NHS Grampian Assurance Board minutes 23 April 2026

Attendees and apologies

Members

• (SG) Stephen Gallagher, Chair, 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
• (TS) Tracy Slater, Head of Performance and Delivery, 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
• (TS) Tracy Slater, Head of Performance and Delivery, Scottish Government

 

Attendees – NHS Grampian

• (AE) Alison Evison, Health Board Chair
• (LSK) Laura Skaife-Knight, Chief Executive
• (JB) June Brown, Executive Nurse Director
• (SD) Sarah Duncan, Health Board Secretary
• (TF) Tara Fairley, Deputy Medical Director, Acute Clinical Governance
• (HFB) Hugh Farrow Bishop, Medical Director
• (GF) Geraldine Fraser, Chief Officer, Acute Services
• (SF) Stephen Friar, Deputy Medical Director, Unscheduled Care
• (LJ) Leigh Jolly, Chief Officer, Aberdeenshire IJB
• (SL) Steven Lindsay, Employee Director
• (SR) Sandy Riddell, Non-Executive Director
• (AS) Alex Stephen, Director of Finance
• (RS) Rick Strang, Site Director ARI
• (PT) Phil Tydeman, Interim Director of Improvement

 

Attendees – SG/Other 

• [redacted] Policy officer (notetaker)
• [redacted] Policy officer
• [redacted] Head of Unit
• [redacted] Head of Planned Care Policy and Performance
• [redacted] Policy Official, Unscheduled Care
• (RP) Robbie Pearson, Chief Executive, Healthcare Improvement Scotland

Meeting Apologies

• (DB) Donna Bell, Director Mental Health & Social Care/NCS development
• (RK) Robert Kirkwood, Head of People, Governance and Appointments Unit
• (PB) Paul Bachoo, Medical Director for Acute Service

 

 

Items and actions

Welcome and Apologies

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

Actions/Updates from previous meetings

Minutes from the previous meeting were accepted with one amendment on page 3 – reference to NHS Grampian to be amended to specify the acute triumvirate leaders.

GD provided an update on the action log:

Two actions referring to governance can be closed as they will be addressed within the meeting:

• A further paper on corporate governance will be brought back to the assurance board to provide assurance and build confidence around the issues being considered. Robert Kirkwood indicated he is happy to provide any support required
• The Chair requested assurance on how these leadership arrangements come together and how information flows through to the NHS Grampian Board, emphasising the importance of seeing this “in the round” to ensure the Board has full visibility of risks, issues, and progress across the system.

Update from action from meeting 17:

• Donna Bell to convene USC Subgroup to have a deep dive on performance and variation at Dr Gray’s Hospital

A meeting took place on 21 April 2026. Points relating to general unscheduled care performance were covered and will be referenced in the discussion of unscheduled care within the meeting. A full deep dive was not completed so this action is carried forward.

One action remains open:

• Phil Tydeman to share a copy of the Quality Impact Assessment (QIA) on value and sustainability with assurance board.

This will be an agenda item for assurance board on 2 June 2026.

Clinical Governance

TF provided an update on Dr Gray’s Hospital, including feedback from senior staff and perspectives from national colleagues. Initial impressions are positive, with the senior team viewed as committed, hardworking and open to engaging with others on the changes required, particularly around strengthening clinical governance arrangements.

It was noted that higher‑acuity services are supported by robust processes; however, more broadly there is a lack of clear structure and consistency in clinical governance arrangements currently. In particular, the flow of governance between hospital and unit level has not been clearly defined, which is creating challenges.

Addressing this will require clearer processes, improved communication, and continued engagement to support confidence and understanding of the changes being implemented.

Immediate action has been taken to progress several Significant Adverse Event Reviews (SAER), with several actions identified and plans in place to address them.

HFB raised concerns that the executive team is not always sighted on clinical governance issues in a timely manner, noting delays in the escalation and receipt of key concerns. He highlighted that there are parallel improvement actions under way to address this.

SG noted this update and invited comments from assurance board members.

GE welcomed the update, noting the value of both the specific actions underway at Dr Gray’s Hospital and the opportunity to apply the learning more broadly across the wider system. He would welcome milestones and some of the issues being resolved.

JB then commented on the development of a new Quality and Safety Programme Board that will undertake several defined workstreams. These will include a comprehensive review of clinical governance arrangements within NHS Grampian and an assessment of how these arrangements integrate with, and are overseen through, the health board’s wider governance framework.

SG noted that engagement with Healthcare Improvement Scotland (HIS) and NHS Education for Scotland (NES) was a key factor in escalation and confirmed that there has been ongoing, constructive dialogue with both organisations on clinical governance. He outlined that as issues had emerged and the assurance board was copied into dialogue; he had been supportive of a package being developed by HIS to support and strengthen approaches to clinical governance across NHS Grampian.

RP outlined the proposed package of support agreed with NHS Grampian and thanked the board for its engagement and acknowledged both the complexity of the issues and that aspects of the work may feel uncomfortable for services. He emphasised that the proposed approach is centred firmly on the parameters of clinical governance and safe care, with a time limited eight-week period to support diagnosis and agreement of next steps.

SG noted it would be helpful if the final agreed proposal could be circulated to members of the assurance board. NHS Grampian would wish to share the outcome of the diagnostic with the assurance board.

LSK outlined plans for the coming weeks, including discussion at the executive team meeting to discuss and agree the next steps and timescales for further strengthening clinical governance. She noted that a more detailed summary of this work would be developed, supported by external input from HIS to the executive team. She highlighted key upcoming milestones, including an additional closed meeting on 7 May 2026 to continue the work and align with HIS escalation activity. A health board seminar is planned for 14 May 2026, where the outputs of this work will be shared, including a focused session on clinical governance and improvement, with clear timescales and named leads for delivery.

SG welcomed the proposed way forward and noted the development of the additional programme board. He confirmed that the programme board should be seen in the context of the other boards, with work conducted in a cross-cutting manner.

Unscheduled Care

GF provided an update on the unscheduled care improvement programme. For the week ending 12 April 2026, emergency department four‑hour performance improved slightly across NHS Grampian, increasing from 52.8% to 54.8%, largely driven by improved performance at Dr Gray’s Hospital. However, rising occupancy across all sites has constrained patient flow, with Aberdeen Royal Infirmary midnight occupancy increasing by around 4% to over 107%. This pressure has contributed to a reversal of recent improvements in eight and twelve‑hour waits, as well as a deterioration in ambulance turnaround times, with the largest increase seen at Aberdeen Royal Infirmary.

Despite these pressures, admission‑avoidance initiatives continue to have a positive impact, including increased activity through rapid acute assessment and discharge, expanded frailty pathways, improved coverage through the front door nurse co-ordinator model, ambulatory care pilots, and extended same-day assessment centre hours, all helping to reduce system risk.

LJ provided an update on the work of the programme board, highlighting the development of a more robust dataset to support understanding of the range of improvement projects and their impact. Aberdeen’s discharge-to-assess programme has now moved into the commissioning phase, and the programme board noted a real and sustained reduction in health and social care delays, which has positively contributed to overall system performance.

The data being reviewed is helping to provide clearer insights into both individual projects and a broader set of key performance indicators. Recent analysis has reinforced that length of stay remains a key area requiring further focus and deeper understanding. This work is informing planning for future improvement activity and the development of a clearer framework to better understand impact and support decision‑making going forward.

SG asked when the health board last received a detailed report on unscheduled care performance and what discussion had taken place.

SR noted that the detailed “How Are We Doing?” report had been discussed at the Performance, Assurance, Finance and Infrastructure Committee (PAFIC) . It was highlighted that PAFIC has been moving more quickly to undertake deeper dives, with an increased focus on strategic priorities.

SG asked what the plans were in terms of the Easter period where performance gains in the previous 4–5-week period had eroded and what improvements will be made over future well known “holiday periods”.

GF outlined the planning process for holidays and that the programme board are now reviewing this approach to identify what they could have done differently.

RS referenced the data of ambulance hours, how it had improved and then the dip at Easter. He talked about possible external support to imbed the process across all staff, considering the challenges caused by geographical area and the number of staff.

GE commented on the discussion in the recent unscheduled care subgroup meeting, highlighting the range of interventions underway and the ongoing challenges, particularly following the recent public holiday period. He questioned how widely the vision for unscheduled care is shared across the system and raised concerns about continuity and resilience when key individuals are not present.

TS reflected on the human behaviours at the front door, asking what actions staff are taking in practice and whether patients are effectively tracked. She noted the scale of strategic work underway, with over 19 projects in place this year, and emphasised that there is no desire to stand down activity. However, she questioned the overall impact being delivered. She highlighted that 12‑month trend data show the system is in a worse position in March 2026 compared to March 2025, underlining the importance of understanding impact and prioritisation.

RS commented that improvements in unscheduled care are being achieved through difficult but necessary work, and that this progress is being demonstrated to the Scottish Government. Daily statistical process control data is shared and indicated that four‑hour performance had been improving. It was agreed that longer waits, and the correlation between different datasets, will be discussed in more detail ahead of the next NHS Grampian board meeting.

RS also provided an update on the frailty unit, outlining what is required to implement it and confirming that it is expected to be in place over the coming months. He expressed confidence that the work can be scaled and embedded, with both processes and physical moves achievable. GE asked if there was a definitive date for the changes to be in place following planning and consultation.

LSK described that a formal paper and case need to go through internal governance as a priority on the frailty unit to move beyond initial engagement, setting out proposals in more detail covering staffing/workforce, finances and funding sources and programme management support required to implement. This is to be brought to the executive team within two weeks, covering each of these aspects so that next steps can be agreed and timescales confirmed.

JM asked what the breach analysis is showing, in particular whether performance falls away in the evening, and highlighted issues around pathways, including admitted and non‑admitted routes. She queried targets, minor streams and opportunities for improvement.

SF responded by outlining work underway on minor pathways, including extended provision into the evening, rescheduling patients to attend later, and the recent introduction of an amber pathway within the emergency department.

SG emphasised the fundamental importance of clinical leadership and expressed strong support for the senior leadership team. He asked how invested leaders feel personally in the work, whether this is reflected in their objectives for the coming year, and what additional value they can bring through visible engagement.

HFB confirmed that he is invested, particularly in unscheduled care. He noted that while there are existing forums that could be better utilised, the visibility of leadership needs to be strengthened. He highlighted the importance of regular touchpoints with the emergency department, while also reflecting that further thought is needed on where and how leadership engagement should be exercised across other pathways.

JB commented on the delivery of care in the context of organisational strategic risk, noting particular challenges in relation to non‑standard patient pathways. SG asked JB to consider where she felt she could add the greatest value, including the importance of the executive nurse lead role.

Reference was made to the NMAP leadership council structure and the importance of clarity on where priorities are set. It was agreed that this is where further discussion is needed to ensure alignment, focus and effective leadership contribution.

JG commented that the financial position is improving and expressed the hope that no elements of the programme would be stood down as a result.

LSK reflected on the discussion around leadership, suggesting all executive team members, the chief executive included, need to consider the unique contributions they can make. She noted that this would be taken away for further reflection, including consideration of individual and shared objectives to strengthen leadership impact going forward.

SG reflected on the discussion, highlighting the importance of the work underway on frailty, improvement methodology and the need to re‑assess timelines to ensure delivery remains realistic and focused. The work had to move outwards from a core group to all with a role in improving and sustaining unscheduled care pathways and flow. The health board need to consider the spread and sustainability of recent improvement. He emphasised the importance of leadership and consistent messaging across the organisation, noting that the board is fully aligned and supportive of the direction being taken to drive performance improvement. Particular emphasis was placed on ensuring that strategic intent and leadership engagement translate into visible impact “on the floor” reinforcing the connection between board‑level oversight and removing barriers to effective day‑to‑day delivery of care.

The assurance board would meantime retain a close interest in unscheduled care performance and the effectiveness of NHS Grampian’s plans for improvement.

Value and Sustainability

PT provided an update on the plans for the 2026/27 Value and Sustainability Programme. The programme has now moved fully into the implementation and monitoring phase. Of the £41.9 million total value of schemes identified, £38.9 million has been locally approved and has progressed through the quality and impact assessment processes, with the remaining £3 million scheduled for completion by the end of April 2026.

Work continues to strengthen delivery through the development of mitigation schemes, supported by organisation‑wide engagement. There are currently no material escalations to report. The paper also outlines plans for a pan‑Grampian system diagnostic, with a 12‑week programme expected to commence in early May, subject to final agreement of scope with the three integration joint boards and local authorities. Overall, this provides assurance that plans for 2026/27 are well advanced and moving into active delivery.

PT provided an overview of the month 12 year-end results on value and sustainability and the savings achieved. The provisional year‑end position shows an overall NHS Grampian outturn of £35 million, representing an £8 million improvement from forecast. This improvement reflects lower‑than‑anticipated final‑quarter activity, additional savings delivered through the Value and Sustainability Programme, and improved Integration Joint Board positions. £64 million of savings were reported against plan, with £48 million delivered on a recurring basis. The paper also provides a brief update on the 2026/27 Value and Sustainability Programme, confirming that the majority of schemes are now approved and in implementation, with no material escalations at this stage.

SG noted the significant improvement in the year‑end position, highlighting that the delivery of 3.56% recurring savings and the 2025/26 outturn represents a considerable improvement from the position that originally triggered escalation

De-escalation criteria

LSK provided an overview of the papers on the final version of the agreed criteria and timeline for de-escalation. The criteria have been refreshed following extensive engagement with the health board and the assurance board chair and members, to strengthen clarity, ownership and accountability.

It is recognised that de‑escalation on any aspect of the escalation will not take place before January 2027. As such, the paper sets out a revised set of measurable criteria covering finance, performance and leadership and governance, with milestones extending through 2026/27. These include the requirement for a credible, scoped savings plan by Quarter 3 2026/27 to move towards a £25 million deficit in 2027/28, alongside agreed trajectories for planned care and unscheduled care performance.

Notably, the unscheduled care criteria have been reshaped to focus on achievement of agreed quarterly targets for four‑hour performance, ambulance handovers and delayed discharges, alongside demonstrable whole‑system working. Governance criteria have also been strengthened, with a greater emphasis on evidence‑based assurance around risk management, staff engagement and health board oversight.

The assurance board was asked to approve the proposed criteria, enabling finalisation and confirmation of the route map to de‑escalation, with progress assessment commencing later in 2026.

A discussion took place around the need to ensure that the measures align with agreed key performance indicators in the broader system so as not to duplicate effort and evidence.

PT noted a question around the quarterly measures in planned care and unscheduled care and confirmed that this would be clarified through slight rephrasing of the narrative.

SG stressed the need for targets for planned care not to be higher than those for boards not in escalation and noted the fluctuation in unscheduled care at the moment and today’s discussion on sustainable performance improvement

The assurance board agreed to note the paper and that some further work around precise evidence in planned care and unscheduled care targets should be conducted during May to discuss and agree in June.

Action: De-escalation criteria on planned and unscheduled care performance to be included on a June agenda.

AOB

LSK provided an update on the North-East of Scotland system diagnostic and transformation work. She confirmed that the final scope for the diagnostic phase has now been agreed, with strong engagement from integration joint board colleagues throughout the process. A 12‑week programme is planned to commence in early May, with the finalised scope to be shared with all partners. She also noted that arrangements are in place to stand up a programme management office to support delivery with each partner committing resource to this, and highlighted that the paper sets out the critical success factors required to ensure the programme delivers the intended system‑wide impact.

AE provided feedback and reflections from the recent health board seminar on governance, including the proposed next steps. A key theme from the seminar was the importance of understanding accountability both individually and collectively as a board and across groups. Several common themes and actions were identified, and these will be captured in a paper to support transparency and shared understanding going forward. One of the key actions arising was to identify and learn from best practice in other health boards. AE noted that she will follow this up with SG offline to explore what additional support may be helpful. She also highlighted the importance of strengthening the thread and alignment between the Clinical Governance Committee and wider governance arrangements.

LSK provided an update on the recruitment of the substantive Director of People and Culture. Jay O’Brien will take up post on 03 August 2026. Meanwhile Melanie Saunders will continue in the role on an interim basis and support a handover process.

 

Next meeting: Meeting 19 is scheduled for Thursday 7 May in person at ARI, this will be preceded by a walkthrough of unscheduled care by some AB members.