NHS Grampian Assurance Board minutes: 21 October 2025

Attendees and apologies

• Stephen Gallagher, Chair, Scottish Government 
• Robert Kirkwood, Head of People, Governance and Appointments Unit, Scottish Government
• Jack Gillespie, Deputy Director of Finance, Scottish Government
• Professor Graham Ellis, Deputy Chief Medical Officer for Scotland, Scottish Government
• Fiona Hogg, Chief People Officer, Scottish Government
• Tracy Slater, Head of Performance and Delivery, Scottish Government
• Mark Simpson, Professional Advisor (for Donna Bell), Scottish Government
• Laura Skaife-Knight, Chief Executive, NHS Grampian
• Alison Evison, Board Chair
• Phil Tydeman, Interim Director of Improvement
• Alex Stephen, Director of Finance
• June Brown, Executive Nurse Director
• Leigh Jolly, Chief Office, Aberdeenshire IJB (Unscheduled care item)
• Paul Bachoo, Medical Director for Acute Services (Planned Care item)
• Philip Shipman, Interim Director of People and Culture (Workforce item)
• [redacted], Head of Unit, Scottish Government
• [redacted] Private Secretary Office of the Executive Team, Scottish Government
• [redacted] Policy Officer, Scottish Government

Apologies

• Donna Bell, Director NCS
• Hugh Bishop, Medical Director

Items and actions

Welcome and Apologies

The Chair welcomed members to Meeting Seven of the Assurance Board (AB), noted apologies and outlined the agenda.

Actions/Update from Meeting Six

The Chair confirmed that the minutes from Meeting six had been circulated and invited any final comments. The AB approved the minute with amendments to the month of the meeting and a request that page numbers be included in future.

The Chair invited updates on actions from the previous meeting, in particular he asked Laura Skaife-Knight to update on the amendment to the whole systems governance paper (the inclusion of flow of accountability to the Performance Assurance, Finance and Infrastructure Committee (PAFIC) and the NHS Board) that was discussed. Laura advised this was still a work in progress and would be discussed this week at an NHS Grampian Board briefing and a Board seminar on 13 November 2025. 
The Chair also requested an update on a joint meeting planned between the Area Clinical Forum and Grampian Area Partnership Forum. Laura confirmed the meeting was scheduled for 30 October 2025.

Future support

Laura Skaife-Knight presented on the paper of future support, building on a paper that had been previously circulated and responds to funding available for 2026/27 linked to level 4 escalation. She described the paper as a “bridging paper” and advised that clinical and operational colleagues continue to consider and define how this investment will support the three priority improvement programmes Unscheduled Care, Planned Care, and Value & Sustainability; noting the majority of funding would support Unscheduled Care. Workforce and specifically workforce planning, is another area that NHS Grampian would welcome support in the future as will be discussed in the later agenda item. 
The chair invited comments from AB members.
Jack Gillespie advised that the level of financial support for 2026/27 had been agreed and if there was something additional required in addition, that Laura, as Accountable Officer, could consider this based on the return on investment. 
The Chair agreed with Laura’s comments that she would like to take time to consider where gaps may be in design or redesign of service and the Assurance Board would be content to receive an update at a November meeting. 

Finance update

Month 6 financial position:

Alex Stephen reported that the forecast was still looking at the £45 million maximum overspend and that the team is still looking at in-year opportunities for further savings. The overall forecast has improved by £2.1 million from the August 2025 forecast which confirmed the trend to the agreed outturn. 
There will be a more detailed conversation at next week’s NHS Grampian Chief Executive Team meeting about the position of budgets and that they continue to focus on arresting any expenditure where there is a deteriorating trend. 
The full report on Month 6 will come to the next Assurance Board as is now routine.
The Chair thanked Alex for this update and invited comments/questions.
Jack Gillespie noted that it was helpful to see that the projection was still consistent with the financial recovery plan but that he must know ASAP if there is any slippage to ensure overall portfolio balance. Jack also emphasised that the agreed maximum overspend was to be seen as maximum and that any improvement on this level would be welcomed. 

Value and sustainability

Phil Tydeman provided an update on the Value and Sustainability Programme. There was not much change in the in-year programme and that monitoring on the key areas continues. These are :
•    Review of underperforming schemes and recovery of in-year savings 
•    Holding the current trajectory of savings
•    Maintaining enhanced measures to control pay and non-pay expenditure 
Work for next year’s programme has begun and that includes an inaugural meeting of the Value and Sustainability Programme Board on 23 October 2025. A 20-week development phase of the programme will commence which includes the development of workstreams and agreement of workstream leads. 
Alison Evison confirmed the role of the Board in the governance of the programme. 
The Chair thanked Phil for the update and invited comment from AB members.
Jack Gillespie reflected it was helpful to see and that things were heading in the right direction and welcomed the early start to 2026/7 planning.
Professor Graham Ellis noted the synergy with realistic medicine themes and offered the support from the realistic medicine team, to engage clinicians if it would be helpful. Phil thanked Graham for the offer and would be in touch if helpful
The Chair requested more detailed information on the specifics of the programme, particularly the specific owners of specific changes and to avoid using the term “various” here. Phil welcomed the feedback and agreed to revise the plan to reflect this. 

Planned Care

Paul Bachoo provided an update on the Planned Care external review feedback. There was a meeting on 10 October 2025 with the external review team, and the formal report is expected at the end of this week.
Paul stated, there was a similarity in the methodology and practice being adopted at NHS Tayside and NHS Lothian regarding trajectories, modelling approaches, finance and gap analysis. Feedback suggested assurance around the governance around urgent and routine activity. Similarly around productivity and administration. There is much good practice identified in the review, whilst areas for improvement. NHS Grampian looks forward to receiving the final report.
There are challenges around day case surgery unit, however, Paul reported that the day case surgery unit will be back in operation from early November 2025. 
The feedback also noted the work on the outpatient reengineering cohort to maximise capacity. There were no comments on did-not-attend or cancellation rates. 
The Chair thanked Paul for the update and invited Tracy Slater to comment.
Tracy Slater thanked Paul and reminded that the impact of this is a significant reduction of new outpatients waiting more than 52 weeks. She thanked those involved for the support in the work and identifying what can be done to reduce numbers. Tracy also reminded the group of the committed £900,000 funding for Dermatology. Tracy also stressed the need for review of progress, through this group and other forums. 
Process for agreeing the trajectories has already been done through the programme governance assurance and formally accepted. 
Professor Graham Ellis asked on the plans of day care surgery, and whether, beyond opening, if there is more expected. Paul provided an overview of the intentions on deliverable and usable projections.
Paul explained that due to there having not been a day case surgery unit in Grampian now for over three years, a greater number of patients now have co- morbidity and  greater acuity. However in Aberdeen Royal Infirmary they have 24-hour hospital cover. He explained that the work they do will be no different to other day case units.  
Laura Skaife-Knight welcomed the verbal feedback from the review and that there were some areas of good practice that could be shared with other Boards as well as several areas where NHS Grampian can further improve, including around reporting and triangulation of data. She expects the formal report will be received before the next AB. 
Laura Skaife-Knight explained she is still considering the offers of mutual aid from other Health Boards and support and will feedback when this has been agreed. 
Laura also advised that the Planned Care Programme Board will meet this week for the first time, which will further strengthen governance and oversight arrangements for this organisational priority. 
Tracy Slater asked for assurance that the capacity for day surgery trajectory was what had already been submitted and that those patients who been waiting the longest time would be seen first. Paul agreed on both these points.  
The Chair welcomed the update and noted the considerable work that has been done locally and the confirmed trajectories by SG.  The Assurance Board would continue to seek assurance and looked forward to receiving the final written report and plan at the next meeting.  

Unscheduled Care (USC) Improvement Plan – Progress Report

Leigh Jolly provided an update on the Unscheduled Care Improvement Plan including the governance arrangements.

She advised that she is the Chair of the USC Programme Board which meets weekly and shared slides showing the overall governance structure. 

The Board will integrate with the wider governance of both local and national priorities. Escalation routes, including wider escalation and rapid escalation of risks, are included. Leigh stressed the need for clarity, transparency and continuous improvement.  

Data measurement is planned with data collection starting in October 2025 with data being available in November 2025. This will include the commitment to trajectories which will be built into the dashboard. 

The upstream delivery updates include:
•    Existing Flow Navigation Centre (FNC) model being strengthened to optimise use of current resources.  This includes increasing use of Near Me, development of SharePoint site to host clinical pathways and working with Grampian Medical Emergency Department (GMED) (out of hours urgent primary care) to explore alternative models for out-of-hours staffing
•    Future FNC model being developed which will include increased staffing and a more suitable location to support improved joint working
•    Improvements being made to the Chest Pain Pathway (most common presentation at the Emergency Department and Acute Medical Initial Assessment (AMIA) with aim of increasing number of patients seen on zero-day length of stay pathway.  Test of change underway to expand ambulatory assessment into the out-of-hours period.  Abdominal pain pathway next to be scoped
•    Plans in place to expand capacity on zero-day length of stay pathways from mid-Nov 25, through additional hours and locum cover pending permanent recruitment 
•    Feasibility of Remote Assessment Hubs being explored.  These hubs would carry out initial steps of assessment process for key pathways to reduce unnecessary attendance at hospital and reduce unnecessary travel for patients

Downstream delivery group updates include:
•    Discharge to Assess – recruitment underway for all posts and creation and agreement of pathways.
•    Frailty at the Front Door  (FaFD)– continuation of Tests of Change (ToC) and progressing with recruitment of Geriatric support at ARI.  Despite recruitment issues at Dr Gray's Hospital they are proceeding with Frailty at the Front Door principles and are recruiting additional AHP resource to enable frailty assessments at the front door.  Vacancies with recruitment awaiting advertisement.  Moray also plans to try and recruit several specialty doctors.
•    Integrated Discharge Hub/Planned Date of Discharge – ToC re Multi Disciplinary Team Huddles and Predicted Discharge Date compliance will commence w/c 27 October 2025.  This cycle will include 2 wards in Aberdeen Royal Infirmary and 1 ward in DGH.
•    Community Hospital/Step Down Rehab – Project group established and meeting on 21/10/25 to confirm and share activity underway across Grampian.

Leigh reported the need for the Board to oversee the work and that the test of change were clear about what they were there to do and what improvement would they bring. 

Operational service delivery updates include:
•    Pharmacy dispensary hours extended from 6 October 2025 –Extended Allied Health Professional hours – first vacancies now being progressed on JobTrain with impact measures under development
•    Flow Enabler Support (Facilities & Estates) – guidance on financial arrangements provided, Single Point of Contacts for prioritisation of work for this team being developed, impact measures under development

Leigh stressed that communication and engagement was key to everything and outlined the strategy:
•    USC Plan and associated papers distributed through programme structure on 6 October 2025 with request for wide distribution through operational structures
•    Update provided to all staff through Daily Brief on 8 October 2025
•    Unscheduled Care SharePoint site launched as part of Daily Brief update; this will receive regular updates
•    Joint working with Corporate Communications across NHS Grampian and Health and Social Care Partnerships on further communication and engagement requirements including information in the public domain.

The Chair thanked Leigh for the activity update.

Mark Simpson also thanked Leigh and was pleased to see the governance in place and the actions. He advised that it would be helpful to see the best estimate of what improvements the actions would have on performance month-on-month. Ministers would expect to see improvements going forward. 

Leigh advised that as well as the Key Performance Indicators (KPI’s) already approved there will be a number of measures underneath that the USC board will receive. 

Mark Simpson asked whether the social care capacity was there. Leigh advised that at this time there were no concerns across all three HSCPs.  

Professor Graham Ellis reflected on the reason we are doing what we are doing is to support people and that he would like to see more detail on what was being done, and by whom. 

Tracy Slater reflected on the plan and that it would be really useful to see the data and to hear more about the progress towards the KPI’s.

The Chair said it was really helpful to see the report and the activity and the whole system approach. He asked for more detail in future reports including data about outcomes, i.e. what and by when, actions and deliverables on what is being done.  

The Chair invited Alison Evison to reflect on the role of the Board in this plan and of its advocacy to key partners

Alison Evison said the Board welcomed the report and having been pushing for regular updates on the metrics, most of the non-executive directors are IJB Board members and are pushing for development. Commitment is there, supporting and being involved. Alison reflected on how Board members see people in different roles and how they can share the communication message. 

Leigh summarised and thanked the group for the feedback and recognised the need for more detail and will be able to provide that. 

The Chair thanked all for their input and suggested that there would be a deeper dive into the data at a future meeting. 

Workforce and engagement

Fiona Hogg proved an update on the commission to review, redesign and diversify the NHS Grampian workforce. She thanked June Brown for her input. 
Fiona asked the Board to consider whether a more rapid review would be helpful rather than the profession-led approach. This would be a smaller scale review to test methodology to see how things work.
She reflected on how a profession-led review would be time consuming. She also asked the AB whether it would be helpful to have a subgroup looking at this topic.
June Brown asked how much the AB is expecting, as she and Philip Shipman agreed it would be helpful to start small and look at a service or area. 
Philip Shipman agreed on comments made by Fiona and June. 
Professor Graham Ellis reflected on how different Grampian is to other Boards and how it might be useful to look at something rural or community models.
Fiona Hogg advised this gives the opportunity to look at workforce planning differently. 
The Chair thanked those involved for the discussion and if the Board was content then Fiona would scope a sub-group and for NHS Grampian to consider what area or areas would be helpful for the group to look at. Linking to a performance priority would make most sense. 
June Brown said that there was development work being done and that there were principles already there that could be used. 
The Board agreed to establish a subgroup to work with NHS Grampian on an organic approach to workforce review and planning. 

KMPG recommendations and actions

Phil Tydeman provided an update on the work that is being done on monitoring and progressing the recommendations on the diagnostic review, to ensure that all recommendations are being considered.
He outlined that the Executive team have reviewed all recommendations and completed an assessment for prioritisation and completeness. 
A governance framework is being developed to oversee delivery and assure progress against timescales.
The next steps are:
(a)    Continue to work with executive leads to develop milestones, key performance indicators, and evidence for completion by 28 October 2025.
(b)    Socialise the ownership of recommendations and governance framework through key forums, including with non-executive directors through informal monthly briefings, PAFIC and the Board seminar (13 November 2025).
(c)    Compile a detailed timetable by early November of those recommendations with expected closure dates in 2025/26. 
(d)    Commence monitoring and reporting from November 2025. 
Phil advised that there were seven recommendations that were subject to a decision to omit, these will be reviewed by the Executive team and supported by a clear narrative to require approval through internal governance for the Board to formally omit. 
[redacted] advised from a Scottish Government perspective that there is one recommendation that specifically mentioned Scottish Government and that was included in the seven to omit. 
It is important that Ministers will be able to answer questions in Parliament about what work is being done on the recommendations and on the position. 
Messaging shared on the publication acknowledged that this is just one source of insight, and that the recommendations would be subject to local consideration and decision making. 
Phil advised that this will be reported monthly to the Executive team and this can also be shared to the AB.
The Chair thanked both for the update.

Reflections on the publication of the report 

The Chair invited reflection on the publication of the report and asked Alison for feedback on the meeting with local MP’s/MSP’s. The meeting has now been rescheduled to 24 October 2025.
Laura Skaife-Knight said she felt it went as well as well as it could. There was a lot of pre briefs which served us well and enabled proactive communication. As expected, the media focussed on work force which has caused anxiety to staff, and as such a number of follow-up communications, messages and reassurance has since been shared with staff. There will also be work internally and externally around the work being done on the recommendations.
Alison Evison mentioned on how well attended the briefings to staff were and how much they were appreciated.
Philip Shipman reflected on the good relationships with the trade unions and how they have supported the approach.
[redacted] agreed the preparatory work was helpful but also that it has been parliamentary recess and a local holiday period, there may be an increase in media interest and/or parliamentary questions may come up over the next couple of weeks when Parliament is back. 
It was agreed to continue to work closely on communications, to be open and pro-active and to respond to any misinformation. 

Any other business

There was no other business.

The Chair thanked colleagues for their contributions to the seventh assurance meeting and closed the meeting.