NHS Grampian Assurance Board minutes: 3 July 2025

Attendees and apologies

Members

• Stephen Gallagher, Director of Mental Health, Scottish Government (SG) (Chair)
• Donna Bell, Director NCS & SRO Service Renewal Framework
• Fiona Bennett, Chief Finance Officer Health and Social Care
• Fiona Hogg, Chief People Officer

Attendees – NHS Grampian

• Adam Coldwells, Interim Chief Executive
• Alison Evison, Board Chair

Attendees – SG/other 

• [redacted], Sponsorship Support Officer
• [redacted], Private Secretary Office of the Executive Team
• [redacted], Sponsorship Officer

Apologies

• Robert Kirkwood, Head of People, Governance and Appointments Unit
• Tracy Slater, Head of Performance and Delivery

Items and actions

Welcome and apologies

​​​​​​The Chair welcomed members to ‘Meeting Zero’ of the Assurance Board (AB), noted apologies and outlined the agenda. The Chair would like to put the foundations in place today to move forward. This meeting will focus on agreeing the Terms of Reference, the background of this escalation, and making plans around the expected diagnostic report. For however long the AB is in existence, the Chair would like meetings to be open and honest, especially around support required, and for both parties to collaborate, speak well of each other and keep commitments that are made. There will be a focus on outcomes and building key relationships to move forward positively. The AB endorsed these ways of working.

NHS Grampian Escalation (background and engagement timeline)

The AB noted the background and information that supported the escalation of NHS Grampian to Stage 4 on the NHS Scotland Support and Intervention Framework. Adam provided a reflection on the background information, noting that despite a deteriorating year end position for 24/25 that NHS Grampian had achieved a significant level of savings. Adam confirmed NHS Grampian and their Executive Team will engage with this AB moving forward. It was noted that engaging the staff within NHS Grampian will be fundamental to addressing the challenges faced.

Fiona Bennett provided a summary of the financial position from a Scottish Government (SG) perspective in NHS Grampian, this included financial outturn from previous financial years, the 2025-26 financial plan, and the medium term look. The Board explored the timing of the financial deterioration and it was noted that the pandemic period and associated non recurrent financial support made this difficult to be definitive. Adam felt despite recent deterioration in outturn there has been an underlying sustainability issue for at least five years, but this is not obvious at a headline level due to non-recurring payments from SG to NHS Grampian.  

Update from NHS Grampian

Adam Coldwells presented information focussing on the NHS Grampian financial position, this looked at the current financial position and projected overspend. For this financial year, NHS Grampian have submitted their financial plan to SG, which includes financial recovery information for this year and the following two financial years. The AB noted that without service transformation, NHS Grampian would still be in deficit by the end of Year 3 of the plan. Adam anticipated that the  KPMG diagnostic will help support the identification of further savings, and service redesign opportunities over a longer period of time. Known financial risks and pressures that NHS Grampian currently face were also described.

NHS Grampian provided information around their ‘Plan for the Future’ strategy for 2022-2028, which has made progress in its first two years, although this has slowed in year 3. The Chair asked for a copy of the strategy and the progress reports to be shared with the AB. The AB sought assurance on both clinical engagement and the whole system nature of the Strategy. It was explained that there has been wide engagement and that although Integration Joint Boards (IJBs) were in the process of developing their own 3 year plans while Plan for the Future was developed, the IJB plans and the Strategy were broadly aligned.

NHS Grampian are open to receiving help from other areas across the system to supportive transformative work. The AB noted and welcomed this commitment to learn from others.

Alison confirmed that the Board is proactive in assessing risks and adjusts their risks accordingly when necessary. A general discussion took place on the risk appetite of NHS Grampian.

The AB explored issues around the funding of IJBs. Given the impact on the NHS Grampian financial position, the Chair confirmed that this issue would be within the remit of this AB. Adam continued to provide further information on IJBs and confirmed that NHS Grampians risk share agreements with the three IJBs is not based on delegated services but a share of all overspends.

The AB noted the M2 position and would seek further information on M3 at the next meeting.

Action: NHS Grampian to share their ‘Plan to the Future’ reports with the AB.
Action: A paper on the financial position at the end of June to be brought to a future meeting.  
KPMG Diagnostic Commission and discussion on handling

The group discussed the KPMG diagnostic commission, which has been broken into three parts. The report is on track to be provided to NHS Grampian and SG week commencing 14 July. The report would go to NHS Grampian first for accuracy checking and then to SG as commissioner on or around 17 July. The group agreed to meet on 22 July to have an initial discussion of the findings of this report. This will be an in-person meeting and a location for this meeting will be determined as soon as possible.

The AB will consider a proactive publication approach. It was stressed that the Diagnostic may not be definitive and that further work is likely to be required and that the work of converting opportunities into results would be down to NHS Grampian in its financial recovery plan and transformation plans. The AB will want to consider what support NHS Grampian may need and to discuss the medium to longer term approach with the incoming Chief Executive.

The AB also noted the need for NHS Grampian to keep in view (and in balance) the ongoing performance position of NHS Grampian as well as its financial recovery and service transformation planning. This may also need support.

Draft Terms of Reference for Assurance Board

The draft Terms of Reference was shared with the group and includes a remit for sub-groups that can be identified for external support. Members offered comments on the Terms of Reference. The Chair will review and amend the Terms of Reference in line with the comments raised. The AB agreed that they need to be equally focussed on both financial and performance related issues seen within NHS Grampian, alongside the Leadership and Governance strands, to ensure a whole system view can be taken.

Any other business

The Chair thanked the group for attending this meeting and noted that AB members can reach out to the NHS Grampian Board when necessary. The AB will meet on 22 July.