NHS Grampian Assurance Board minutes: 27 January 2026

Attendees and apologies

Members

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

NHS Grampain attendees

• Alison Evison, Board Chair
• Laura Skaife-Knight, Chief Executive
• Paul Bachoo, Medical Director Acute Services
• Sarah Duncan, NHS Grampian Board Secretary
• Hugh Farrow Bishop, Medical Director
• Stephen Friar, Deputy Medical Director, Unscheduled Care
• Geraldine Fraser, Chief Officer Acute Services
• June Brown, Executive Nurse Director
• Philip Shipman, Interim Director of People and Culture
• Alex Stephen, Director of Finance
• Rick Strang, Site Director ARI
• Phil Tydeman, Interim Director of Improvement
• Scottish Government officials 

Apologies

• Irene Barkby, Associate Chief Nursing Officer

Items and actions

Welcome and Apologies

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

Actions/Update from Meeting Twelve

The Assurance Board (AB) agreed the minutes. One action remains on the action log – to bring an update on whole-system financial planning to an AB meeting after 13 February 2026, following local planning meetings. Laura Skaife-Knight will consider the optimum time for this and advise which AB meeting agenda this is to be added to.

Culture, Governance and Leadership

 

Philip Shipman provided an update on the new Culture Programme Board which has been established to co-ordinate improvement across three areas: leadership and management, equality, diversity and inclusion, and staff wellbeing. Early projects include a stocktake of current culture activities, improved accessibility, strengthened harassment prevention and enhanced support for managers. Alongside this, the ‘Focus on Fundamentals’ programme is setting clear expectations for managers, aligning these with national leadership profiles and preparing a system‑wide development plan for roll-out from April 2026.

Alison Evison outlined the ongoing work to strengthen visibility of the health board, including an increased focus on formal visits and engagement with staff. Non‑executive board members are being encouraged to carry out regular visits and hold conversations with teams. Short reports capturing key observations are supporting triangulation of information and helping ensure insights from staff feed into committee work. Efforts are also underway to better align board member visits with committee remits to strengthen the overall assurance process.

Laura Skaife‑Knight emphasised the importance of staying connected to staff and understanding what matters to them. She highlighted the value of having the executive team remain visible and engaged, including through participation in staff networks and sessions led on topics requested by colleagues. These activities are helping maintain strong connections across the organisation.

The Chair welcomed the update and appreciated the health board's efforts to target their visibility and engagement more effectively.

Fiona Hogg also welcomed the progress, noting the good work underway on leadership fundamentals. She reflected on the iMatter results and the challenges it highlights. She emphasised that gaining meaningful data and insights on organisational culture remains difficult, and that the culture dashboard could be strengthened further. She suggested the programme board consider how senior managers beyond the senior executive team could play a greater role in this work.

Philip Shipman returned to earlier discussions from the working group, confirming that the programme board is the right place for this work to sit. He acknowledged the comments regarding the number of executives on the board, noting that its composition reflects the importance of senior leaders setting and modelling organisational culture.

Graham Ellis noted that while there were both positive and negative aspects highlighted, there remains a significant gap in relation to the leadership fundamentals. He asked how Scottish Government colleagues could further support NHS Grampian, particularly around strengthening financial and professional governance.

The Chair welcomed the establishment of the programme board, noting that it is drawing on evidence, including learning from whistleblowing cases, as a strong foundation for its work. The Chair emphasised the importance of ensuring that voices from across the wider organisation are included, and encouraged NHS Grampian to reflect on the overall structure and composition of the culture programme board. Staff‑side feedback was also highlighted, particularly the need to improve how concerns are followed through, closed off, and acted upon when issues have previously been missed. The Chair stressed the importance of embedding learning and continuing to drive improvement.

Laura Skaife‑Knight provided an update on actions to stabilise leadership, including progress on the recruitment of the two substantive executive director posts (Director of People and Culture and Director of Strategy, Transformation and Performance), and will follow this up with a paper setting out proposals for strengthening operational governance and decision‑making.

Alison Evison then provided a verbal update on board governance and triangulation. Alison highlighted recent development work, including an induction and development seminar for non‑executives, ongoing board member training via TURAS, and additional workshops arising from the iMatter findings. Committee work continues to evolve, with clear roles for the chair and vice‑chair and planned development sessions to support strengthened scrutiny.

On triangulation, Alison emphasised the importance of ensuring that information presented to the health board and its committees supports informed strategic decision‑making and reinforces awareness of the health board’s accountability for organisational performance.

Sarah Duncan provided an update on the administration behind the board. Both the board and the committee use the same process. Templates are being developed to ensure the right information at the right level is provided. Committee papers were revised last year with attention on wording of recommendations.

The Assurance Board (AB) noted the establishment of the fourth workstream and the associated improvement plan. The AB acknowledged that the Culture Programme Board has met once and asked NHS Grampian to reconsider the composition of the board going forward to ensure it is more inclusive of wider organisational perspectives. It was noted that several key issues highlighted in the KPMG diagnostic report are being addressed through this workstream, and that targeted health board visits play an important mechanism for gathering insight and strengthening assurance.

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

Unscheduled Care

Geraldine Fraser provided an update on the latest performance. NHS Grampian continues to experience very high occupancy and significant flow pressures following recent severe weather. However, early improvement is evident through targeted actions, including enhanced discharge support, the use of additional ward areas, and implementation of the ‘10 before 10’ initiative to increase early discharges and improve flow through and out of ARI. Progress is also being made across wider workstreams, including expansion of ‘Hospital at Home’, volunteer‑supported medication delivery, strengthening of the Flow Navigation Centre, and development of downstream pathways such as the Moray Home Assessment model. All workstreams are undergoing assurance review to refine priorities for 2026/27 and support whole‑system improvement. Ambulance turnaround times remain challenging, but joint work with the Scottish Ambulance Service has reduced the maximum wait time from 11 hours to 8 hours and the next step will be to move this maximum level to 7 hours.

Geraldine also updated the AB on logic‑modelling work to assess the expected impact of the nineteen workstreams in the Improvement Plan on performance. She confirmed that the unscheduled care subgroup has met twice since the last AB meeting and has received a presentation on the outputs of the logic modelling.

Rick Strang welcomed the progress on ‘10 before 10’, noting it has provided a valuable platform for improving flow despite ongoing challenges. He highlighted the discipline of the daily debrief, which remains open and constructive. Prior to the start of the ’10 before 10’ initiative, the average number of discharges before 10am over a 6 week period had been two patients per day. This extremely low level is unusual for a large acute hospital and is reflective of an imbalance in the times of peak arrival and discharge from the site.

Stephen Friar provided some reflections on his engagement so far and what is beginning to change within NHS Grampian. The focus on culture is positive and there are signs of genuine hope in many places. He reported that today, 10 patients had been discharged by 10am for the first time since the 10 by 10 Initiative had been launched.

Hugh Farrow Bishop also shared reflections on early in the day discharges and a culture shift that needs belief in positive change. This involves engagement with nursing staff on the wards and encouragement of staff nurses to support and challenge colleagues on how things are done at ward level.

Graham Ellis commented the methodology which has been put in place is positive and really heartened by the numbers.

The Chair summarised that the AB are pleased to see both Rick and Stephen now in their roles and the positive leadership being demonstrated. The whole systems programme combined with the work on flow and culture represents a significant investment and opportunity to improve performance, staff experience and patient care. The AB noted that it will take time to deliver everything and it is appropriate to start small and build outwards, amplifying successes and dialling up successful approaches and dialling down approaches that were not delivering anticipated results. It is necessary for performance data to distinguish ED performance and programme activities between Aberdeen Royal Infirmary and Dr Gray’s Hospital in all circumstances so that improvements can be clearly identified and tracked.  

The AB noted the significant activity which is taking place in key areas of challenge, further planned reduction in the maximum ambulance waiting times, the ’10 by 10’ methodology, and noted the decrease in boarding numbers reported since the last meeting.

Action: Performance data and programme activities to be disaggregated by site to allow improvement at ARI to be tracked.

Planned Care

Paul Bachoo provided an update on planned care. He confirmed that the Central Decontamination Unit is expected to be operational this week, subject to  successful clean‑room pass and water testing completed. Airflow and air‑quality checks have also been undertaken, alongside significant staff training on the new equipment.

The revised performance trajectories are now fully signed off, and external support through mutual aid in the independent sector has been maintained over the last quarter. Revised activity figures and trajectories have been completed for the end of March 2026, and a comfort letter for Quarter 1 of 26/27 has been requested from the Scottish Government. Tracey Slater confirmed she is content with the direction of travel and will report back on the financial position for 26/27 in due course.

The Assurance Board noted the Planned Care update.

Value and Sustainability

Alex Stephen confirmed that the financial forecast remains at a £45m deficit and that he continues to work closely with Scottish Government Health Finance.

Phil Tydeman reported that months one and two savings are on track, with £33m of savings identified for next year through the Programme Board. He also confirmed that meetings with IJBs are scheduled to explore further opportunities for savings

Jack Gillespie noted that since escalation, there has been stronger financial control, reduced reliance on non‑recurring support, and overall improvement in grip and governance.

The Assurance Board noted the latest position on projected outturn and the strong performance of the savings programme and planning for 26/27 savings.

Draft de‑escalation criteria

​​​​​​​Glen Deakin invited comment on the paper outlining the draft de‑escalation principles that had been circulated to AB members and shared with the health board by Laura Skaife-Knight. The Support and Intervention Framework sets out that consideration of de-escalation should be aligned to the terms of the original escalation, and based on evidence of sustained improvement. Some criteria are quantitative and already established, such as financial spending limits; other criteria will be qualitative in nature and need to be developed, such as indicators of leadership and governance which will reflect, for example, the outputs of the Culture Programme Board.

Laura Skaife‑Knight expressed her intention for NHS Grampian to help shape and take ownership of the criteria and delivery. She advised that this had been discussed at the recent health board seminar and that the Executive Team intends to consider the criteria further ahead of a further full Board discussion scheduled for 19 February 2026 before providing a formal response to the Scottish Government.

It was confirmed that the Public Audit Committee appearance is expected late February 2026, and the Board was preparing to attend and evidence the actions in hand and improvements NHS Grampian can evidence.

Any Other Business​​​​​​​

 

​​​​​​​Meeting 14 is scheduled for 10 February 2026, 1-3pm

 

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