NHS Grampian Assurance Board minutes: 24th March 2026

Attendees and apologies

Members

• Stephen Gallagher, Chair, Scottish Government
• Donna Bell, Director NCS, Scottish Government
• Professor Graham Ellis, Deputy Chief Medical Officer for Scotland, Scottish Government
• Jack Gillespie, Deputy Director of Finance, Scottish Government
• Fiona Hogg, Chief People Officer, Scottish Government
• Robert Kirkwood, Head of People, Governance and Appointments Unit, Scottish Government
• Jess Milne, Unscheduled care policy lead, Scottish Government
• Tracy Slater, Head of Performance and Delivery, Scottish Government

Attendees – NHS Grampian

• Alison Evison, NHS Grampian Board Chair
• Laura Skaife-Knight, Chief Executive
• Hugh Farrow Bishop, Medical Director
• June Brown, Executive Nurse Director
• Duff Bruce, Clinical Director at Dr Gray’s Hospital (item 3 and 4)
• Helen Chisholm, Chief Nurse at Dr Gray’s Hospital (item 3 and 4)
• Sarah Duncan, NHS Grampian Board Secretary
• Geraldine Fraser, Chief Officer, Acute Services
• Leigh Jolly, Chief Officer, Aberdeenshire Integration Joint Board
• Alasdair Pattinson, General Manager at Dr Gray’s Hospital (item 3 and 4)
• Alex Stephen, Director of Finance
• Rick Strang, Site Director at Aberdeen Royal Infirmary
• Phil Tydeman, Interim Director of Improvement
• Paul Bachoo, Acute Medial Director

In attendance

• [redacted] Policy officer
• [redacted], Head of Unit
• [redacted], Policy officer (notetaker)

 

Meeting Apologies

• Irene Barkby, Associate Chief Nursing Officer
• Stephen Friar, Deputy Medical Director, Unscheduled Care
• Melanie Saunders, Interim Director of People and Culture

 

 

Items and actions

Welcome and Apologies

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

Actions/Updates from previous meetings

Glen Deakin provided an update on the action log. Two actions can be closed as papers have been received ahead of this meeting.

• NHS Grampian to reconsider the composition of the Culture Programme Board to ensure it is inclusive of wider organisational perspectives.
• The Chair asked for clarity on the clinical, senior executive, and site level leadership arrangements at Dr Gray’s Hospital, including the frequency of engagement with teams on-site and how this fits within the overall governance structure. 

Written updates have been provided and will be discussed under item 3. The terms of reference of the Culture Programme Board have been updated to reflect the more inclusive membership and will be considered by the programme board in April 2026.

Two actions remain open

• 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 health board, emphasising the importance of seeing this “in the round” to ensure the health board has full visibility of risks, issues, and progress across the system – in relation to Dr Gray’s Hospital.

The Chair and Robert Kirkwood will be joining the NHS Grampian health board seminar on 16 April 2026 covering these matters. An update will be brought to the assurance board meeting thereafter.

The Chair noted one further matter arising, reflecting on the previous meeting in Marischal College in which ‘Once for Grampian’ initiatives were raised. He invited NHS Grampian colleagues leading this work to engage with Jack Gillespie regarding the additional support requested and confirmed that Scottish Government would facilitate this in 2025/26.

 

Clinical Governance

Hugh Farrow Bishop provided a verbal update on Dr Gray’s Hospital. A paper had been circulated to the assurance board to update on progress to strengthen clinical governance at Dr Gray’s Hospital. Internal capacity is being enhanced. Senior acute sector leaders have also increased their on-site presence. NHS Education for Scotland (NES) and Healthcare Improvement Scotland (HIS) have engaged positively, and NHS Grampian welcomes this external support.

Graham Ellis welcomed the paper and commented on the new appointments at Dr Gray’s Hospital. He noted that clinical governance issues are not exclusively experienced in Dr Gray’s Hospital and asked if there was intent to widen the scope of this work. It was confirmed that the work to strengthen and review clinical governance at Dr Gray’s Hospital would be rolled-out, with any lessons learned, across the wider acute sector.

Fiona Hogg noted the consideration of an additional review into culture, leadership, and the relationship between Dr Gray’s and the wider NHS Grampian system. She also asked whether there were any further thoughts on how this could be incorporated into the ongoing work on culture.

Jack Gillespie noted that the financial situation is a symptom of wider systemic issues and asked how closely the financial position is linked to these wider pressures across the Board, and whether there is a credible path to sustainability.

Laura Skaife-Knight highlighted the immediate priority of further strengthening clinical governance in Dr Gray’s Hospital

Donna Bell observed that this work is closely linked to discussions on Unscheduled Care (USC) and Aberdeen Royal Infirmary (ARI). A deep dive on unscheduled care performance in Dr Gray’s Hospital will be brought to the next USC sub‑group meeting to consider future approaches.

The Chair noted the significant variation in performance and the need to understand the causes of recent deterioration in performance at Dr Gray’s Hospital.

Alison Evison advised that the NHS Grampian health board are also concentrating on clinical governance and how it reports into the assurance board. The Chair welcomed this.

Alasdair Pattison welcomed the work that has gone on in the acute sector and the portfolio sector arrangements. He confirmed that he was familiar and engaged with what has been said in the board meeting.

Duff Bruce commented on the importance of site presence moving away from being a reactive measure and becoming business as usual that overall the change is positive.

The Chair welcomed the paper and noted the immediate actions underway to strengthen clinical governance at Dr Gray’s Hospital. The assurance board acknowledge that NHS Grampian is seeking external support, with HIS and other partners also offering assistance. The Chair emphasised the importance of ensuring that the scope of this activity is appropriate and delivers the added value intended. Given the Scottish Government’s assurance requirements, work at Dr Gray’s Hospital has applicability for the wider acute sector. The Chair also reflected on the role of the three key teams that collectively form the pathway into the health board’s clinical governance oversight. The assurance board will further consider how clinical governance structures and reporting best support the health board going forward.

NHS Grampian’s acute triumvirate plans to undertake monthly visits to Dr Gray’s Hospital, providing on‑site visibility and senior oversight. The assurance board agreed that the focus of the paper, and the wider work on clinical governance, is appropriate and centres on both service design and overall governance arrangements.

Alison Evison commented on recent visits from HIS/NES and the importance of these relationships. She noted that these face-to-face conversations enabled open dialogue on leadership, including NHS Grampian’s participation in leadership programmes, how teams work together, and how the organisation can broaden its perspective by looking externally. The visit also provided an opportunity to showcase the improvement work underway and to begin shaping how this activity can be more effectively focused going forward.

Laura Skaife-Knight reflected on the value of effective scene setting during her visit, including meeting with the Area Clinical Forum (ACF) chair, engaging with award winning staff, and walking the emergency pathway. She highlighted that these visits have further strengthened relationships, and are supported by wider conversations and regular touchpoints which the chief executive, medical director and nurse director have with NES and HIS. She emphasised that while operational updates are important, the core focus was on building strong relationships that enable open dialogue and collaborative and sustainable improvement.

 

Unscheduled Care

Geraldine Fraser provided the current performance update across the three sites. The assurance board received an update on the unscheduled care improvement plan, noting slight improvements in 4-hour emergency access performance and reduced long waits at Dr Gray’s Hospital, alongside better ambulance turnaround times. Key operational actions continue, including reduced maximum ambulance wait times, closure of non-standard beds, strengthened ward to board processes, and progress on frailty pathway development. Wider programme work is advancing, including the integrated flow hub go-live, expansion of Rapid Acute Assessment and Discharge (RAAC) and Same-Day Emergency Care (SDEC) pathways, growth of the Flow Navigation Centre (FNC) workforce, and enhanced assurance reporting for 2026/27. Overall delivery is progressing, though prioritisation, funding confirmation, workforce risks and outcomes reporting remain key areas of focus. The number of delayed discharges are holding and levels are being sustained.

Leigh Jolly emphasised the importance of understanding the role of the unscheduled care programme board, noting that it continues to provide a clear executive touchpoint where issues can be escalated and are not lost. She highlighted that the programme board’s focus is on ensuring strong grip and oversight across the 19 improvement projects, maintaining control of delivery and progress. Key milestones were noted, including the flow hub referral process going live, strengthened FNC capability, and the continued expansion of the RAAC model. She reiterated that this structured approach ensures the improvement programme is monitored effectively and that critical dependencies and risks are clearly managed.

A discussion then took place regarding out-of-hours support and the associated concerns. Leigh Jolly highlighted the pressures created by the small number of staff available to cover these services, noting the impact on GPs and out of hours nursing teams, with the burden often falling disproportionately on them, particularly as services expand. Donna Bell welcomed the progress being made and recognised that while the foundations being put in place may not immediately affect the KPIs shown in the slides, the trajectory is positive.

Rick Strang reflected on recent improvements, noting that use focus on early in the day discharges and improving flow had already resulted in a significant shift in performance.

Jess Milne noted that the Centre for Sustainable Delivery (CfSD) had recorded a planned 5% improvement by the end of March 2026 and asked whether NHS Grampian remained on track, as well as what the projected trajectories were beyond this period. Rick Strang confirmed that future trajectories would be ambitious and designed to deliver the required level of improvement. Geraldine Fraser added that all trajectories had been confirmed, with the exception of the planned reduction at Dr Gray’s Hospital, which is still under consideration.

The Chair acknowledged the importance of the progress being made and thanked colleagues for their continued efforts in driving improvement. The assurance board noted that performance at Dr Gray’s Hospital shows variation, with overall performance generally higher than at Aberdeen Royal Infirmary, though with significant fluctuations. A further focused discussion on Dr Gray’s Hospital will be scheduled. The Chair also highlighted the ongoing work to review the impact and added value of the 19 improvement programmes. He emphasised that accountability can be strengthened thoughtfully and must be connected to the wider rigour of leadership and management of flow across the organisation, which will be central to shaping culture and leadership going forward.

Action – Donna Bell to convene USC Sub Group to have a deep dive on performance and variation at Dr Gray’s Hospital.

 

Planning for 2026/2027

Laura Skaife-Knight presented the NHS Grampian organisational priorities for 2026/27, noting these were shaped through extensive staff, partner, patient and community engagement undertaken between January and March 2026. She highlighted five strategic priorities: People, Leadership & Governance, Prevention, Planned Care, Urgent & Unscheduled Care, and Value & Sustainability, had been agreed by the NHS Grampian health board for the year ahead.

It was confirmed that each priority will be overseen by a dedicated programme board, with quarterly reporting through the “How Are We Doing” (HAWD) performance framework.  There was clear evidence of join-up with national priorities (annual improvement priorities for 2026/27 as recently communicated by the NHS Scotland deputy chief executive and chief operating officer), sub-national priorities and wider system priorities across Grampian.

Tracy Slater welcomed the update and the section on waiting times within the slide deck. She noted that while the information was helpful, there were no specific measures presented for waiting times, including one year and two year waits. She also raised concerns about the funding shortfall projected over the next three years and asked how this would be addressed, seeking clarity on whether the necessary work was already underway or yet to begin. Geraldine Fraser confirmed that NHS Grampian is still working through the detail of this.

The Chair summarised it was helpful to see the focus highlighted from the diagnostic and keeping the priorities sharp.

The Chair invited June Brown to provide an update on recruitment of nursing staff. She described the work being done to encourage nursing staff to the north of Scotland. Recruitment of healthcare workers remains challenging, but a programme is in place. The chief nurses come together as a group to make recruitment and deployment decisions collectively. They continue to recruit via the common staffing method and are able to over-recruit in order to reduce dependency on high-cost agency staffing. The vacancies for registered nurses have decreased to the lowest level in ten years. It was noted that this result is due to a lot of background work over several years.

Alex Stephen provided a brief update on the financial position, noting an 11‑month deficit of £41.5m and a forecast year‑end deficit of £42.8m, which remains within the available deficit support.

He confirmed savings delivery is strong, with £48.77m achieved to February and a forecast of £61.8m, including £44.5m recurring savings, exceeding the 3% national target.

Alex Stephen highlighted ongoing risks for 2026/27, including a funding shortfall in the operational improvement plan and no confirmed funding for additional planned care and diagnostic capacity beyond quarter 1.

Phil Tydeman provided an update on the Value & Sustainability Programme, noting the plan sets out a three-year savings approach aligned to NHS Grampian’s organisational priority to improve financial sustainability. He highlighted that £40m of savings have been identified across 14 workstreams and through engagement with staff across the organisation and that the NHS Grampian health board formally approved the three-year savings plan on 19th March 2026.

He confirmed that the programme is supported by strengthened governance, regular reporting, and dedicated resource through the Value & Sustainability Team and that all savings were subject to a quality impact assessment review by the health board’s clinical executives to ensure patient safety and staff well-being were safeguarded. The programme is expected to achieve c80% recurrent savings broadly consistent with 2025/26 performance

Phil emphasised that ongoing engagement, rigorous grip and control measures and system wide collaboration with the three local councils and integration joint boards will be essential to delivering the required savings and transformational change in 2027/28 and 2028/29.

Donna Bell asked whether impact assessments have been carried out for all the savings plans, and where people and patient experience comes into decision making. Phil Tydeman confirmed that quality impact assessments are attached to each scheme, with associated indicators, and a report is being prepared for submission to the Clinical Governance Committee on 23rd May 2026. The chair commented that it would be helpful for the assurance board to have sight of this report.

The assurance board noted the paper on the value and sustainability programme, and take significant assurance from the rigour being applied to the programme. They would welcome sight of the integrated impact assessment report

ACTION: A copy of the final Quality Impact Assessment (QIA) report to be shared with the assurance board.

AOB

Laura Skaife-Knight noted the first meeting of the refreshed North-East Transformation Group was held on 20 March 2026 with system partners. She referenced the emerging work on the terms of reference, the interface with integration joint boards, and the importance of maintaining good governance throughout this process. She added that the system diagnostic work underway will help ensure that redesign efforts are well informed and aligned across partners.

 

Next meeting: The next meeting is scheduled for Tuesday 7 April 2026. As this is immediately following the Easter public holiday, it has been agreed to reschedule this meeting. Meeting 18 will now take plan on Thursday 23 April 2026 at 1500 via Teams.