NHS Grampian Assurance Board minutes: 22 September 2026

Attendees and apologies

Members, Scottish Government

• (SG) Stephen Gallagher, Chair
• (DB) Donna Bell, Director of Social Care & Mental Health
• (GE) Graham Ellis, Deputy Chief Medical Officer for Scotland
• (FH) Fiona Hogg, Chief People Officer
• (RK) Robert Kirkwood, Head of Governance and Appointments Unit
• (CP) Claire Pearce, Deputy Chief Nursing Officer

Attendees – NHS Grampian & Partners

• (AE) Alison Evison, Health Board Chair
• (LSK) Laura Skaife-Knight, Chief Executive
• (JB) June Brown, Executive Nurse Director
• (JCo) John Connaghan, Interim Health Board Chair
• (JCr) Jim Crombie, Deputy Chief Executive NHS Lothian
• (HFB) Hugh Farrow Bishop, Executive Medical Director
• (GF) Geraldine Fraser, Chief Officer, Acute Services
• (SF) Stephen Friar, Deputy Medical Director, Unscheduled Care
• (LJ) Leigh Jolly, Chief Officer Aberdeenshire Integration Joint Board
• (MK) Michael Kaiser, Planned Care Lead (External Support to NHS Grampian)
• (SL) Steven Lindsay, Employee Director
• (JO), Jay O’Brien, Director of People and Culture
• (AS) Alex Stephen, Director of Finance
• (RS) Rick Strang, Unscheduled Care Improvement Director, NHS Grampian
• (GW) Gail Woodcock, Director of Strategy, Transformation and Performance

In attendance

• [redacted], Assurance & Improvement Unit
• [redacted], Assurance & Improvement Unit
• [redacted] Hayley McMinn, Assurance & Improvement Unit
• (TS) Tracy Slater, Assurance & Improvement Unit
• (MS) Mark Stirton, Health Finance (obo Jack Gillespie)
• (CR) Clare Renton, Scottish Government

Apologies

• (JG) Jack Gillespie, Deputy Director of Finance

 

Items and actions

1: Welcome and Apologies

SG opened the meeting and welcomed returning and new attendees, including the incoming interim chair, John Connaghan, who takes up post on 10 October 2026.

2. Actions/update from meeting

[redacted presented the action log, and members noted progress in the development of governance KPIs, with further work required on targets and trajectories and an initial set of quality and safety indicators due to be reported in October 2026. JCo emphasised the need to strengthen links between quality, safety and risk management.

LSK advised that NHS Grampian was seeking external support through regional (east of Scotland) arrangements to help address backlogs in complaints and significant adverse event reviews, with any wider improvement support to be considered following the HIS diagnostic report.

3. Leadership & Culture

JO presented an update on the culture programme, noting improvements in 2026 iMatter results, action planning and compliance with statutory and mandatory training, while highlighting appraisal performance as a continuing area for improvement.

He outlined a number of initiatives underway, including development of an employee lifecycle framework, introduction of a management development programme, and a review of the people and culture function to strengthen management capability and expectations across the organisation.

LSK described a three-strand approach comprising an organisation-wide culture programme, targeted interventions in priority services, and focused support for teams experiencing cultural challenges. An October 2026 workshop with the culture programme board will support development of the framework, which will define standards of excellence across the employee lifecycle, assess the current position and identify improvement priorities before wider staff engagement.

Members also discussed the integration of speaking up arrangements within the culture programme, with work underway to strengthen links between whistleblowing, staff voice and governance structures. Positive examples of culture improvement, including achievement of “Magnet Pathway” status in parts of the organisation, were highlighted.

The assurance board emphasised that the culture programme must demonstrate a clear link to the improvement plan, leadership expectations and operational performance, and requested a further update in November 2026. Throughout the discussion, members repeatedly linked culture to performance, highlighting the importance of role clarity, communication, escalation processes, managerial confidence and consistent leadership in delivering sustainable improvement across services.

Action:  Provide further update on the culture programme to the assurance board in November 2026.

 

4. Planned Care

GF introduced this item and reported that treatment time guarantee performance is ahead of the previous trajectory and 52-week new outpatient waits are also ahead. However, 104-week and 78-week outpatient waits remain off track, especially in dermatology - new outsourced activity started this week, with 400 referrals sent and 100 appointments already booked.

CR made clear that long waits are being discussed weekly with the First Minister and that Grampian remains the main exception to national progress. The board stressed that long-wait recovery must not come at the expense of sub-52-week performance and must not result in a worsening year-end position after substantial investment and recovery effort.

JCo noted that the number of patients waiting over a year had reduced from 5,200 to just above 5,000, but that current trajectories show an upward rise by March 2027. He asked for clearer visibility of how the additional investment will support improved trajectories by specialty through to March 2027. Revised trajectories are expected to be submitted by the end of September 2026.

GF highlighted local redesign work. A recent urology workshop supported by the Centre For Sustainable Delivery (CFSD) had brought together consultants, specialist nurses and administrative staff, with Moray participating. The group had identified quick wins, opportunities for workforce redesign, and potential for more nurse-led outpatient activity to release consultant time for complex work. A board seminar had separately examined work to address long waits and cancer performance, diagnostics, infrastructure, redesign and improvement, and its output would be taken into the fuller planned care report scheduled for 08 October 2026 public board meeting.

JCr provided an update on the eight-week orthopaedics support programme delivered through the east regional network. Six domains were examined: Demand, Capacity, Activity and Queue (DCAQ) maturity, infrastructure and capacity, productivity, consultant job planning, productive opportunities with CFSD’s National Elective Coordination Unit (NECU), and governance and assurance. This work identified the need for more mature demand forecasting, alongside significant infrastructure and workforce challenges that were affecting service delivery, particularly at Dr Gray's Hospital.

JCr advised that regular weekly reporting to the chief executive throughout the programme enabled issues to be addressed in real time and helped avoid further disruption to patient services.

MK reported that the findings from the recent external support work were consistent with the regional review, with a focus on identifying the specific drivers of backlog, accelerating recovery actions, and distinguishing immediate improvements from the longer-term changes required to achieve sustainable performance. He stressed his role was not to conduct another diagnosis but to understand the specific causes of backlog at specialty and sub-specialty level, identify what would reduce the current long-wait position quickly, and distinguish those short-term recovery actions from the different measures required for long-term sustainability.

TS reinforce the importance of looking across the east and national systems for specialty capacity, particularly in areas such as dermatology where Grampian remained a clear outlier while other boards were closer to zero on their longest waits. GF confirmed that this cross-system work was in hand through chief operating officer and access-performance discussions.

Action: Review cancer performance in more detail at the next meeting and NHS Grampian to share the orthopaedic report once cleared.

5. Unscheduled Care

LJ introduced the unscheduled care update, setting out the approach focused on moving from performance analysis and diagnosis to implementation and sustainable improvement ahead of winter. She reported some early signs of improvement, particularly in length of stay, but emphasised that greater consistency was still required. The analysis concluded that pressures in the urgent care pathway were driven not only by demand but also by variation in pathways, unclear ownership, delayed escalation and inconsistent application of processes, highlighting the need for more reliable operational management and delivery.

The assurance board heard that hospital stay and delayed transfer data show early improvement in parts of the system. This included a sharp reduction in delayed transfers in Aberdeenshire during the sprint period and a reduction in long-stay patients through the 21-day review process. Members welcomed the fact that some gains are being generated through tighter operational practice and management discipline rather than through additional funded projects alone.

SG stated that aggregate Grampian-wide urgent care figures obscured what was actually happening in specific sites and asked for more site-specific reporting, especially given earlier projections that frailty and ambulatory care changes could drive 10 to 15 percentage point improvement in emergency department performance at Aberdeen Royal Infirmary.

JCo asked whether the organisation had a single detailed improvement plan linking actions, impacts, timescales and resource assumptions. RS confirmed that such plans existed, including a detailed point-by-point programme and a separate 12-point plan for Dr Gray’s Hospital. There was also reference again to the Public Health Scotland hour-by-hour performance analysis, described as a “pointillist report”, which could help rebalance staffing patterns and improve non-admitted performance outside the board setting.

GE asked for an update to the frailty expansion work. LSK was clear that the board-approved frailty model remains the intended direction of travel. As the expanded frailty model required changes in ward configuration an incident management team approach had been stood up to test the evidence, mitigations and options for impacted areas without reopening the whole scheme back up for discussion and bringing new elements to the table at this late stage. Two meetings had already been held, and the final meeting is scheduled to take place on 29 September 2026. A report is due on 06 October 2026.

TS challenged whether the resulting delay could weaken the intended impact of the frailty expansion, and LSK accepted that timing mattered but said the organisation was determined to conclude the issue quickly and definitively, and do this in the right way by listening to clinical colleagues’ concerns. Several members linked the frailty issue back to the earlier culture discussion. RS said the organisation is trying to move away from treating each improvement effort as a separate project and instead make accountability, challenge and follow-through part of normal managerial practice.

SG asked for an update on the expansion of the front door model. HFB updated the board on consultant recruitment linked to the expansion of the front door model. Interviews were planned in phases: November to December 2026 for 3 posts, March 2027 for a further 3, and June 2027 for the final 2. He said there was confidence in filling those posts through open competition.

In closing this item, SG acknowledged the current performance pressures while noting the more structured approach now visible in the paper and discussion. He asked for a fuller account of the learning from the sprint once the month had been completed and reiterated the need to understand which elements of the wider urgent care programme were being strengthened, deprioritised or discontinued in order to support the whole-system plan.

6. Value & Sustainability

AS reported that the 2026-27 deficit forecast remains within the agreed support level and that savings delivery is slightly ahead of schedule, although new medical and nursing pressures are emerging. Planning for 2027-28 is now focused on closing a much larger gap through refreshed proposals, learning from other boards and wider engagement with leaders across the system on difficult choices.

LSK advised that integrated financial planning with system partners will be built back into the critical path in quarter 3. This reflects the need to understand the consequences of savings decisions beyond NHS Grampian itself and to assess knock-on effects across the wider health and care system.

AOB

SG asked to take a fuller look at progress against the 2025 diagnostic report recommendations. This will be done through a deep-dive session.

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