NHS Grampian Assurance Board minutes: 2 September 2025

Attendees and apologies

• Donna Bell – Acting Chair, Scottish Government
• Fiona Hogg, Chief People Officer, Scottish Government
• Professor Graham Ellis, Deputy Chief Medical Officer for Scotland, Scottish Government
• Robert Kirkwood, Head of People, Governance and Appointments Unit, Scottish Governemnt
• Tracy Slater, Head of Performance and Delivery, Scottish Government 
• Adam Coldwells, Interim Chief Executive, NHS Grampian

• Alison Evison, Board Chair, NHS Grampian
• Hugh Bishop, Medical Director, NHS Grampian
• June Brown, Executive Nurse Director, NHS Grampian
• Phil Tydeman, Interim Director of Improvement , NHS Grampian
• Laura Skaife-Knight, Chief Executive, NHS Orkney
• Alex Stephen, Director of Finance,NHS Grampian
• John Tomlinson, Aberdeenshire IJB and one of NHSG's Non-Executive Board Member (Aberdeenshire IJB budget item)
• Leigh Jolly, Interim CO Aberdeenshire (Aberdeenshire IJB budget item)

• Scottish Government officials 

Meeting apologies

• Fiona Bennett, Chief Finance Officer Health and Social Care
• Stephen Gallagher, Director of Mental Health, Scottish Government

Items and actions

Welcome and apologies

The Chair welcomed members to Meeting Four of the Assurance Board (AB), noted apologies, and outlined the agenda. Angie Wood was in attendance, in her Scottish Government role, as Donna Bell took on the Chair responsibility for this meeting.  Substantive items on the Board’s agenda includes NHS Grampian’s month four finance position, savings programme, focus on delegated budgets, financial governance map and unscheduled care plan. 

The Chair noted that the minutes from the previous meeting had been circulated with the meeting papers. The AB approved the minutes.

An update was provided on outstanding actions from Meeting Three.

Actions/update from meeting “3” including minutes 

Seven actions from meeting 3: 

Action - NHS Grampian to provide information on savings plans for delegated services to get a better understanding of the full range of pressures and savings plans at a future meeting (noting the detailed focus has been on non-delegated services thus far). The AB were content for the Chair and Adam Coldwells to further discuss the action and confirm timescales.  Covered in item 3.

Action – Follow-up internal meeting for NHS Grampian and meeting Chair to confirm intentions regarding future NHS Grampian attendees at the Assurance Board.. Laura Skaife-Knight confirmed there has been an initial conversation and will follow-up with the Chair in the next week. 

Laura Skaife-Knight met with Stephen and agreed that key system leaders, including IJB Chief Officers, would attend for agenda items as necessary. 

Action: A ‘governance map’ to be produced (a high-level summary sheet to detail the financial governance process going forward where spend and savings were being considered —covering NHSG Board frequencies, the roles of the Financial Recovery Board and Performance Committee, and their respective responsibilities). 
Such a map could include suggested frequency of update to the Assurance Board.  Covered in item 3.

Action: Detail of decision-making responsibilities for each board, and interdependencies between them to be included in the ‘governance map’. Covered in item 3.

Action - Alex Stephen to update on AfC Reduced Working Week (RWW) impacts in October when the National return is made to Scottish Government and give further assurance that these are built into financial plans and projections. To be deferred to October meeting. 

Action  - Donna Bell to establish an Unsheduled care subgroup of the AB, convene relevant parties and provide an update to the next AB meeting. Covered by item 4.

Action – Fiona Hogg and Health Workforce colleagues to meet NHSG colleagues in relation to workforce planning and report back to next AB Covered by item 5.

Matters arising 

Graham and Hugh had a discussion regarding cardiology. Following this, Graham provided Hugh with an update on four key items from the KPMG report that had previously been identified as off track. NHS Grampian has since submitted a formal response to the Scottish Government confirming that all four items have now been completed. This was welcomed by Scottish Government. 

Alison Evison confirmed the MPs and MSP’s meeting that was mentioned at the previous AB has now been delayed till 9th October.  

Aberdeenshire IJB budget

Leigh Jolly shared slides on the Aberdeenshire IJB budgets covering the financial position of 2025/26, the current position, the recovery plan for 2025/26 and highlighted what had been achieved to date. 

John highlighted that the IJB has faced difficulties in implementing its intended approach. As Chair of the Budget Recovery Group, he now observes the financial grip and control that had been requested.

Risks are being reviewed through the Medium-Term Financial Strategy (MTFS). Like Other IJBs are running out of options and recognise the need to operate within their financial limits.

The Chair welcomed feedback on the slides. 

Jack Gillespie raised concerns about the 300% improvement in run rate compared to last year, questioning the drivers behind it. NHS Grampian attributed the change to tighter financial control and difficult decisions, such as reducing care home placements and packages of care.

Jack also queried the 3-year forecast, particularly for 2025/26. Leigh Jolly confirmed the MTFS will guide planning, with service demand rising and financial envelopes under review. Figures are expected by end of October, with options and expectations to follow.

Jack asked about the £3m savings scheme and its impact on the forecast. Grampian confirmed it's included in the £45m figure, with IJB CFOs reviewing it and £19m held via the integration scheme.

Concerns were raised by Aberdeenshire IJB on UC and DD about high discharge numbers and the need for funding and a discharge model moving forward.
 
The Chair queried the impact of actions in relation to care packages and if the removal of low and moderate packages of care are having an impact from an  early intervention point of view. Leigh confirmed that the IJB are not funding low and moderate care packages, but are liaising with local partners and providers to identify alternative sources of support for individuals. 

The AB welcomed the update and thanked Leigh and John for the update.  

The chair noted there are no health related savings reflected in the IJB recovery plan and queried where these appear. It was noted the recovery plan is focused on social care due to the situation that they were in within the last financial year. 

NHS Grampian month 4 financial position  

Alex Stephen presented the formal paper which focused on NHS Grampian’s financial position at M4, an action from Meeting Three. Alex Stephen presented the PAFIC Finance Report, outlining NHS Grampian’s financial position for the first four months of 2025/26. The Board is facing a significant challenge, with a year-to-date overspend of £23.4 million and a projected annual deficit of £53.9 million exceeding the Scottish Government’s cap by £8.9 million. Despite a £62 million savings target, only £12.4 million has been delivered to date. Key risks include underperformance in savings, cost pressures, and potential overspends by IJBs. Mitigating actions are underway, including strengthened governance and targeted interventions. The capital programme totals £103.8 million, with major hospital infrastructure investments. The Board remains under stage 4 escalation and is working closely with the Scottish Government to restore financial sustainability.

The Chair thanked Alex and welcomed thoughts and feedback on the paper.

Jack Gillespie confirmed Scottish Government are up to speed and is assured that Phil Tydeman is working on the savings plan. There were no further comments from the AB.  

Value & sustainability programme

Phil Tydeman provided a paper beforehand to the AB. An update was provided on the Value & Sustainability Programme via slides. NHS Grampian is advancing its Value and Sustainability Programme to address a £62 million savings gap for 2025/26. Since the last Assurance Board, £3.7 million in new savings schemes have been approved, with an additional £0.9–£1.7 million under review. Key initiatives include tighter vacancy and non-pay controls, procurement reforms, and workforce cost reductions. Notable schemes include converting agency locums to direct engagement or fixed-term contracts and cancelling underused service developments. A further £920k–£1.72 million in potential savings is being considered, with a target to approve £7 million in new schemes by the end of September. Engagement with KPMG is ongoing to explore VAT efficiencies, and further actions are planned to meet the £45 million deficit target.

The Chair welcomed thoughts and feedback on the paper. 

Jack shared information regarding workforce initiatives including moving locums to direct engagement which has significant cost reduction.

Phil noted that one area has achieved 100% compliance in this, and confirmed that this data will be shared going forward.

Jack queried the full-year impact of the £45m figure. Phil responded that the numbers are a best estimate and highlighted that a weekly panel has been established to review discretionary spending.

Some concerns were raised about perceptions within the workforce that grip and control measures are not being applied consistently between different professions. Phil assured that, in line with the open approach, expectations will be shared that this applied to all colleagues and a number of planned initiatives to address this are included in the schemes..

Hugh reiterated the importance of consistent messaging and committed that the medical workforce will subject to the same controls as other professions. 

The Chair welcomed the in-year savings and noted the identification of £3.7m in savings. The Chair asked whether these were all recurring and requested that they be factored into future projections. Grampian confirmed that the majority of the savings are expected to be recurring and will be considered in future planning.

The Chair asked in terms of assurance how confident are Grampian are regarding the £45m target. 

Grampian are confident as they can be at the moment and will see opportunities come up and are doing everything that they possibly can. The most challenging point in terms of the year is still to come.  Grampian will be clearer at the end of Q2 as to the expected forecast of  £45m and are working hard to make the gap.

The chair summarised and noted it is important to make sure three year profiling is complete to collectively plan and the intention is for Aberdeen and Moray IJB Chief Officers to provide further insight on the position of their IJB’s in the coming weeks. 

Governance mapping

Alex Stephen provided an update on the paper which outlines the roles and responsibilities of key committees, including the newly established Financial Recovery Board (FRB). The FRB will lead system-wide financial recovery and is scheduled for an effectiveness review in January 2026. Improvements to financial reporting are underway, and the paper includes updated terms of reference for both the FRB and PAFIC. The Board was asked to note these arrangements and the planned review.

The Chair welcomed thoughts and feedback on the paper. 

Laura Skaife-Knight welcomed the paper and said it has her full support. Operational governance and Board assurance will both consider the effectiveness of the arrangements on an ongoing basis. Laura said that page 7 of the notes indicated that the ToR for the Assurance Board were not formally signed off and asked if anything was outstanding so that we could ensure the ToR were finalised ASAP. 

Action: [redacted] to review ToR and issue out the final version to the AB. 

Alison Evison confirmed there are closed Board meetings  every month to enable discussion. Next meeting is scheduled for September 11th. The chair requested Alison provides an update on Board findings at the next AB meeting on 23rd.

Action: Alison Evison to report back to the next Assurance Board meeting on 23rd September. 

Unscheduled care

The Chair provided an update on the commitment to establish a subgroup of the Assurance Board, convene relevant parties and provide an update to the next Assurance Board meeting. 

The unscheduled care subgroup met for the second time on 28 August. They discussed the terms of reference and membership of the group, then considered the NHS Grampian plans for improvement. This includes actions currently in progress and priority actions to be carried out in the coming weeks. Feedback from the discussion will be added to a revised plan which was circulated among the subgroup. 

Further to the work undertaken since then feedback has been provided to NHS Grampian. Scottish Government need more time to collate comments on the revised plan. 

The Assurance Board was joined by Angie Wood for this discussion. 
Following the work undertaken since the last update, feedback has now been shared with NHS Grampian and revisions received from NHSG. Further analysis work will be carried out rapidly given the urgency of making progress.  
The Chair noted that the Cabinet Secretary is keen to receive an update on NHS Grampian’s progress, with a particular focus on UC and confirmed that an update will be provided.
The Chair indicated that the aim is to move towards signing off the funding. They also confirmed that the subgroup will further review the feedback to reach a decision on funding. It was agreed that a meeting will be arranged to stress test the plan in more detail.
Laura Skaife-Knight is supportive of the plan being discussed at the sub group and has asked colleagues to engage with NHS Lothian to compare and contrast their plans (including governance, leadership and resource arrangements).

Workforce update 

Fiona Hogg has followed up with June and Hugh regarding the action on workforce planning. The aim is to begin shaping the approach and explore any potential support that could be offered. A meeting is now scheduled for Thursday 4 September, and a more detailed update will be available at the next AB meeting.
On Wednesday 27 August, Stephen Gallagher, Fiona Hogg, and [redacted] met in person with the NHS Grampian Employee Director and a number of other union representatives. This followed an initial call held on Wednesday 13 August.
Fiona will connect with Laura and Adam separately to discuss the key themes arising from these engagements. The Chair will also be invited to join this meeting to gain a clearer understanding of the background and current developments.

Communications and engagement

The Chair fed back Cabinet Secretary views for the publication of the TORs, minutes and any associated reports (including the diagnostic report) and a publication strategy was in formulation. It has been suggested as part of the diagnostic report handling plan that Cab Sec may wish to take the opportunity to join this meeting to welcome Laura into post and affirm his expectations around improvement (TBC). 

[redacted] will be discussing the handling of the diagnostic report with Adam Coldwells on Thursday, to ensure SG and NHSG comms are aligned. 

The chair queried if NHS Grampian have a response to the report. Grampian confirmed this update is imminent with a clear plan of handling. Grampian are pulling together a draft and should be prepared by next Monday and a summary with key recommendations.

Jack Gillespie has discussed with the publication with KMPG and confirmed that their standard approach in this situation is to take a “no comment” stance if approached by media. There should therefore be no risk if they are not included in the handling plan. 

Any other business

The Chair noted the paper NHS Grampian – Planned Care Waiting Times – External Review. Laura Skaife-Knight described that the scope has been agreed as per the attached paper and that the review was about to get underway, with the conclusions from this review coming back to the AB in October. 

The Chair thanked colleagues for their contributions and closed the meeting. The next AB meeting will take place on Tuesday 23rd September at Grampian. This will be Laura Skaife-Knight’s first meeting as substantive Chief Executive and the Chair thanked Adam Coldwells for his work with the Assurance Board and wished him a long and happy retirement.