition of the Culture Programme Board to ensure it is inclusive of wider organisational perspective. The director of people and culture will consider this.
• A further paper on corporate governance will be brought back to the assurance board to provide assurance and build confidence around the issues being considered. Robert Kirkwood indicated he is happy to provide any support required.

• The Chair asked for clarity on the clinical, senior executive, and site level leadership arrangements at Dr Gray’s Hospital, including the frequency of engagement with teams on site and how this fits within the overall governance structure.

• The Chair requested assurance on how these leadership arrangements come together and how information flows through to the NHS Grampian Board, emphasising the importance of seeing this “in the round” to ensure the Board has full visibility of risks, issues, and progress across the system.

The NHS Grampian Board is holding a seminar on 16th April to discuss Governance and a comprehensive update will be brought back to the Assurance Board thereafter.

Integrated financial and service planning

Laura Skaife‑Knight thanked partners for attending the Assurance Board and offered some initial reflections. She referenced the findings from the external diagnostic review and highlighted the strong progress being made, which will be evidenced in this meeting which has a system focus, including strengthened relationships with partners, enhanced financial reporting including Integration Joint Board financial reporting to the NHS Grampian Board, governance and the shift in focus towards redesign and transformation taking a Once for Grampian approach.

Phil Tydeman provided an update on integrated financial and service planning. Further to this confirming the Grampian system continues to face significant financial pressure, with all three Integration Joint Boards (IJBs) and NHS Grampian requiring deficit support in 2024/25 and further challenges expected in 2025/26 and 2026/27. For 2026/27, the system faces a combined pre‑savings deficit of £128m, reducing to £59m after planned savings, with NHS Grampian carrying the largest share.

Leigh Jolly noted that partners are strengthening collaboration with weekly IJB Chief Officer meetings, whole system planning workshops, enhanced financial reporting, and the re-establishment of the North East System Transformation Group. Savings programmes are progressing, with £42m of NHS Grampian schemes under development and multiple savings options under consultation across the IJBs.

Fiona Mitchelhill commented on the major system risks remaining, particularly around financial sustainability, workforce, inflationary pressures, and the scale of savings required. Demand pressure is intensifying due to a rapidly growing over-65 population, alongside continuing workforce pressures, increasing non pay costs, and ongoing challenges across social care and prescribing.

Laura Skaife-Knight commented that the critical path to 2027/28 depends on continued strengthened joint working, with the aim of developing all saving options by November 2026 for 2027/28 by all partners and further strengthening whole system governance.

The chair invited comments from Assurance Board members.

Jack Gillespie noted the positive progress with the financial grip and control arrangements. He welcomed the organisation’s commitment to meeting the £45 million deficit target, recognising this as a substantial improvement compared with the previous year.

He also reflected on the three-year forward view for non-recurring support, formally noting the health board’s commitment to living within that agreed level, even though it represents the highest level of support provided to date.

Jack Gillespie welcomed the overall approach taken and emphasised that there is positive learning to take from this work, particularly in understanding how these improvements affect the organisation’s current and future financial position.

Angela Scott noted that there has been strong and routine financial discipline, with improved clarity and alignment across the three system partners in relation to the IJBs. She emphasised that the financial position is now being viewed more consistently across the whole system.

Jim Savege welcomed the totality of the approach, commenting that the whole system focus within NHS Grampian has been both helpful and productive. He highlighted that collaboration and alignment between the IJBs has been particularly positive.

Karen Greaves also welcomed the approach taken, recognising the challenge, pace and shared learning that has taken place across partners. She stressed the importance of understanding the impact of financial challenges, noting that while collaboration is strong, the system must remain mindful and careful in how these issues are addressed.

Overall, members agreed that the collaborative, systemwide approach is having a positive effect on planning, decision making, and financial alignment.

Donna Bell reflected on the presentation and welcomed the significant shift in system-wide planning and collaborative working, noting that the development of this approach is very much welcome. She felt the presentation provided a clear and balanced expression of the wide range of factors that have been considered and highlighted the positive impact this is having across the whole system.

She further noted that, while collaboration is strengthening, it is important to explicitly recognise risk interactions across the system. A change or improvement in one area may unintentionally create failure demand elsewhere, and she asked whether this interdependency has been fully factored into the assessment of risk. She emphasised the importance of ensuring risks are understood not only in isolation but in terms of their wider system impact.

The Chair welcomed the update and asked for further evidence to strengthen assurance; particularly around how collaborative work is driving measurable improvements. The Chair stated the responses focus specifically on Donna Bell’s earlier question on whether changes resulting from collaboration have required adjustment elsewhere in the system. The Chair emphasised the need to understand not only the progress but also the system wide consequences of shifts in practice, to ensure that unintended impacts are identified and addressed.

Fiona Mitchellhill highlighted the example of the ten beds and the collaborative effort undertaken with partners to support safe and effective utilisation. She noted that this demonstrated strong joint working and a willingness across organisations to adapt capacity to meet need.

The Chair asked whether there were additional areas of collaboration where similar work was underway or planned, and whether these could be brought forward to further strengthen understanding of whole‑system interdependencies.

Leigh Jolly provided a practical example from Aberdeenshire, noting that because Aberdeenshire owns its own care homes, there is a strong opportunity to create greater consistency in how services are delivered. She highlighted that this approach brings grip and control, enabling the system to establish a more unified and aligned way of working across different parts of the service.

Leigh Jolly emphasised the importance of ensuring that, as these approaches are developed, the system brings people with us around the table, recognising that successful implementation depends on collaboration, shared understanding, and maintaining collective ownership across partners.

The chair asked for more detail on the “once for Grampian” schemes, including how they are prioritised, the organisation’s capacity and capability to deliver them, and when work is expected to begin.

Phil Tydeman advised that the team is undertaking a prioritisation exercise of the initial eight identified schemes and that each had been assessed against potential savings opportunity and ease of implementation. The list was stated not to be exhaustive and further engagement was required to understand the wider offering for integration.

The Chair closed by emphasising the need for an integrated approach. The Assurance Board can draw assurance from the examples shared across the IJBs.

Unscheduled care

Geraldine Fraser provided an update on the Unscheduled Care performance at NHS Grampian. Unscheduled care performance remains challenged but shows early signs of improvement. Ambulance turnaround times have slightly recovered, and four-hour emergency access performance has risen to 53%, with improvements supported by the ambulatory clinic trial and extended hours in RAAC. Daily early discharges through the “10 before 10” initiative continue to strengthen patient flow, reducing ARI midnight occupancy from 756 to 704 beds.

Key pressures persist, particularly delays for onward care, ambulance waits, and cultural/logistical barriers to timely discharge. Work is focused on bed rebalancing, increasing frailty capacity, reducing general medicine boarders, better use of discharge lounges, and strengthening collaboration with HSCP partners. A new dual sign‑off process aims to cut ambulance waits to a four‑hour maximum across the next two weeks.

System-wide improvements include rapid progress on the Integrated Flow Hub, due to go live on 18 March 2026, and modelling to support a targeted 5% uplift in four-hour access by end of March 2026. Tier 2 KPIs improved in December 2025 but dipped in January 2026 due to weather and high demand. Engagement on 2026/27 priorities continues as non‑recurring funding is reviewed for sustainability and risk.

Jess Milne welcomed the improvement in performance but asked how confident Grampian is that this progress is sustainable. She noted that there are still days where performance at ARI is in the 30% range and asked what the barriers are to consistently reaching 40% and then above.

Leigh Jolly responded that there is now greater confidence in the changes implemented, with early indications showing positive and more stable performance.

Rick Strang added that change affects everyone, but teams are beginning to find a more consistent rhythm as new ways of working bed in.

Graham Ellis noted improvements in Tier 1 performance, 12‑hour breaches, and corridor care, describing these as the key foundational elements that must be in place. He said he is encouraged by the early signs of improvement across these areas.

Donna Bell requested a summary update on progress against the original improvement plan, asking whether Grampian remains on track with the commitments previously set out and whether any elements are now off plan.

Leigh Jolly provided a practical example, noting that 280 bed days have been saved since December 2025, and confirmed that a review is underway to assess progress within the committed workstreams and identify where further adjustments may be needed.

Leigh Jolly described recurring funding challenges, to enable commission with less variance. Significant effort of delivering discharge and improved flow and the plan to ensure the right people are transferred to community hospitals.

The Chair asked about the “second firebreak” that had been planned. Leigh Jolly reported that currently 14 or 15 people have been transferred as a result and that is in addition to the 24 transferred in December 2025.

Tracy Slater asked about the escalation at the front door of Aberdeen Royal Infirmary and the focus on getting patients through in four hours.

Rick Strang responded and explained that, as not all the improvements are in place yet, it is difficult to go back to staff and say that things are not working well. He did note, however, that they are currently exploring this approach and moving in the right direction.

Geraldine Fraser described that the whole system message is spreading and that they are looking at some of the work NHS Lothian are doing to see whether it could be replicated in NHS Grampian.

Laura Skaife-Knight responded that it was important to get the basics right and to stay closely connected with staff to understand how things feel on the ground. She described how she had recently spent a night shift visiting the wards and said it was encouraging to see the difference in staff when they had experienced a good day and night.

Hugh Farrow Bishop described that he felt they were getting to the point they could earn the right to some optimism.

Stephen Friar reflected that there was more confidence that the system is working better now and there are other bigger things due to happen which will have a positive impact.

The Chair asked about the frailty ward expansion as discussed at the last meeting. Rick Strang said it is on track, despite the difficulties, to be up and running by the end of March and work through the summer to finesse in preparation for winter.

Stephen Friar described the importance of bringing all the teams with them and that discussions are in place.

The Chair asked about ambulance waiting times and the planned reduction to 6-hour breaches to 4 hours max. Rick Strang described that, apart from one day last week, they did meet that target and the changes that would help. This includes the increase in frailty beds He said that they needed to look at the escalation pathway to incorporate improvements and this was a work in progress.

The Chair reflected that it was encouraging to note that there is a small positive improvement in performance but that one week is not a trend but there should be a cause to celebrate and promote small wins.

 

De-escalation principles and criteria

The Chair opened the discussion by noting that, while it is a decision of the Scottish Government to escalate a health board, it was helpful for the health board to take ownership of co-developing and progressing de-escalation criteria and principles. SG and NHS Grampian have taken this approach, and this provides a collective focus for colleagues to aim for.

Laura Skaife-Knight described the discussions that have taken place with the Health Board and following this there are some inclusions to be included, specific metrics, details on the sub national and national agenda, and relationships with NES and HIS.

Alison Evison reflected on the sense of direction and ownership and how it was helpful for the health board to be able to respond. The NHS Grampian board will be scrutinising the progress and what they need to do around the whole system approach.

Glen Deakin provided some feedback on the suggested amendments put forward by NHS Grampian. Overall, the edits are helpful, and it was noted that criteria have been added to the initial draft and nothing taken away. The addition of specific metrics is also helpful. He noted that some of the narrative linking to the terms of escalation has been amended and reflected that some of this is down to the original draft over-simplifying the links between reasons for escalation and improvements to address these, as there is not always a simple one-to-one relationship. He suggested that a reworking of that would ensure that the programmes of work remain explicitly linked to the original terms of escalation, which would keep the validity of each programme on an equal footing. He also suggested that a couple of the additional criteria were not phrased in an outcome-focused way, so could also be reworked. He offered to help take these pieces of work forward out with the meeting.

The Chair described how in previous escalations culture change is often the one that takes longer to evidence and achieve. He described how it was possible that Health Boards could be de-escalated on one aspect and not others.

Jack Gillespie said he was nervous about amendments to the language of “material changes” in the finance section as this term can have different meanings. He advised he will feedback his thoughts directly to be considered in further discussions.

Laura Skaife-Knight welcomed a further off-table discussion to move things forward. She shared her thoughts on the risk of the complete withdrawal of external support too soon and how it would be more helpful that it is tapered off, rather than completely withdrawn and this is what she would be looking at for 2026/27.

ACTION: An offline discussion is to take place between Glen Deakin, Alison Evison and Laura Skaife-Knight to agree the principles and Health Finance to consider any changes to the wording of “material changes” and the wider changes as above.

 

AOB

Laura Skaife-Knight advised that Gail Woodcock has been appointed as director of strategy and performance and will be starting in June 2026.

The Chair thanked local authority Chief Executives for their attendance and engagement in the Assurance Board process and invited final comments.

Angela Scott described the work that is being done around public health and how it was useful to see/hear from NHS Grampian about the longer-term programmes underway. She outlined that there is a lot of innovation taking place, including around digital and children to adult pathway that do not exist anywhere else in Scotland.

Karen Greaves welcomed the update on all the work in hospital and the ambition for innovation. She echoes the need to have the same approach and use all resources available including third sector, however, being aware of the difficulties in the financial climate.

Next meeting: Meeting 17 is scheduled for Tuesday 24 March 2026.