NHS Grampian Assurance Board minutes : 23 September 2025

Attendees and apologies

Members

• Stephen Gallagher, Chair, Scottish Government
• Donna Bell,  Director NCS, Scottish Government
• Fiona Hogg, Chief People Officer, Scottish Government
• Robert Kirkwood, Head of People, Governance and Appointments Unit, Scottish Government
• Tracy Slater, Head of Performance and Delivery, Scottish Government
• Jack Gillespie, Deputy Director, Health Finance, Scottish Government

 

Attendees – NHS Grampian

• Alison Evison, Board Chair
• Hugh Bishop, Medical Director
• Phil Tydeman, Interim Director of Improvement 
• Laura Skaife-Knight, Chief Executive, NHS Grampian
• Alex Stephen, Director of Finance
• Dennis Robertson, Moray IJB Vice-Chair (Moray IJB budget item)
• Judith Proctor, Chief officer Moray (Moray IJB budget item)
• Bridget Mustard, Moray Chair (Moray IJB budget item)

 

Attendees – SG/Other 

• [redacted], Head of Unit
• [redacted], Private Secretary Office of the Executive Team
• [redacted], Policy Officer

 

Meeting Apologies

• Professor Graham Ellis, Deputy Chief Medical Officer for Scotland
• June Brown, Executive Nurse Director

 

Items and actions

Welcome and apologies

The Chair welcomed members to Meeting Five of the Assurance Board (AB), noted apologies, and outlined the agenda. Substantive items on the Board’s agenda includes verbal reflections, workforce update, finance position including delegated budgets, communications and engagement, unscheduled care group, allocation for 26/27 and a planned care update. 

The Chair noted that the minutes from the previous meeting had been circulated with the meeting papers. The AB approved the minute with one amendment (reference on page 5 to Q1 should be Q2) and the updated Terms of Reference. 

An update was provided on outstanding actions from Meeting Four.

Actions/update from Meeting “4” 

Two actions from meeting 4. 

Action: [redacted] to review ToR and issue out the final version to the assurance baord. The ToR were circulated with the meeting papers, and this action closed. 

Action: On the previous meetings governance mapping item Alison Evison agreed to report back to the next Assurance Board meeting on 23 September on the closed board meeting.

Alison Evison provided an update on the closed Board meeting, focusing on in-depth discussions regarding USC governance and the financial recovery board. She highlighted that the financial recovery board will maintain strong oversight through deep dives but will avoid duplicating topics already covered by other committees or the NHS Grampian Board. The financial recovery board will be reviewed in January. Only one amendment to the Terms of Reference was identified, clarifying the statement about commissioning work. With regard to USC governance, the NHS Grampian Board emphasised that IJBs are key partners, and endorsed the new elements, with the exception of some changes to the Terms of Reference. This update closes the action.

The Chair thanked Alison Evison for her update.

Verbal reflections 

Laura Skaife-Knight reflected in her first week in post on the fact that she has had a thorough handover with Adam, has met all members of the Chief Executive Team ahead of commencing in post, and had one to ones with a number of key partners and external stakeholders. Laura recognised Adam’s contribution, the improvement work that is underway and said the key projects are progressing well, with actions against the diagnostic report scoped or well advanced and a comprehensive improvement plan in development to bring together all recommendations. This will return to an assurance board in October 2025. While some governance arrangements may evolve and be further strengthened with Laura’s arrival, the priorities remain unchanged, notably planned care, unscheduled care and sustainability and value and updates will be brought back to the assurance board as soon as possible re: governance arrangements in each of these areas. Additionally, a meeting with staff-side leads and the Employee Director is scheduled, with a further discussion planned at the Chief Executive Team meeting next Tuesday to reflect on the feedback received and to agree next steps.

The assurance board noted the further development of the governance arrangements and the streamlining of priorities and thanked Laura Skaife-Knight for her early reflections and setting out her priorities. 

Workforce update  

Fiona Hogg provided a verbal update as a follow up from the previous AB meeting. 

Key activities included a session with some health colleagues on 4 September to review the current workforce position, discuss insights and recommendations, and identify next steps to inform future planning. It was noted that increases to NHS Grampian’s workforce numbers are not significantly out of sync with some national figures. June and Hugh have agreed to collaborate on a rounded “workforce paper” and will work with SG Workforce colleagues and provide an update at an October Assurance Board meeting.

Action: Workforce update to be on the agenda on October 21 meeting with Fiona Hogg leading. 

The chair welcomed comments from the Assurance Board and it was agreed that this item would come back to Board on 21 October with an update on workforce as a whole. 

Finance position including delegated budgets (IJB chief officer) 

Alex Stephen provided an update on the Month 5 position, with NHS Grampian reporting a year-to-date deficit of £25.7 million (Month 4, £23.4 million). NHS Grampian have reported a full year projected overspend of £45 million, which is in line with the financial recovery plan. However, there is a £7 million gap which underpins the £45 million deficit outturn target. This was highlighted to Scottish Government during the quarter 1 finance review meeting by the Interim Director of Improvement. NHS Grampian confirmed there needs to be savings programmes set up as soon as possible. 

The Scottish Government welcomed the improved monthly financial position and will continue to work closely with NHS Grampian on a monthly basis to support further progress. The financial plan shows a significant reduction. 

Jack Gillespie queried the Month 4 figures, noting a £4.2 million variance above the £45 million projected overspend, and NHS Grampian confirmed that the £4.2 million reflects the phasing of savings realised. Alex also confirmed that a meeting with the IJB CFO is scheduled for this afternoon, and the £2.3 million IJB provision remains in the current forecast.

Phil Tydeman provided an update on the current position of the value and sustainability programme update consisting of £5.6 million in new savings have been identified, with £1.3 million under review by the Chief Executive team. £17.95 million has been delivered year-to-date, with a forecast of £60.4 million. Focus remains on recovering £3.5 million from underperforming schemes and preparing for the 2026/27 programme. A VAT opportunity is being considered, and next steps include finalising resource needs and progressing new savings schemes. Overall, in terms of risk a moderate and increasing level of confidence is growing. 

After discussion on the figures the Chair requested that NHS Grampian clearly set out and map out the progress against the target number of £45m with the narrative to support this – highlighting what is included in the monthly outturn figure and year end projection including any assumptions about the phasing of savings.

Judtih Proctor provided an update on Moray IJB financial position using a slide deck. This was the second of three planned updates from the IJB Chief Officers to the assurance board. The Moray Integration Joint Board (IJB) has approved a balanced budget for 2025/26, relying on £1 million in earmarked reserves, 3.5% efficiency savings, and £7.3 million in tracked savings projects, but currently faces a projected year-end overspend of £4.7 million as of June 2025. Both partner organisations have budgeted for a potential deficit, and a Recovery Plan is in place, focusing on continued and new savings, budget reductions, and reserve use. However, there is a £2.6 million risk of non-delivery of planned savings this year, with ongoing efforts to identify further savings. Looking ahead, the medium-term financial plan forecasts an £18.2 million budget gap through 2029/30, with £4.8 million in savings needed for 2026/27, and any shortfall this year will increase future savings requirements.

The Chair welcomed comments from AB members.

Jack Gillespie asked whether there were any IJB contributions included in the previous financial year, and Judith confirmed that there were, with an approved balanced budget this year that included additional funding. 

The current MTF financial position was shared as part of the financial planning discussion. 

The Chair queried the £2 million overspend in the first three months, noting that if this trend continues, it would result in an £8 million overspend by year-end, and asked what measures are in place to address this. 

Judith Proctor confirmed there is a high degree of confidence in the forecasted savings and financial controls. The question was also raised about whether the IJB has control over recruitment; it was explained that there is a weekly resource management group reviewing vacancies, which are then considered by the NHS vacancy panel, and high-cost packages are reviewed fortnightly.

The Chair queried the extent to which IJB financial planning is integrated with the wider service and financial plans of the Grampian “health and social care system”. 

Judith Proctor highlighted the importance of a shared understanding of pressures across the IJBs and health board, using the example of UC funding for community hospital beds for step up/step down care, emphasising the need for joint planning, service redesign, and effective use of budgets, and welcomed support in these areas. 

The Assurance Board thanked Judith for her presentation. 

SubCo proposal

Phil Tydeman provided an update on a VAT opportunity which has not been undertaken before in NHS Scotland. NHS Grampian is supportive of the opportunity but suggests if exploring feasibility of the opportunity, it may be best led by the others given NHS Grampian’s current position and capacity to ensure alignment with policy direction and ministerial priorities. 

Jack agreed that given the current focus on delivering £45 million in savings this financial year, it may not be the right time to dilute focus by piloting new initiatives locally. 

Laura Skaife-Knight expressed a commitment to exploring all options, including difficult choices, and with this to engaging early with the Employee Director and Partnership and staff side representatives, and said further work would be done to explore the proposal before ruling out. 

Fiona Hogg noted the risks involved and the need to understand the complexities in the Scottish context, referencing the SRF and ensuring alignment with its ambitions and any other workstreams. 

The Chair acknowledged the risks and potential impact on senior team capacity and partnership working, noting there may be value in exploring the pharmacy aspect with support at national level. 

Communications and engagement

Laura Skaife-Knight provided an update on NHS Grampian's communication and engagement strategy in relation to the upcoming publication of the diagnostic report. Key points discussed included the work underway by NHS Grampian to develop a single improvement plan which brings all of the recommendations into a single plan, with clear Executive Leads/owners, KPIs and timescales for delivery which are prioritised. This draft improvement plan will be brought back to the Executive Team next week. 

In response to KMPG’s diagnostic report NHS Grampian welcomes the findings, many of which align with existing priorities, and is committed to sustainable improvement through enhanced collaboration, financial transparency, and clinical productivity. The organisation pledges to maintain patient care and staff wellbeing while implementing savings and will provide regular updates through public board meetings and government assurance forums. Laura Skaife-Knight fully supports the improvement plan and will lead the next phase of the organisation’s recovery.

There was a discussion on proposed governance arrangements for monitoring progress against the Improvement Plan internally as set out in the paper, and the need to agree frequency of reporting to the Assurance Board. 
 
The Chair noted that prioritisation is aligned and consistent, and that the Scottish Government is also reviewing the KPMG report, mapping the recommendations, and considering how best to collectively report progress and agree on reporting frequency. This will ensure both parties get maximum value from the reports findings/recommendations and we track outcomes/learning. 

Action: Phil Tydeman and [redacted] will undertake a review of the collective activities associated with the KPMG report.

Fiona Hogg emphasised the importance of developing a joint response in collaboration with NHS Grampian. NHS Grampian confirmed its media lines and welcomed contributions and feedback from Assurance Board (AB) members.

Alison Evison advised that the next Board meeting is scheduled for 9 October, with a briefing for MSPs and MPs planned for 17 October.

The Chair noted that communication channels must be robust and engaging the whole of the system, including primary care teams and General Practitioners (GPs), with a focus on outward-facing messaging.

Hugh Bishop confirmed the existence of a weekly meeting forum where the KPMG report is discussed. This includes participation from relevant stakeholders, including Primary Care leadership.

Unscheduled care and subgroup update

Geraldine Fraser shared two papers ahead of the Assurance Board meeting, summarising progress on unscheduled care. The paper provides an update on the progress of the unscheduled care (USC) sub-group, which was established by the NHS Grampian Assurance Board to oversee and support improvement actions related to health and social care flow in unscheduled care. Since its formation, the sub-group has met four times to refine the draft USC Improvement Plan. Version 3 of the plan was agreed and signed off on 17 September 2025 and is now shared with the Assurance Board. NHS Grampian has also updated the terms of reference and governance for its Unscheduled Care Programme Board, which will meet weekly starting 1 October 2025. Key performance indicators (KPIs) have been developed to track progress, and regular reporting will be made to the NHS Grampian Board and the PAFIC Committee. The USC Sub-Group will continue to provide assurance and oversight for targeted improvement actions in unscheduled care.

The Chair noted the paper and offered AB members to comment further. 

Donna Bell reported that the USC group and board plans are progressing well, with valuable input from Grampian partners. Around £6 million in funding was confirmed on 17th September, with formal documentation to follow. The group is now moving into delivery mode and will continue meeting to stay on track. 

Laura Skaife-Knight confirmed she had formally written to NHS Lothian to request support, will set clear criteria, and will share these with the Assurance Board to ensure transparency.

AOB 

Laura Skaife-Knight provided an overview of the principle paper regarding funding allocation 26/27. It outlined that NHS Grampian, under Level 4 intervention due to financial and governance concerns, is aiming to deliver £62 million in savings for 2025/26 and develop a credible plan for 2026/27. To support this, they propose targeted resource investment aligned with high-value opportunities identified in a recent diagnostic review, with a formal request to be submitted to the Assurance Board in October for consideration. Laura Skaife-Knight has engaged with health finance in Scottish Government and Jack reflected on a recent conversation with NHS Grampian and will socialise early thinking ahead of the next meeting. 

Laura Skaife-Knight provided a verbal update on the planned care - external review and support offers from Boards across Scotland that was at the previous AB. 

The external review was previously presented to the Board and remains on track for completion by the end of September, with the review team in place and in regular contact. Work is ongoing to review support offer letters from other Health Boards, focusing on high-volume offers, and discussions underway with these Boards to validate the offers. Support is also being sought from NECU, with a steering group being established by Laura and the terms of reference for this group shared with Chief Executives. A proposal is also being developed by the North of Scotland that explores further improvement opportunities re: planned care performance. The Dermatology procurement exercise is confirmed as part of the external review team’s remit.

Tracy Slater welcomed the external review is on track for next week and has offered support in terms of reporting and thanked Grampian for the ongoing work. 

The Chair welcomed the updated and noted progress. 

The Chair thanked colleagues for their contributions and closed the fifth meeting.