NHS Grampian Assurance Board minutes: 22 July 2025

Attendees and apologies

Members

• Stephen Gallagher, Director of Mental Health, Scottish Government (Chair)
• Donna Bell, Director NCS & SRO Service Renewal Framework
• Fiona Bennett, Chief Finance Officer Health and Social Care
• Fiona Hogg, Chief People Officer
• Robert Kirkwood, Head of People, Governance and Appointments Unit
• Tracy Slater, Head of Performance and Delivery

Attendees – NHS Grampian

• Adam Coldwells, Interim Chief Executive

• Alison Evison, Board Chair
• Hugh Bishop, Medical Director
• June Brown, Executive Nurse Director
• Phil Tydeman – Interim director of improvement 

Attendees – SG/other 

• [redacted],  Sponsorship Support Manager
• [redacted],  Private Secretary Office of the Executive Team
• [redacted],  Sponsorship Support Officer

External – KPMG

• Richard Mills, Director
• Harriet Fisher, Senior Manager
• Suhaib Motala, Manager
• Emad Maqbool , Senior Manager
• Jason Parker, Global Improvement Lead

Meeting apologies

• Professor Graham Ellis, Deputy Chief Medical Officer for Scotland

Items and actions

Welcome and apologies

​​​​​​The Chair welcomed members to ‘Meeting One’ of the Assurance Board (AB), noted apologies and outlined the agenda. This meeting will focus on agreeing the Terms of Reference, KPMG draft diagnostic report headlines, NHS Grampians initial response to the report, NHS Grampians quarter 1 financial position and engagement.

Draft terms of reference for assurance board

The final draft Terms of Reference was shared with the group at the previous meeting and includes a remit for sub-groups that can be identified for external support. Members offered comments on the Terms of Reference at the previous meeting. The Chair reviewed and amended the Terms of Reference in line with the comments raised. The AB agreed a line of partnership needs to be added which will be picked up after the meeting and further published online.

The chair provided an update on two actions from Meeting 0:

Action – NHS Grampian to share their ‘Plan to the Future’ reports with the AB. This actioned from 9th July via email which Adam Coldwells shared with the AB. The Chair thanked this plan being shared.

Action - A paper on the financial position at the end of July to be brought to a future meeting. This will be discussed today.

The Chair advised feedback from SG members after meeting zero was the concern about the impact of the gap between escalation and the new Chief Executive of NHS Grampian taking up their position. Following discussion with NHS Grampian, it was noted that weekly hand-over meetings had already begun between the incoming and outgoing Chief Executives, that an interim Director of Improvement had been appointed who would help with the transition (and was in attendance today) and that the incoming Chief Executive would attend a number of meetings (including future meetings of the AB) from August. The new Chief Executive would be fully in place from 23 September and would be consulted on all major decisions prior to assuming full AO status.

KPMG draft diagnostic report headlines (KPMG update external)

The report was shared to AB members on Friday 18 for initial review ahead of the meeting. AB was asked to read the Executive Summary of the report prior to the meeting.

The Chair confirmed we will digest the report in full prior to the next meeting to see if any further information or discussions are required. Packages of work will then be decided. Introductions were made for KPMG members who joined the call for this item. KPMG thanked Grampian and SG for their engagement and rapid responses whilst the diagnostic work was ongoing.

KPMG external team provided an update on the headlines from the report. The three areas SG commissioned were leadership and governance arrangements, a further analysis on the deficit drivers and identifying costs savings in the future. These aspects have been completed apart from one area highlighted, which was in relation to external concerns  that requires some further work and an update to be added to the report will arrive shortly.

KPMG colleagues shared the key findings from the diagnostic and detailed overarching improvement activities to the AB. Prioritising the primary issues will be key moving forward. AB members asked further questions on the diagnostic report which were answered and discussed in full.

The Chair provided an overview of the issues brought forward and requested further information which KPMG will respond to following the meeting.

NHS Grampian attendees thanked KPMG for their work and asked for some clarification on particular areas of the report.

The Chair thanked everyone for their contributions and closed this item. KPMG colleagues left the meeting following this item.

NHS Grampian initial response to draft KPMG diagnostic report

Adam Coldwells and Alison Evison provided an overview of the NHS Grampian response to the KPMG diagnostic and their plan for moving forward. This will focus on financial sustainability and improving performance in planned care (PC) and unscheduled care (UC). The plan includes KPMG insights and additional information provided from within NHS Grampian. NHS Grampian have reviewed and recognised the main three issues identified within the KPMG report. NHS Grampian still need to look at prioritising the key issues and the AB will play a key role in this work.

NHS Grampian continued to provide information on strategic prioritisation for each issue. This included recommendations and suggested actions. A discussion then took place on the drivers for change and opportunities that were included in the KPMG report. NHS Grampian highlighted two opportunities where further clarity will be required from KPMG. NHS Grampian ended the presentation by sharing their overall approach to this work, noting that actions will be prioritised for implementation and that this prioritisation will be tested with the AB

Alison had provided an update to the NHS Grampian Board when the KPMG information was shared with them for the first time. The overall feeling was that this is a fair report and they recognise the issues raised. The next NHS Grampian Board meeting is due to take place in August 2025 and will have a more substantive discussion on the report and how it is intended to take the work forward. .

Discussions took place on the nature of support that could be provided to NHS Grampian in taking forward its improvement plan.  Possible opportunities that have been identified at this stage were offered by members of the AB to NHS Grampian. It was noted that in previous stage 4 escalations, clinical colleagues were key to the conversation and it will be important to have them included in the work of the AB. This is particularly relevant in the need to focus on key priorities, redesign unscheduled care and improve patient flow as well as ensuring that staff increases aligned to the period captured in the KPMG report were in line with safer staffing legislation and guidance.

The Chair welcomed thoughts and information from the senior Clinicians in attendance. They confirmed that conversations that took place at this meeting are consistent with those taking place within the NHS Grampian executive team. NHS Grampian aim to zero in on issues and determine which of these the AB can offer assistance with.

Action - SG members to convene for a discussion on how support that can be provided with UC and safer staffing levels, o provide one collective package of support on these topics as well as other more tailored inputs in other areas if required.

NHS Grampian Q1 financial position

Adam Coldwells provided an overview of a presentation that was previously issued to the AB which focussed on NHS Grampian financial position at Q3, this was an action from meeting zero.

The presentation included information on planned saving in 25/26 and the financial saving delivery at the end of June. The following information shared was on the 2025/26 forecast outturn and next steps.

The next meeting of the AB is to include a fuller paper. The AB Chair also requested a confidence assessment on the existing savings propositions for 25/26.

Communications and engagement

Adam Coldwells presented a slide on NHS Grampians planned approach and next steps to engaging and communicating on the KPMG report and improvement plans. Plans are in place for sharing the KPMG report with internal and council partners in a roadshow approach. Within this, Grampian are planning to seek actions from these areas with a holistic style approach. An information pack is to be prepared to determine tools which can be used in team meetings to identify key roles to address actions. NHS Grampian will think about the narrative and how they will address concerns.

The Chair advised NHS Grampian that a more proactive approach might be to share the proposed improvement plan and approach, informed by the KPMG diagnostic.

NHS Grampian will pick up a formal conversation with Chief Officers on the KPMG diagnostic report. 

The Chair confirmed clearance will be sought from Cabinet Secretary for the publication of the report. This would clear the way for wider sharing of the publication.

Any other business

The Chair thanked the group for attending this meeting and noted that AB members can reach out to the NHS Grampian Board when necessary. The AB will meet on 5 August in Grampian.