NHS Grampian Assurance Board minutes: 19th May 2026

Attendees and apologies

Members

• (SG) Stephen Gallagher, Chair, Scottish Government
• (IB) Irene Barkby, Associate Chief Nursing Officer, 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

 

Attendees – NHS Grampian

• (AE) Alison Evisone, 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
• (LJ) Leigh Jolly, Chief Officer, Aberdeenshire Integration Joint Board
• (JN) Jason Nicol: Head of Wellbeing, Culture and Development
• (AS) Alex Stephen, Director of Finance
• (RS) Rick Strang, Site Director Aberdeen Royal Infirmary

 

Attendees – SG/Other 

• [redacted], Assurance & Improvement Unit
• [redacted] Policy officer (notetaker)
• (TS) Tracy Slater, Assurance & Improvement Unit

 

Apologies 

• Stephen Friar, Deputy Medical Director, Unscheduled Care
• Jess Milne, Policy Official, Unscheduled Care
• Melanie Saunders, Interim Director of People & Culture
• Phil Tydeman, Interim Director of Improvement

 

Items and actions

Welcome and Apologies

SG welcomed members and attendees to the twentieth meeting of the assurance board, noted apologies and outlined the agenda.

The minutes of the last meeting were adopted.

Actions/Updates from previous meetings

There are two actions that were closed on Friday 15 May 2026:

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

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

A response was sent to AE covering both these points on 15 May 2026. Any feedback will be picked up in the context of item 4.

 

Two actions are closed by the meeting as these feature on the agenda:

• 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. This will be discussed under item 4

• De-escalation criteria on planned and USC performance to be included on a June agenda. This is being discussed under item 6

 

Three actions remain open

• 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 2 June 2026.

• June Brown to consider the role nurses are playing in the discharge process and clarify the role of discharge coordinators.

Update: this will be brought back to a future assurance board meeting.

• The chair and Laura Skaife-Knight to discuss feasibility of holding an AB meeting at Dr Gray’s Hospital. The chair discussed with Laura on 14 May 2026.

Update: this has been discussed; mindful of not overloading DGH with visits, with options being considered for 16 June 2026 or later.

 

Item 3: Unscheduled Care

GF provided an update on the performance of unscheduled care. Aberdeen Royal Infirmary performance is at 50.5% and Dr Gray’s Hospital at 69.4%. However, system pressure remains high, with occupancy rising further to just over 107%.

There has been some reduction in boarding at Aberdeen Royal Infirmary, down to 68, although the majority remain general medicine patients, and delayed discharges have increased to 59. On ambulance waits, there has been notable improvement. The number waiting over an hour at Aberdeen Royal Infirmary has fallen significantly from 210 to 143, and turnaround times have improved across all sites. At Dr Gray’s Hospital in particular, there has been sustained improvement over the past month in reducing very long delays over 3 hours.

Overall, while demand and flow pressures remain high, there are clear improvements emerging in ambulance turnaround times and some stabilisation in performance. GF highlighted that the overspill area in the emergency department at Dr Gray’s Hospital is now being protected and used more effectively for observation and clinical decision-making. Improvements to triage processes have also been introduced, including earlier assessment of patients waiting in ambulances, reflecting approaches already in place at Aberdeen Royal Infirmary.

The focus of improvement work at Dr Gray’s Hospital is supporting patient flow, particularly for those requiring admission or specialist review. This includes strengthening processes to ensure patients are seen and managed more efficiently. There is also work underway to improve sustainability, including the development of a more integrated model through closer working with a joint assessment unit.

GE noted encouragement at the emerging progress, particularly in relation to improvements against the four-hour target, while emphasising the importance of continuing to do the right things to sustain this trajectory.

DB highlighted that discussions at the subgroup meeting were positive, with a promising outlook. There was a focus on the sustainability of improvements, including how current progress will be maintained over time, with particular attention to funding and how initiatives are being integrated as business as usual. While there has been good recent feedback on performance at Dr Gray’s Hospital, some underlying fragility remains.

TS emphasised the importance of maintaining a strong understanding of sustainability factors. She also noted the need for further work on workforce modelling and benchmarking to support longer-term planning and resilience.

LJ provided an update on the current Unscheduled Care Programme Board , who are considering the 19 workstreams of the programme with a view to streamlining these and updating the terms of reference of the programme.  There are discussions underway to transition to a delivery board, with terms of reference under review.

LSK confirmed that this will include a focus on roles and responsibilities to ensure accountability and an ability to hold to account.

The assurance board noted this work and would welcome sight of the revised programme workstreams and terms of reference in due course.

Action: updated unscheduled care programme details to be shared with the assurance board.

The assurance board noted the update on unscheduled care, including an improving performance against 4 hours at Aberdeen Royal Infirmary and specific progress at Dr Gray’s Hospital.

Item 4: Governance

AE provided an update on NHS Grampian board governance, focusing on the key outputs and improvement actions following recent board seminars. She highlighted a strengthened approach to governance, with a greater focus on clear, outcome‑based reporting and stronger alignment between performance, finance and risk to support assurance. Recent health board seminars identified a number of key themes, including the need to improve transparency and culture, enhance the quality of board discussions, strengthen the use of patient and staff voice, and refine reporting processes to better support decision-making. In response, a range of actions are already being implemented, including improvements to board and committee reporting, better access to information for board members, alignment of agenda with strategic priorities, and more structured assurance processes. Overall, the emphasis is on embedding more effective, transparent and outcome-focused governance to strengthen oversight and delivery.

 

SG noted the significant level of activity, noting that it was presented clearly, with a logical flow of actions that the health board has been undertaking. He also reflected on whether the health board is making the right connections between issues, and considered what further changes could be made to optimise its effectiveness and fully realise its potential.

 

RK shared some early reflections on NHS Grampian, noting a growing focus not just on what the health board does, but how it conducts its business. He highlighted the importance of how board members engage and understand their roles in providing assurance. He emphasised the need for a more focused, targeted approach, alongside reflection on what has not worked previously and what the future approach should prioritise - recognising that some areas may need to be deprioritised to allow greater focus elsewhere.

 

AE reflected that attention is now moving to the “how” of governance. She noted that key issues have been surfaced and the next stage is to structure and embed these effectively. She also indicated that there will be a need to reflect on what can be parked, building on the work already undertaken, as the health board moves forward.

 

IB highlighted the importance of non-executive capacity to support delivery, and the need to ensure that the revised governance approach is matched by sufficient capability and capacity to sustain it.

GE questioned whether it is fundamentally the health board’s role to ensure that work is being delivered effectively. He highlighted the importance of how well the health board will handle difficult situations and manage the required shifts in approach.

AE welcomed the emphasis on transparency and the positioning of people to support this, but stressed that the health board must be clear on its role in overseeing delivery and driving improvement. She also noted the importance of the health board having a strong understanding of what is required to ensure progress, including clarity on priorities and how these are being taken forward.

SG noted the update and highlighted following an approach for support from the chair, that the Chair of NHSFV would work AE and the board to review progress and offer further suggestions for improvement (given the board has learned through stage 4 escalation) and how to implement the proposed changes. AE welcomed this support and had also followed up the AB suggestion of contacting the chair of NHS Lothian to discuss how the Board should review unscheduled care performance going forward.

JB provided an update on the seminar outputs from a clinical perspective, as well as progress on the Healthcare Improvement Scotland (HIS) diagnostic and improvement work at Dr Gray’s Hospital. She highlighted the level of resource required to deliver this work at pace, particularly in relation to the HIS diagnostic and ensuring quality within a managed clinical environment. Work is underway to finalise the diagnostic, alongside wider engagement to shape what the approach should look like going forward.

This has included collaboration with other health boards, such as Forth Valley and Tayside, and discussions around integration joint board arrangements and clinical processes, to understand best practice and inform local improvement.

JB also noted ongoing work to strengthen clinical processes and support arrangements to underpin improvement, particularly at Dr Gray’s Hospital.

The next clinical assurance board meeting has been scheduled for 16 June.

SG welcomed the update, recognising the breadth and scope of the work underway and the significance of the activity being progressed. SG was pleased to note that the NHS Grampian board was reaching out to better understand practice in other NHS boards.

GE commented on the importance of acknowledging past limitations, while also welcoming the forward direction of travel and the focus on learning and improvement. He queried whether the level of resource available is sufficient to deliver the work at the required pace, raising this as a key consideration.

JB advised that the HIS inspection is ongoing, with the quality team fully engaged. However, she highlighted that capacity remains very limited, with resources being drawn from across the system on an ad hoc basis and not yet fully established into a sustainable model.

LSK confirmed theterms of reference and communications for the HIS diagnostic are closed to being finalised. Next week (week commencing 25 May 2026) will be week one of the eight week piece of work.

An update on progress will be brought back to the assurance board at an appropriate point, with further detail to be provided by Tara Fairley in due course.

Item 5: Leadership and Culture

LSK provided an update on the strategic objective for 2026/27 relating to people, leadership and governance, noting that these had been shared previously and are underpinned by clear key performance indicators. She reflected that, while progress is being made, there is a clear focus and ambition to progress this work further over the coming year. The programme is supported by defined commissioning timelines, which set out key delivery milestones.

The priorities this year are centred on three main areas: strengthening engagement and listening to staff, increasing leadership visibility, and improving staff wellbeing. There was also recognition of the importance of strong governance to support delivery.

LSK highlighted that, overall, there is a positive trajectory, with encouraging progress in key areas and a number of substantive executive director posts have been recruited to that will strengthen capacity and support delivery. She also reflected on leadership development, noting that in addition to individual director objectives, a set of shared objectives for the year has been agreed by the executive team. These are intended to support collective leadership and contribute to the organisation’s ambition to become a population health organisation.

She highlighted that there is now a broader range of leadership development offers in place. While these do not sit under a single umbrella, they form a menu of opportunities to support leaders at different levels.

FH welcomed the progress that has been made, noting that there is now greater clarity around priorities, decision-making and what will make the most meaningful difference. This aligns well with feedback from the staff side and feels appropriately structured. She also emphasised the importance of focusing on the ‘first 100’ leaders to drive improvement and embed the desired culture and leadership approach across the organisation.

IB reflected on how effectively objectives are being cascaded through the organisation, noting the importance of ensuring clarity on how far these are embedded across teams. She highlighted that the health board agenda can play a key role in driving cultural change and supporting alignment with personal development plans.

GE emphasised the need to actively shape culture by addressing negative behaviours while also defining what good looks like. He highlighted the importance of enabling constructive challenge and disagreement within teams, and developing high‑performing team behaviours. He also reflected on focusing effort on the ‘top 100’ leaders and identifying early adopters to help drive and sustain change.

LSK discussed the need to clearly communicate and cascade strategic objectives across the organisation, recognising the importance of sharing these widely to support alignment. She noted that operational governance arrangements have evolved, including changes to the executive team and extended leadership team and updated terms of reference for both..

SG summarised the item, noting the revisions to the executive team and extended executive team, the revised terms of reference and the development of shared as well as individual director objectives. While the objectives have now been clearly set, SG also highlighted an opportunity in line with the culture programme to share these with staffside colleagues through the Area Partnership Forum (APF) and Area Clinical Forum (ACF).

Item 6: De-escalation

GF presented the aims of the NHS board on planned and unscheduled care trajectories to be considered in the de-escalation criteria.

GF provided an update on the revised trajectories for planned care for this financial year, noting that funding allocations are not yet confirmed. She highlighted a particular focus on addressing long waits and outlined engagement with the four chief officers to help firm up revised planning assumptions. For unscheduled care, this was covered separately at the recent workshop.

SG emphasised the importance of agreeing a set of measures that are realistic and achievable, and felt fair in comparison to other systems, with the aim of bringing this work to a conclusion over the coming weeks.

Item 7: AOB

LSK said that the two-weekly assurance board meetings had supported improvement and momentum, however, she raised the pattern of assurance board meetings and invited reflection on whether fortnightly remained the correct frequency so there is more time to do the work and deliver and report improvements rather than what the health board aim to be doing. SG noted that emerging concerns around governance, and unscheduled care performance in the early part of this year, have required a sustained focus, but that the time is right to consider the cadence going forward and to set out the frequency of scrutiny appropriate to each issue under the stage 4 escalation.

Action: Stephen Gallagher and Laura Skaife-Knight to meet offline to discuss the cadence of the assurance board meetings.

TS noted the written update on complaints recording that had been provided following the last meeting of the assurance board.

Next meeting: Meeting 21 is scheduled for Tuesday 2 June @ 1pm.