NHS Grampian Assurance Board minutes: 11 August 2026

Attendees and apologies

Members

• (SG) Stephen Gallagher, Chair
• (GE) Graham Ellis, Deputy Chief Medical Officer for Scotland
• (JG) Jack Gillespie, Deputy Director of Finance
• (FH) Fiona Hogg, Chief People Officer
•  Claire Pearce, DCNO

Attendees - NHS Grampian and partners 

• (AE) Alison Evison, Health Board Chair
• (LSK) Laura Skaife-Knight, Chief Executive
• (SF) Stephen Friar, Deputy Medical Director, Unscheduled Care
• (LJ) Leigh Jolly, Chief Officer, Aberdeenshire IJB
• (AS) Alex Stephen, Director of Finance
• (RS) Rick Strang,  Unscheduled Care Improvement Director, NHS Grampian
• (GW) Gail Woodcock, Director of Strategy, Transformation and Performance
• (HFB) Hugh Farrow Bishop, Executive Medical Director
• (JO’B), Jay O’Brien, Director of People and Culture
• (MT) Matthew Toms, Head of Performance Governance (deputising for Geraldine Fraser)
• (JB) June Barnard, Acute Nurse Director (deputising for June Brown)
• (JS) Jim Savege, Chief Executive, Aberdeenshire Council
• (JP) Judith Proctor, Chief Officer, Moray IJB
• (FM) Fiona Mitchelhill, Chief Officer, Aberdeen City IJB
• (KG), Karen Greaves, Chief Executive, Moray Council
• (AS), Angela Scott, Chief Executive, Aberdeen City Council

Scottish Government policy team

Apologies

 

• (JB) June Brown, Executive Nurse Director
• (GF) Geraldine Fraser, Chief Officer, Acute Services
• (DB) Donna Bell, Director of Social Care & Mental Health
• (RK), Robert Kirkwood, Head of People, Governance and Appointments Unit
• (TS), Tracy Slater, Assurance & Improvement Unit
• (GD), Glen Deakin, Assurance & Improvement Unit

 

 

Items and actions

1: Welcome and Apologies

The chair welcomed members and attendees to meeting twenty-three of the assurance board, noted apologies and outlined the agenda.

2.  Actions/update from meeting

The minute from meeting twenty-two was signed off and it was noted there were no outstanding actions.

3. Quarter 1 performance overview (allow 20 minutes)

Gail Woodcock presented on the performance of the six strategic priorities at the end of Quarter 1 2026/27: Quality and Safety; People, Leadership and Governance; Prevention; Urgent Care; Planned Care; and Value and Sustainability.

She reported that People, Leadership and Governance, Prevention, and Value and Sustainability were on track. Urgent Care and Planned Care were off track. The Quality and Safety programme and its indicators remain in development.

Hugh Farrow Bishop reminded the Assurance Board that Quality and Safety had been added as a strategic priority at a later stage (approved at June 2026 Board meeting) and that the associated Key Performance Indicators (KPIs)  were still being developed.

As examples of work in progress, he outlined proposed amendments to the Serious Adverse Event Review (SAER) process, including:

 

• A one-year retrospective review of all Level 1 SAERs to ensure appropriate actions had been taken and any learning for the organisation
• The development of a Clinical Governance Framework Policy, which will be published and shared across the organisation.

Graham Ellis asked what elements might be included within the Quality and Safety KPIs. Hugh Farrow Bishop agreed that this is being explored both during the KPI development process and through one-to-one discussions.

Action: Hugh Farrow Bishop to discuss the Quality and Safety KPI framework with Graham Ellis and through one-to-one meetings, and bring proposals to a future Assurance Board meeting.

The Chair advised that Clinical Governance must be a key focus at the next Assurance Board meeting, at which it is hoped that NHS Grampian may be in receipt of the Healthcare Improvement Scotland (HIS) Diagnostic Review which has been commissioned by the NHS Grampian CEO to explore opportunities to further improve clinical governance systems and processes, and in turn quality and safety.

Jay O'Brien, Director of People and Culture, introduced himself and outlined recent work undertaken by the Culture Programme Board, including a review of workforce data.

Claire Pearce asked what learning could be shared from other boards to support the development of the Clinical Governance Framework. Hugh Farrow Bishop explained that examples of good practice from elsewhere were being considered and incorporated, for example NHS Tayside and Forth Valley following recent visits to these boards.

Laura Skaife-Knight acknowledged that NHS Grampian was currently falling short in some areas of Quality and Safety governance and welcomed the further discussion that was requested, including input and support from HIS.

Action: Policy Team to ensure Clinical Governance is on the agenda for the next meeting of the Assurance Board.

Gail Woodcock reported that work under the Prevention priority remained on track, although there were some risks and issues relating to data lag.

Alex Stephen presented the Value and Sustainability update and confirmed that NHS Grampian were on forecast to deliver a year-end deficit of no more than £36 million. He also noted that close liaison arrangements were in place with the Integration Joint Boards (IJBs).

Jack Gillespie commented that he was reassured by the position at the end of Quarter 1. A discussion followed regarding the impact of the Band 5 to Band 6 regrading exercise, and it was agreed that this would be revisited once further information became available.

Laura Skaife-Knight outlined work undertaken on a self-assessment against the agreed de-escalation criteria. She reminded the Assurance Board that metrics in relation to planned and unscheduled care were outstanding and under development. It was agreed that discussion should take place on developing a joint assessment process and that therefore this agenda item should be removed from public NHS Board meetings until that process had been completed and there was more than a self -assessment to share.

In closing, the Chair thanked NHS Grampian for the presentation. He acknowledged the preventative measures being implemented, noted the forecast financial position for 2026/27, welcomed the initial work undertaken on de-escalation reporting and self assessment but the need to move to joint assessment, and emphasised the need to view de-escalation as a dynamic and ongoing process as circumstances change over time. He underscored the need to focus on clinical governance in a future meeting.

 

4. Transition from stability to system, pathway and clinical service transformation and redesign

Gail Woodcock presented a paper outlining the proposed refresh of NHS Grampian's Plan for the Future and the transition from stabilisation to longer-term redesign, transformation and sustainability. The paper recognises that, although progress has been made in strengthening governance, leadership, performance and financial grip and control, significant service redesign will be required to achieve sustainable services and financial balance.

The refreshed strategy will define NHS Grampian's future health and care model, supported by workforce, digital, infrastructure, population health and financial sustainability frameworks. A prioritised programme of transformation will then be developed to deliver the required changes across services, pathways and systems.

The Board was asked to take assurance from the proposed approach and timeline, endorse the development of the refreshed strategic plan, and note that further updates and the final Plan for the Future will be brought forward for consideration during 2026/27, with final approval anticipated in April 2027.

Gail Woodcock highlighted the engagement undertaken in developing the transformation plan. She outlined the local, sub-national and national processes that had informed its development.

The Chair invited local council partners to share their views on transformation in the context of their own plans and strategic priorities.

Jim Savege reflected that it was helpful to see the different levels of planning, the links into local systems, and the progress made in transformation work. He expressed support for identifying further opportunities for joint working in the future.

Karen Greaves welcomed the approach of joint ownership, noting that collaboration is essential as organisations are working towards shared outcomes and sustainable change.

Angela Scott also expressed support for the approach and the progress made to date. She commented that the KPMG diagnostic had been valuable and referred to the forthcoming Programme for Government (PfG), noting that it would be important to understand any implications for public sector reform.

The Chair advised that partners would need to consider whether any changes to plans would be required following publication of the PfG. He also recognised the engagement and relationships that had been developed between partners over the previous 12 months.

Graham Ellis asked about clinical engagement in developing future models of care. Gail Woodcock advised that workshops are planned later in the year and welcomed wider input at the appropriate stage.

Hugh Farrow Bishop noted that a monthly Clinical Board is in place, providing opportunities for detailed discussion on key issues. He emphasised the importance of engaging both clinical staff and service users through a range of approaches.

June Barnard added that work is ongoing through community appointment days to better understand local needs as the transformation programme progresses.

Laura Skaife-Knight suggested that the Programme for Government should be incorporated into the transformation timeline and stressed the importance of considering local, sub-national and national developments in planning.

The Chair reminded members that the KPMG report had highlighted the need for fundamental service redesign and for ensuring affordability within available resources.

Laura Skaife-Knight provided an update on the North East System Transformation Group. She reported that:

• Project management resource is now in place.
• The Terms of Reference have been approved.
• The Terms of Reference will be shared at the public NHS Board meeting on 13 August 2026.

She also outlined examples of potential workstreams that could be used to test the programme methodology and ability to get some quicker wins, and that a workshop held in July 2026 had identified several priority areas for further exploration, with a follow-up workshop planned for September.

Jim Savege agreed that it would be beneficial to take stock following publication of the Programme for Government in order to assess both its impact and the opportunities arising from it.

Laura also outlined the involvement and leadership of Executive Team members across the various sub-national workstreams.

The Chair reflected on the substantial volume of work being undertaken across this transformation agenda and recognised the efforts of all those involved in progressing this work alongside their day-to-day responsibilities. He asked that the process be updated to reflect on Programme for Government once published.

5. Unscheduled care

Leigh Jolly provided an update on the Unscheduled Care Improvement Programme. While governance and oversight arrangements have strengthened and some improvements have been seen in emergency department waits and patient flow, performance challenges remain. Assurance remains partial pending evidence of sustained improvement against key performance measures and national standards.

She provided an update on the most recent performance, noting it was below where it should be, but there were some improvements in waiting times and delayed discharge and the use of non-standard areas has reduced.

Claire Pearce asked about ownership of daily discharges.

Rick Strang outlined the current process and advised that nurses who performed strongly in relation to the early discharge of patients would form a peer group to share good practice across wards. He also noted following a complaint from a patient who experienced a significant delay in discharge despite being ready to leave in the morning had agreed to record a video to support learning and improvement.

Graham Ellis welcomed the overview but requested further detail on the use of non-standard  areas and alternatives to admission.

Stephen Friar explained that corridor areas and additional bay beds were being used for appropriate patients when required and only for the shortest possible time.

June Barnard advised that a monthly monitoring group oversees the use of non-standard areas, with decisions made on an individual patient basis. Patient complaints relating to this issue remained low.

Rick Strang reflected that current processes lacked resilience and highlighted the need for stronger accountability arrangements. He also updated the board on the introduction of twice-weekly reviews of patients with a length of stay exceeding 21 days, noting that 65 patients currently met this criterion.

The Chair emphasised the need for robust processes, accountability and a balance between support and challenge where standards are not met. He also noted a disconnect between Executive Team intent and frontline delivery, expressing concern that performance appears to be declining despite significant leadership effort.

Hugh Farrow Bishop provided further context on the July performance dip and outlined planned workforce initiatives.

Stephen Friar and Rick Strang updated the Board on plans to expand the Acute Frailty Service from 39 to 68 beds and establish a Rapid Frailty Assessment Unit. He reminded the Board that the proposals are intended to improve patient flow, reduce Emergency Department pressures and improve outcomes for frail patients.

Following NHS Grampian Board approval in July 2026, implementation planning is underway. Governance arrangements, project structures and workforce planning have been established, with delivery dependent on funding, recruitment and estate changes.

Graham Ellis welcomed the proposals and sought assurance that implementation would proceed at pace. Stephen Friar outlined the task-and-finish groups and assurance arrangements in place, while Rick Strang highlighted recruitment plans to support timely delivery.

Laura Skaife-Knight highlighted the cultural challenges NHS Grampian is grappling with which Unscheduled Care performance highlights, but she started this was replicated across broader areas which needed to be addressed, notably: clarity on roles and responsibilities, holding to account, escalation and ownership.

6. Planned Care 

Matthew Toms provided an update on planned care performance and delivery trajectories. While £9.7m of non-recurring funding has been secured to support recovery plans and waiting list trajectories, current projections indicate continued challenges in meeting national expectations, including the elimination of 52-week waits.

Work is underway to improve performance through service redesign, regional collaboration across the East of Scotland, and additional improvement support. Key risks include infrastructure failures, recruitment challenges, operational pressures and limited flexibility within available resources.

Graham Ellis advised that after looking at national statistics Grampian have two-thirds of the total waits of over 52-weeks. He wondered if NHS Grampian are using the same clinical system for triaging than other NHS boards.

Matthew Toms advised the main waits are in dermatology and there are plans to reduce those, he referred to the external review conducted last year and there were no issues raised with the system in use.

The chair advised that in addition to planned care waiting times, the board will in future also look for an update on cancer waiting times. The board would also want to understand if cultural issues, reflected in unscheduled care systems, was also a feature of planned care performance.

Action: Deep dive into cancer waiting times to be included in a future meeting (after 10 September 2026)

Alison Evison advised that these issues have been raised at the NHS Grampian Performance, Assurance, Finance and Infrastructure Committee (PAFIC) meeting and the committee was not assured, She advised that a Board seminar is being held to discuss further on 10 September 2026.

7. AOB

There was no further business.

Date of next meeting – 8 September 2026