NHS Grampian Assurance Board minutes: 10th February 2026

Attendees and apologies

Members

• Stephen Gallagher, Chair, Scottish Government
• Donna Bell, Director NCS, Scottish Government
• Professor Graham Ellis, Deputy chief medical officer, Scottish Government
• Fiona Hogg, Chief People Officer, Scottish Government
• Tracy Slater, Head of Performance and Delivery, Scottish Government
• Robert Kirkwood, Head of People, Governance and Appointments Unit, Scottish Government

Attendees, NHS Grampian

• Alison Evison, Board Chair
• Laura Skaife-Knight, Chief Executive
• June Brown, Executive Nurse Director
• Paul Bachoo, Medical Director for Acute Services
• Stephen Friar, Deputy Medical Director
• Alistair Palin, Medical Director for Mental Health and Learning Disabilities
• Philip Shipman, Interim Director of People and Culture
• Alex Stephen, Director of Finance
• Rick Strang, Site Director ARI
• Phil Tydeman, Interim Director of Improvement

Meeting Apologies

• Irene Barkby, Associate Chief Nursing Officer
• Geraldine Fraser, Chief Officer, Acute Services
• Hugh Farrow Bishop, Medical Director
• Jack Gillespie, Deputy Director of Finance
• Leigh Jolly, Chief Officer, Aberdeenshire IJB

 

 

Items and actions

Welcome and Apologies

The Chair welcomed members and attendees to the fourteenth meeting of the assurance board, noted apologies and outlined the agenda.  

Actions/Updates from previous meetings

 

June Brown is to be added to the attendees list in the minute of the last meeting.

There is one action still open from meeting 12:

 

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

Laura Skaife-Knight confirmed that the session scheduled for this Friday will go ahead. It is proposed that we allow time to work through the outcomes with system partners, and that the Assurance Board meeting where system leaders come will be held in person. This will be confirmed outside of the meeting.  Update: Complete - the meeting date has been confirmed as the 10 March 2026, in person at Marischal College Aberdeen

 

There are two actions outstanding from meeting 13:

 

• NHS Grampian to reconsider the composition of the Culture Programme Board to ensure it is inclusive of wider organisational perspectives.

Philip Shipman confirmed that he has taken away the proposal to revise and enhance the Programme Board format for further consideration and will bring an update back after the next Programme Board which is meeting on 3 March 2026.

 

• Performance data and programme activities to be disaggregated by site to allow improvement at ARI to be tracked.

This will be covered in item 5, Unscheduled Care update. The supporting paper includes Emergency Department weekly performance data for Aberdeen Royal Infirmary, Dr Gray’s Hospital and Royal Aberdeen Children’s Hospital separately. The chair noted this action to be closed but noted an ongoing ask of the system to provide disaggregated data where possible and when this will support meaningful analysis of performance. Update: Complete – agreed that future performance reporting will differentiate between sites.

Unscheduled Care

 

Rick Strang, ARI Site Director, updated on the latest performance across the board, and the weekly focus on themes including pharmacy and boarders. These are key areas of operational improvement aimed at strengthening unscheduled care through improving patient flow, reducing delays, and ensuring services work more efficiently together. This is about strengthened collaboration across departments, better use of resources, and targeted actions to unblock pressure points in the system, such as discharge processes, assessment capacity, and front door redesign.

Overspill bed area has been split in half and given back to the Emergency Department which will support the operational running of the department. The plan is to shut this fully within the next week with the expectation of flow to improve.

 

Stephen Friar noted that the integrated flow hub now has a clearer and more structured plan of work for the next two to three months, which it previously lacked. This plan should support a significant amount of ongoing improvement activity, strengthen oversight and assurance, and add value to the work already taking place within acute services.

 

Graham Ellis acknowledged that performance against the four-hour target had been poor this week. However, he emphasised that the greatest clinical risk relates to patients waiting over 12 hours, and these cases should be actively managed as a priority clinical concern.

 

Donna Bell highlighted that a deep dive into Emergency Department performance had been undertaken, showing that some areas continue to perform well. She expects further discussion on this as part of winter pressures planning and is particularly interested in understanding the systemic factors influencing performance.

 

Rick Strang commented on the scale of the improvement work, noting that attempting to address everything at once can create barriers to progress. He suggested that scaling up is possible, but sustainability will depend on demonstrating first and foremost that NHS Grampian can successfully deliver the initial phase of change.

 

[retracted] noted that performance on Thursday at Aberdeen Royal Infirmary was at 27% and asked whether there were any reflections on the effectiveness of escalation process in light of this. Rick Strang responded that the group had reviewed the performance issues and discussed a slight shift in how escalation is being managed, including some improvements in reducing bed waits. He also highlighted that last week was one of the highest demand weeks experienced.

 

Laura Skaife-Knight She stressed the importance of understanding how long we should expect it to take before we see meaningful improvement. She described this as a real challenge, emphasising that the first priority is to focus on staff engagement and hearts and minds, and prove and inspire belief that the system can deliver change, supported by strengthened clinical engagement.

She also noted that we are beginning to look further ahead at the longer-term work and root causes, and that it will be important to see how all the different improvement components align. Laura suggested mapping the key decision points and timeline required to understand the overall impact and changes and interventions, including the role of community services.

The Chair summarised the discussion by noting that the Assurance Board recognises the approach NHS Grampian is taking to test and demonstrate changes that can build system confidence and show that scaling improvement is achievable. The Assurance Board also acknowledged the mixed performance metrics, including ambulance turnaround times and the recent fall in Emergency Department performance over the past seven days.

In addition to the changes made so far, the Chair noted that the team is undertaking a “consolidation week” to review what has been implemented to date and to clarify next steps. The team was asked to reflect on previous changes made, particularly the shift to more frailty bed-based models during the pandemic and to consider whether there are more effective ways of working now.

Finally, the Chair noted the wider ongoing work to redesign the local system and encouraged continued consideration of any design elements that could further support improvement.

Planned care

Paul Bachoo updated on the progress of the reopening of the Central Decontamination Unit and the lessons learned. He summarised key sections of the paper: the unit closed in October 2025 due to suspected contamination, causing major disruption to surgical activity; an incident management team co-ordinated emergency recovery, supported by safety and technical subgroups; key problems included weak maintenance processes, limited track-and-trace capability, and fragile local/national decontamination capacity; strong staff effort and external support helped maintain essential services.

 

The review calls for earlier expert involvement, clearer contingency planning, and stronger infrastructure to avoid similar incidents. The recovery relied on a national mutual aid response and included the introduction of five new machines in total.

NHS Grampian has maintained a strong relationship with NHS Orkney through the mutual aid arrangements. One new machine is now fully operational and is supporting activity. Learning from the incident is also being shared across NHS Scotland.

 

Tracey Slater noted that they are not seeing any impact on the functioning of the unit. She raised an issue regarding the fire alarm system and sought assurance on this.

 

Paul Bachoo explained that, when the new system went live last week, it was discovered that the fire alarm had not been disconnected. As a result, activation of the alarm caused the Aberdeen Royal Infirmary ventilation system to shut down. He confirmed that this issue has now been fully resolved.

 

Graham Ellis asked about the track-and-trace system and whether a full solution is now in place.

 

The group noted a slippage of around £250,000, which has already been declared. Scottish Government is now at the point of reinvesting the slippage, and it was acknowledged that the funding could be used quickly if there are no delays.

Paul Bachoo added that a key challenge in rapidly deploying this funding is identifying where additional inpatient capacity can be safely and effectively supported, given the constraints of the current footprint.

 

The Assurance Board noted the report, and acknowledged the staff training programme, which is intended to cover 100% of the workforce.

 

Culture, Governance and Leadership

 

Philip Shipman provided an update on the workforce commission. The Workforce Commission presentation highlights the need to reshape NHS Grampian’s workforce to improve productivity while maintaining safe planned and unscheduled care. Although the diagnostic report identified potential efficiencies, national benchmarking shows Grampian’s staffing levels remain lower than most health boards relative to population. Audit Scotland notes persistent productivity challenges linked to system pressures and delays. The proposed approach focuses on integrating workforce, service and financial planning, targeting areas where activity and staffing are misaligned, such as dermatology, ophthalmology, general surgery and high-pressure acute specialities. Next steps include finalising the integrated planning model, selecting priority services, and starting test cycles to drive sustainable workforce transformational pressure acute specialities.

 

Laura Skaife-Knight commented that the work needs to be broken down into clearer timescales though said the presentation described thelocal context well which was missing from the KPMG analysis. She noted that NHS Grampian now needs to move into a phase focused on identifying quick wins and test cases. She also highlighted the importance of developing wider scale integrated planning in Quarter 3 and into the next financial year, covering the whole organisation..

 

The Chair noted that there are clear similarities in demonstrating that NHS Grampian can deliver progress in an area that is hugely complex. The work underway highlights the scale of that complexity, the multiple data sources involved, and the range of possible opportunities. The Chair encouraged NHS Grampian to focus its efforts on a defined area, emphasising the importance of allocating dedicated resources. They also highlighted that additional targeted support will be required to drive this work forward effectively.

 

Philip Shipman welcomed the observation and reflected that, looking back, some areas need to be reduced with urgency. He noted that the work so far highlights the scale of transformation required.

 

Laura Skaife-Knight then updated on strengthening operational governance and decision making. NHS Grampian is redesigning its operational governance to strengthen decision making and improve transparency following its Level 4 escalation.

Strengthening Operational Governance

At the Chief Executive Team meeting that morning, it was noted that the external diagnostic report set out opportunities for improving the effective of operational governance in the organisation and delegating decision-making closer to local teams. , The Chief Executive Team agreed on a two-phase approach. From the end of March, NHS Grampian will move away from the current arrangements and establish a new Executive Team with weekly meetings. This team will operate as the primary decision-making body within the governance structure and its membership will consist of the Chief Executive’s main line reports..

 

An Executive Team development programme will be commissioned and delivered in Quarter 1 of 2026/27. In addition, an operational governance reviews under way. The outputs of this work will return to the Chief Executive team, including recommendations on which groups should formally report to the Executive Team going forward.  Phase two will see views being sought from the wider leadership community on the proposal to move to a more inclusive decision-making model later in the year.

 

Alison Evison commented that she is supportive of the work underway and the pace at which the changes are being delivered. She noted that the key elements are being developed appropriately, the pace feels right, and the programme should lead to meaningful improvements.

 

Fiona Hogg and Robert Kirkwood are supportive of the proposals and the phased approach.

 

Robert Kirkwood asked about the overall scale of the challenge facing NHS Grampian, how the organisation reached this point, and how this links to corporate governance. He highlighted the importance of understanding how the review of the health board’s corporate governance arrangements fits into the wider improvement work.

 

Alison Evison reflected on the work currently underway, noting that the health board seminar held at the start of January 2026 had already begun to explore some of these issues. She confirmed that there will be a further review on 16th April 2026 to refine and respond to the feedback gathered.

 

Action: 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. This will be scheduled after the health board’s seminar, around the end of April 2026.

 

The Assurance Board noted the paper and the welcomed update. Members expressed their support and acknowledged that the executive team development programme will follow as part of this work. The issues highlighted align with several of the themes identified in the diagnostic report.

 

 

Improvement Plan

 

Phil Tydeman provided an update on the progress report on the improvement plan. NHS Grampian’s Single Improvement Plan brings together 87 recommendations from the diagnostic report, organised under four priority programmes with clear governance, standardised reporting and committee oversight. Most Value & Sustainability and Planned Care actions are expected to be completed and ready for closure by April 2026. Committees will review evidence and only the NHS Grampian Board can formally close recommendations. The next steps focus on finalising timelines, strengthening evidence, and handing delivery to programme boards.

 

Glen Deakin commented that it was helpful to see the range of criteria to be used to measure the impact of the actions included in the paper, and concurred that the high proportions of actions due for completion at the financial year-end was consistent with these being tied to financial performance.

 

On longer-term objectives Glen Deakin noted that it would be important to monitor these for indicators of anything needing to change around deliverables or end dates. Phil Tydeman agreed that this would be picked up via the monthly reporting and quarterly review processes agreed in a previous meeting of the assurance board [16 December 2025].

 

Value and Sustainability

 

Phil Tydeman provided a verbal update on Value and Sustainability. The three Integration Joint Boards and NHS Grampian presented savings schemes at the weekly Chief Executive Team meeting on 3 February to assess the potential of schemes being delivered in one part of the system having a negative impact on another part of the system. Phil Tydeman conveyed this work will continue as new schemes are identified.     

 

 

AOB

 

Laura Skaife-Knight provided an update on de-escalation principles and explained that the draft principles have already been discussed by the Board and were being discussed at tomorrow morning’s Chief Executive Team meeting. She noted that the team is well-prepared for this discussion. The closed NHS Grampian board session on 19 February 2026 will also consider these principles, and the outcome will then flow through to the full board. Laura highlighted the strong engagement in this work and emphasised the importance of the criteria being developed being realistic and fully owned by the NHS Grampian Board, which this approach evidenced. The Health Board have confirmed that they are content to remain fully engaged in this work, recognising that ownership rests with them. An update will be brought back to Assurance Board in due course.

Laura also updated on the substantive Executive Director recruitment and confirmed that final interviews for the two posts will take place on Monday 16 February 2026. The Assurance Board welcomed the progress being made.

 

Next meeting: Meeting 15 is scheduled for Thursday 26 February 2026