NHS Grampian Assurance Board minutes: 26th February 2026

Attendees and apologies

Members Scottish Government

• Stephen Gallagher, Chair, 
• Professor Graham Ellis, Deputy Chief Medical Officer for Scotland
• Jack Gillespie, Deputy Director of Finance
• Fiona Hogg, Chief People Officer
• Robert Kirkwood, Head of People, Governance and Appointments Unit
• Tracy Slater, Head of Performance and Delivery

 

Attendees – NHS Grampian

• Laura Skaife-Knight, Chief Executive
• Mark Burrell, non exec and vice chair of clinical governence 
•  Hugh Farrow Bishop, Medical Director
• Geraldine Fraser, Chief Officer, Acute Services
• Stephen Friar, Deputy Medical Director
• Alex Stephen, Director of Finance
• Rick Strang, Site Director ARI

 

Meeting Apologies

• Irene Barkby, Associate Chief Nursing Officer
• Donna Bell, Director NCS
• June Brown, Executive Nurse Director
• Alison Evison, NHS Grampian Board Chair
• Leigh Jolly, Chief Officer, Aberdeenshire IJB

Items and actions

Welcome and Apologies

The Chair welcomed members and attendees to the fifteenth meeting of the assurance board, noted apologies and outlined the agenda.  Mark Burrell was attending on behalf of the NHS Grampian Board Chair.

 

Actions/Updates from previous meetings

The Chair provided an update on the action log:

 

There are three open actions, but all will be resolved in upcoming Assurance Board meetings:

• Add an update on system discussions to a meeting agenda after 13 February 2026 and invite relevant partners to join a future AB meeting.

Update: Laura Skaife-Knight will provide an update on the meeting under item 4. Local authority chief executives have been invited to the assurance board meeting scheduled for 10 March 2026, at which point this action can be closed.

 

• NHS Grampian to reconsider the composition of the Culture Programme Board to ensure it is inclusive of wider organisational perspectives

Update: Philip Shipman confirmed in meeting 14 that a revised proposal will be brought back in March – aiming for the assurance board meeting of 24th March 2026

 

• 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

Update: This will be scheduled after the health board’s seminar, around the end of March/start of April 2026. Provisionally scheduled for the assurance board meeting on 24 March 2026.

 

Unscheduled Care

 

Geraldine Fraser provided an update on the performance at NHS Grampian. She explained how NHS Grampian is currently performing, describing the key pressures, trends, and operational challenges influencing current outcomes. This includes outlining why performance remains anchored around its present level. A coherent narrative has been drafted that sets out the causes, context, and contributing factors, linking operational data, systemic issues, and recent improvement efforts to provide a full picture of how the Board has reached its current position – this covers the period from pre-pandemic to now.

NHS Grampian’s pressures reflect a mix of geography, an ageing population, and increased acuity and multi-morbidity, and reduced system capacity, which have all worsened post-covid, leading to higher delayed discharges, longer stays, more boarding, and a significant drop in 4-hour emergency department performance, especially at Aberdeen Royal Infirmary; a whole system improvement plan is now underway to reduce admissions, improve flow, expand frailty capacity, and strengthen community pathways to support recovery towards revised year-end trajectories.

Graham Ellis commented that the unscheduled care subgroup had already held an initial discussion on this, highlighting that having a wider map of the structural changes across the system is extremely helpful for understanding both the expected impact and the timeline for delivery. He reflected on the strong partnership working within the group and the constructive conversations taking place, particularly around the significant reductions in social care capacity and the implications for system performance. He asked at what point NHS Grampian expects to see an improvement in performance and flow at the front door as this work progresses.

Geraldine Fraser agreed there needed to be greater clarity on the expected timelines for delivering improvements, and the two change programmes which are expected to have a bigger impact are the rebalancing of acute beds by expanding frailty acute bed capacity, and the startup of the Aberdeenshire Discharge to Assess team. It was confirmed that the original timeline for establishing frailty service improvements at Aberdeen Royal Infirmary had been set at 16 weeks, and work is ongoing to deliver within that period, with some adjustments expected as further progress is made.

Laura Skaife-Knight commented that the narrative provided is hugely helpful in giving a complete picture of the system issues and the changes underway She said this must now be shared in-full with the Board as a priority, and beyond this with system partners and leaders in the organisation. From an improvement perspective, Laura expressed a particular interest in focusing further discussions on Dr Gray’s Hospital noting a recent downward trend in performance.

The Chair emphasised that the narrative is an important tool for strengthening partnership working and asked where the “controlling eye” for unscheduled care sits within the organisation. The Chair stressed the importance of the chief executive team and health board having full visibility of the whole system picture, ensuring oversight and governance is proactive rather than assumed, and highlighted the need to review the information flows that come to the board.

The Chair sought clarification on the reference to the December 2024 reduction of 64 beds at Aberdeen Royal Infirmary, asking whether this related to the shift of frailty beds into the remit of the integration joint boards. The assurance board noted it would be useful to receive further detail on the number of beds being rebalanced within that ward.

In addition, the Chair asked for an update on Aberdeen Royal Infirmary’s current performance this week, including the number of boarded patients today.

Geraldine Fraser highlighted the positive dialogue taking place and welcomed the way partners are supporting this work. She noted that Dr Gray’s Hospital has experienced particular pressures over the past week, and confirmed this will be an area of focused improvement to strengthen overall performance. On bed numbers and the closing of frailty step down beds in Rosewell House, she explained that Aberdeen City is monitoring the position closely and liaising with colleagues daily to ensure patient pathways are managed effectively.

Stephen Friar provided an update on bed rebalancing, noting that work is underway to create an additional 30 frailty beds. He highlighted the benefits of this change, including reduced lengths of stay to an average of around 4.5–5.5 days, which will support the generation of additional bed days and improve overall flow.

Geraldine Fraser provided an update on the current level of boarding within the system, noting that today there are 114 boarded patients in total. She emphasised that the team is keeping a sharp focus on this, as boarding levels tend to rise out of hours. The site manager has been clear on the need to reduce the number of boarded patients given the persistent capacity challenges across the system.

The Chair summarised, noting that the assurance board welcome the whole system narrative and underpinning evidence, and encourage colleagues to socialise this across the organisation and with partners. This should be a narrative fully understood and owned by the NHS Grampian board, and is a useful piece of information that they would expect the board to be discussing. The Chair also noted efforts to rebalance bed base from medical to frailty and asked that the assurance board be kept updated on that as well as being informed on level of boarding and on efforts to progress that. Unscheduled care performance would remain a priority topic for the assurance board.

Value and Sustainability

Phil Tydeman provided a verbal update on Value and Sustainability. NHS Grampian has delivered £43.7m of savings in 2025/26, exceeding its planned target by £1.8m, with 72% of these savings recurring, surpassing the national recurring savings requirement. For 2026/27, NHS Grampian is working towards £33.5m in indicative savings, though the validated total is expected to be around £30m, with ongoing workstreams aiming to close a remaining £10m+ gap. Looking ahead, Years 2 and 3 will require a shift from transactional efficiencies to transformational change, including clinical and non‑clinical redesign, digital optimisation, workforce reform, and whole‑system opportunities developed with integration joint boards and regional partners. A full programme plan covering financial outlook, governance, risks, workstreams, and savings profiles will be presented to the health board in March 2026.

Jack Gillespie welcomed the financial position for 2025/26 and the strong assurance that it is under control. He also formally noted the 2026/27 financial plan, commenting that it provides excellent clarity and assurance, and that the organisation appears on track to meet the financial targets set.

It was noted that Ayrshire & Arran have been escalated for financial reasons, and the Chair highlighted the importance of ensuring any learning from NHS Grampian is shared with NHS Ayrshire & Arran.

The Chair reiterated assurance in the Value & Sustainability Programme and the progress being made and sought evidence of a scheme that had been considered for 2026/27 but was declined on the basis of either safety concerns or wider impacts. An example was provided by colleagues from NHS Grampian.

Alex Stephen then provided an update on quarter 3 financial review. NHS Grampian’s financial position is stabilising, with a forecast £44.8m deficit for 2025/26 within the permitted limit and recurring savings above target. Winter pressures were managed alongside progress in the three priority programmes. Integration joint board positions have improved overall, though Moray remains a risk, with £23m currently assumed for deficit support. For 2026/27, the Board must meet a £36m deficit limit, requiring £40m recurring savings, while managing risks from Agenda for Change reforms, operational improvement costs and wider demand pressures. A three-year plan is in development, focused on transformational change, system‑wide planning, and delivering the external review recommendations. In the process of responding to the Financial Delivery Unit and will share this with the Chair.

Laura Skaife-Knight then summarised the actions resulting from the system integrated planning meeting, which took place on 13 February, highlighting key points from the note of the planning meeting that had been circulated.

The Chair asked for a clearer sense of the types of transformation opportunities that could be taken forward collectively across the system, and how these could come together in a coherent way. They emphasised the importance of identifying areas where joint working would add the most value and support meaningful service change.

The Chair also noted the progress of the Value & Sustainability Programme and the forward plan, highlighting the need to close the remaining £7 million gap to balance the programme in 2026/27. They recognised the strong work underway across the organisation to deliver this and the checks and balances within the approach.

In addition, the Chair welcomed the Q3 financial position, expressing thanks for the assurance provided. They acknowledged the significant effort across NHS Grampian and looked forward to understanding how this work aligns with ongoing discussions with local government partners.

Quality & Safety - Dr Gray’s Hospital

Hugh Farrow Bishop provided an update on the quality and safety standards at Dr Gray’s hospital including governance areas of focus. It was agreed at the start of this item not to take a formal minute of this update in order to protect confidentiality where small staff groups and patient numbers were concerned.

 

The discussion centred around clinical governance arrangements and leadership arrangements in place to respond to the current challenges proportionately and Graham Ellis asked NHS Grampian whether any external support would be useful.

 

Action: Laura Skaife-Knight, Hugh Farrow Bishop, Graham Ellis and the Chair to meet offline to explore what support may be needed/offered regarding the work in hand.

 

Action: The Chair asked for clarity on the clinical, senior executive, and site‑level leadership arrangements, including the frequency of engagement with teams on site and how this fits within the overall governance structure.

 

Action: 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 health board has full visibility of risks, issues, action and progress across the system.

 

Workforce commission

 

The Chair noted and invited the assurance board to  endorse the recommendations of the paper which flowed from previous discussion and would be picked up by the incoming Director of People & Culture.

 

De-escalation principles

 

Action: The Chair requested that Laura Skaife-Knight write to him with a written update now that these had been discussed by both the chief executive team and the NHS Grampian board.

 

Public Audit Committee

 

The Chair acknowledged that Laura Skaife-Knight, Alex Stephen and Alison Evison had addressed the Public Audit Committee earlier in the week, and welcomed the opening statement made by Laura Skaife-Knight – a transcript of which had been circulated to the assurance board members prior to this meeting.

 

A.O.B

 

Laura Skaife-Knight provided an update on recent recruitment. An interim director of people and culture has been appointed – Melanie Saunders – who will begin post on 9 March 2026. A suitable candidate for the role of director of strategy and performance has been identified, and Laura Skaife-Knight hopes to provide a further update on this next week.

 

Next meeting: Meeting 16 is scheduled for Tuesday 10 March 2026, in person at Marischal College.