NHS Grampian Assurance Board minutes: 3 November 2025

Attendees and apologies

•    Stephen Gallagher, Chair, Scottish Government 
•    Robert Kirkwood, Head of People, Governance and Appointments Unit, Scottish Government
•    Professor Graham Ellis, Deputy Chief Medical Officer for Scotland, Scottish Government
•    Fiona Hogg, Chief People Officer, Scottish Government 
•    Tracy Slater, Head of Performance and Delivery, Scottish Government
•    Donna Bell, Director NCS, Scottish Government
•    [redacted] Senior Financial Improvement Manager (for Jack Gillespie), Scottish Government
•    Irene Barkby, Acting Deputy Chief Nursing Officer, Scottish Government

•    Laura Skaife-Knight, Chief Executive, NHS Grampian
•    Alison Evison, Board Chair, NHS Grampian 
•    Phil Tydeman, Interim Director of Improvement, NHS Grampian
•    Alex Stephen, Director of Finance, NHS Grampian
•    Hugh Bishop, Medical Director, NHS Grampian
•    Philip Shipman, Interim Director of People and Culture, NHS Grampian
•    Geraldine Fraser, Chief Officer, Acute Services, NHS Grampian
•    June Barnard, Nurse Director, Acute Service, NHS Grampian

 Meeting Apologies

•    Jack Gillespie, Deputy Director of Finance
•    Paul Bachoo, Medical Director for Acute Services 
•    June Brown, Executive Nurse Director
 

 

Items and actions

Welcome and Apologies

The chair welcomed members to meeting eight of the Assurance Board (AB), noted apologies and outlined the agenda.
The chair introduced Irene Barkby, who will be joining the AB, and assisting Fiona Hogg with the Workforce matters. 

Actions/Update from Meeting Seven

The chair confirmed that the minutes from meeting seven had been circulated and invited any final comments. 
There were no further comments, therefore the minutes were taken as an accurate reflection of the meeting. 
The chair invited updates on actions from the previous meeting. There were two items for follow-up.
•    Update on the joint Area Clinical Forum and Grampian Area Partnership Forum meeting this will be covered under any other business.
•    Update on the workforce subgroup – Fiona Hogg will cover this later in the agenda.

Finance update

The chair introduced the finance update that was split into three topics, investment paper, Quarter 2/Month 6 financial position, and value and sustainability.
Investment proposal update
Laura Skaife-Knight took the paper previously circulated as read and highlighted some key aspects. She reminded everyone this was in relation to the funding support available for the level-4 escalation for 2026/2027. Unscheduled care remains the area where there is the greatest risk. It is intended that £454k will be allocated to support delivery of the Unscheduled Care Improvement Programme with £40k allocated to the Planned Care Improvement Programme. 
Laura went on to describe how there are two critical posts she would like to fill to bolster clinical and operational leadership including a site director for Aberdeen Royal Infirmary for 12 months, and a deputy medical director for unscheduled care. 
The second area is around planned care and £40k of investment would be used in  dermatology and urology areas to support administration associated with the delivery of independent sector arrangements. 
She described how she would take a view in quarter 4 about the interim Director of Improvement post aligned with the ROI and the shape of the wider Executive Team, recognising there were some posts to be recruited to on a substantive basis, including the Director of People and Culture, and Director of Strategy roles.
The chair invited questions from AB members. 
Irene Barkby asked if it was possible that the revised scheme of delegation was shared with the AB, including the new posts, as this would help to understand the grip and control and the accountability.
Donna Bell reflected on how she was supportive of this proposal; however she asked about support for IJB colleagues on financial grip and support. Are IJB colleagues confident on allocation of funding? Also are they confident on change management, are they confident they have what they need to drive this? 
Fiona Hogg asked how the additional roles will fit in with the existing structure. Also, how realistic was it that these posts would be filled almost immediately. 
Iona Mayhew asked whether there were any considerations as to the where the funding for the interim Director of Improvement was coming from. 
Laura responded to the questions. She proposes to share the job descriptions for the new posts and described that there will be clear objectives agreed for both postholders and reporting lines; on recruitment they have already been in contact with relevant agencies and asked for CVs to avoid further delay for the site director as a priority; on the change management for IJBs, this is an ongoing discussion around service planning and transformational change capacity needed across the system and what this could look like moving forward. 
The chair reflected the feedback. He requested the revised scheme of delegation be brought back to the Board in due course to be assured of how the new posts relate to other parts of the organisation and the added value they will bring. 
The chair also mentioned the need to further discuss the IJBs and their capabilities to deliver transformational change and the skills required. 
Action:  Laura to provide information on the new posts – job descriptions and remits/objectives, and how they fit in with existing posts and as a second stage, an assessment of IJB capabilities to meet the challenges ahead. 

Quarter 2/Month 6 financial position

The chair invited Alex Stephen to provide an update on the month 6 financial position. 
Alex Stephen reported that the information is as detailed in the last report, £47.1 million over, however they are working to get it back to £45 million. 
Alex reported that they have the Quarter 2 meeting on Wednesday 5 November with Scottish Government finance, where they will discuss in more details the IJB reports. 
The chair invited questions from the AB there were none. 

Iona Mayhew asked if there was any information on the effectiveness of savings schemes not visible at the moment, e.g. delegated services
Alex responded that he had included that detail for the Q2 report, for the meeting.  He reported there was some movement in the position of IJBs (positive and negative) and the position was under active review.
The chair agreed it would be helpful to discuss the latest IJB positions at the next AB on 17 November 2025 and thanked Alex for the update. 
Alison Evison reported that there is a meeting of chief executives, Section 95 Officers, Directors of Finance, and IJB chief officers from NHS Grampian, Local Authorities and IJBs on Friday 7 November 2025 where finances will be discussed. 
Irene Barkby suggested that table 5 in the paper (risks and assumptions) be updated on an ongoing basis to show the AB whether risks are going up or down. 
Alex thanked Irene for the suggestion and agreed he would implement this.  
The chair reviewed the conversation that there is a possible issue being flagged with IJBs and that an update will be required at the next meeting and the need to make the risk register more dynamic which will have mutual benefit. 
Action: include an update on Q2 discussion, and IJB risk, on the next meeting’s agenda
Action: Alex to review the risk information in table 5 and include reporting on changes.

Value and Sustainability

Phil Tydeman presented on the value and sustainability programme. 
He had circulated a paper in advance and therefore brought some highlights. 
They have now identified savings of £61.8 million; these are currently going through the approval process. He stressed they are doing everything they can to improve the process. He also referenced working with the IJBs and that they had a meeting with them, immediately after this one. 
Phil also updated the AB on the plans for next year, they are pushing ahead with the 13 workstreams and they are on track with the 20-week plan. They have now formalised names across all workstreams. 
Phil also reported that they now have a fortnightly finance recovery board, which is chaired by Ritchie Johnson, a non-executive director. This will prioritise key high value opportunities. Further governance includes deep dives into particular areas; topics so far are medical and nursing. Phil will include the details as appendices for the next AB to see the level of detail. 
He reflected on the progress and that they were now concentrating on the next six months.  
The chair invited questions, there were none. He noted the AB were content to note the progress. 

Unscheduled Care Programme

The chair invited Geraldine Fraser to provide the update on the unscheduled care programme. 
She started by giving a verbal update of the situation over the weekend. She reported it was a challenging weekend with 182 presentations to Aberdeen Royal Infirmary with 166 of those being majors and performance was 44%. There as an incident declared between 13.40 and 17.40, this was safely managed with no ongoing impact. 
Sunday continued to be challenging with over 200 presentations of which 185 were majors and performance was 41.8%. Geraldine reported that other boards had similar challenges. 
Geraldine Fraser then went on to report on the Unscheduled Care Improvement programme. 
She described the reporting of the delivery and oversight and the agreed measurements. They are keen to understand the progress of the activities and the status of the workstreams and that the KPIs are themed around  the workstreams to ensure they are giving them what they need. 
Geraldine also mentioned that they intend to complete a logic model to track the changes and the meaningful outcomes.
She talked through the tiers as described in the presentation and the workstreams and the deliverables and demonstrated the dashboard. 
The chair invited questions from the AB.
Graham reflected it was helpful to see the detail. He commented on the percentage of majors to minors. He feels the logic model approach will be helpful going forward. He also asked if there was any thought on changing tracking from monthly to weekly.   
Geraldine replied that the rate from major to minors is usually similar but that the redirection rate is quite high. They can look to increase the frequency of reporting. 
Donna thanked Geraldine and said that it was good to see the tracking of the plan. However, it would be helpful, to see the new estimated plans if there are slippages to planned events, including reasons. 
Geraldine replied that they had a similar discussion at today’s Programme Board to give more detail and assurance and to use the Programme Board for a deep dive into some areas to give learning.  
The chair invited further comments, there were none. 
The chair summarised the asks of the AB to show variation on the impacts from the plan and also some narrative to help understand whether something is on track and the impact and to consider the frequency of reporting on some of the metrics.
The chair thanked Geraldine for the update and advised the AB may drill down into data in future, such as ambulance turnaround times to show the intention of plans with real life data of impact 

Planned Care update

Phil Tydeman reported on planned care performance. The paper was circulated in advance and he concentred on the key points; NHS Grampian have submitted their improved year end trajectory to Scottish Government which are:
•    New outpatient appointments reduced from 10,038 to 5,489 by end of March 2026
•    Treatment time Guarantee reduced from 3,671 to 3,498 by end of March 2026
The current forecast is to have 775 patients waiting over 104 weeks, which they aim to improve.
This does not include the impact of mutual aid. Mutual aid has been agreed with Golden Jubilee, Tayside, Forth Valley, Fife and Orkney. Travel costs will be borne by NHS Grampian which will have financial implications. 
Phil also reported that the dermatology independent sector contact has began. He also described a bid made to Scottish Government for Urology funding. 
Phil explained there is a Programme Board for planned care which reports to CET weekly and represents further strengthening of governance and oversight. 
Phil also provided a brief update on the CDU situation: an incident management team has been established; they have met twelve times; and there are two subgroups, one concentrating on patient safety and one on infrastructure. They report into CET.  He explained the help from other Boards and the use of Woodend facility. At this moment NHS Grampian do not think this will have an impact on their 52-week trajectory. They are continuing to monitor this.
Paul described the financial impacts of this and explained there were details in the financial paper. 
Laura Skaife-Knight fed back that the report of the external planned care review was expected later today (3 November). She reported how she welcomes the standing up of the Planned Care Programme board and its need for governance. She reported that she has asked for the cost implications of CDU to be presented at the next CET meeting for good governance covering revenue and capital spend.  
The chair invited questions from AB members. 
Tracy Slater thanked for the update. She reflected it was good to see that mutual aid had moved on and the Board’s intention to report on the impact of the CDU on the trajectory. She advised that that NHS Grampian could use any slippage to fund Urology plans, however they should advise performance of this. She described there was work being done nationally on where boards are. There may be capacity across Scotland for this speciality. 
Tracy also asked for an update on the day surgery unit opening. Phil reported that the start date was mid-November. 
The chair summarised the discussion asking for an assurance at the next AB that that the day care surgery unit is operational. He stressed the need that AB meetings focus on value and sustainability, planned care, and unscheduled care.
Action: include an update on the day surgery unit in the next meeting’s agenda.

Workforce Subgroup

Fiona Hogg updated the AB on the action to establish a subgroup to concentrate on workforce planning review. She reported the first meeting is scheduled for 11 November 2025. The agenda will include setting the terms of reference, identifying who will be involved and identifying possible areas for review of a part of the workforce. The intention is that this group will meet fortnightly thereafter to enable feedback at AB. 
The chair thanked Fiona for the update and invited comments. 
Laura Skaife-Knight stressed the need that colleagues impacted were involved and consulted at an early stage and suggested that the commission is shared as early as possible with ACF and APF chairs and members for openness and transparency. Fiona advised she would ensure this was the case and reflected on the staff-side relationship.

Any Other Business

Audit Scotland section 22 report

Alison Evison reported that the Audit Scotland section 22 report into NHS Grampian will be published tomorrow (4 November). She described what the Board had been doing to prepare for a potential invitation to Public Audit Committee. 

Alison also described that the NHS Grampian communications team have been liaising with Audit Scotland comms about what lines they will be using. A briefing has been issued to the Board and an all-staff briefing will be issued when it is confirmed that the report is in the public domain. This brief will link to financial operational challenges and the diagnostic report and the ongoing commitment to staff. There is a media statement prepared should it be needed but not issued proactively. 

The chair thanked Alison for the update and invited any other questions on this topic. 

[redacted] reported that there has been an oral parliamentary question lodged on oversight of finances by NHS Grampian that is being dealt with this week. He will provide feedback as required . 

MP/MSP meeting  

Alison Evison gave an update on the meeting the board held with MPs and MSPs. She described that each party sends a representative. There were also one-to-one meetings the week previously with the chief executive of NHS Grampian with Richard Lochead and Douglas Ross. The presentation had been shared with AB members. 

No comments on diagnostic report, however there were questions on recruitment challenges and Laura’s confidence and optimism for the future.

No comments on finance or value and sustainability or governance, however there were questions on partners and in particular IJBs.

The questions on unscheduled care were related to 3rd sector organisations and there were no questions on the delivery of planned care. 

Alison advised that questions emerging from Laura’s meetings with Mr Ross and Mr Lochhead concentrated on service provision around Dr Grey’s Hospital and waiting times and treatment between there and Aberdeen Royal Infirmary. 

The chair thanked Alison and reported that there had not been questions from Scottish Government either. 
  
Feedback from joint meeting between Area Clinical Forum and Grampian Area Partnership Forum

Laura Skaife-Knight provided feedback on the joint meeting between the Area Clinical Forum and Grampian Area Partnership Forum this was a follow up session. 

There was shared feedback from previous meetings. Laura shared her thoughts; it was an open and honest discussion and was well attended and there was strong engagement. She reported that some staff were not feeling psychologically safe at work, there is an over concentration of targets and finance and not putting staff first. 

Next steps agreed that Laura and Phillip will identify priority themes emerging and what are the pieces of work they need to focus on in the month ahead and be clear on the owners. There will be another meeting arranged for early December to report back. 

The chair asked Philip Shipman, Hugh Bishop and June Barnard to share their views on this item 

Philip Shipman reported on the good relationship with TU colleagues which was evident in this conversation and it was nothing other than positive. The colleagues just want to see tangible progress and openness if delivery is not an option at this time. 

Hugh Bishop said he was unable to attend the meeting however he chaired the Area Clinical Forum weekly touch point and there is a good level of engagement, good level of trust and enthusiasm with the leadership in place and the need to understand what is happening on the shopfloor. He described how he had spent time with the ED team in resus on Saturday and how impressive it was the see the team responding and to get a sense on how the system can support them. His intention is to exercise this soft intelligence approach as well as through the formal structures. 

June Barnard advised she also was not at the meeting but feedback from the team was that transparency on decision making was really important and the information coming through comms and how reenergised they are on the reduced priorities. 

The chair invited comments from AB members. 

Professor Graham Ellis Graham reflected on the usefulness of the feedback and asked for more detail on the lack of psychological safety. Laura advised it was a wide-ranging conversation and they would need to consider what intervention they can do but the hot spots were not new to them. 

Alison Evison agreed with what has been said and that staff welcomed the transparency and looked forward to future conversations.  

Fiona Hogg reflected it was good to hear the update and how important it is to have the balance and the bigger picture and the patient experience, and she is happy to support.

Irene Barkby reflected on how she could add value and how staff morale and health and wellbeing are not as visible, as well as wanting to see patient safety and harms featured in the discussions at AB. 

The chair reflected on this and mentioned previous conversation on a balanced set of metrics. He will consider this with Laura going forward.

Laura welcomed the comments and mentioned that there was a lot of work that had been done or would be done as a result. She has had conversations on how that work translates to patient safety and there will be a much-strengthened focus on safety data. 

Irene Barkby thanked for the update and noted how important the presence of  management and senior management on the floor is, and the value of visible leadership. 

Laura agreed that this was a feature of conversations and while all have different ways of doing this, it feels more beneficial for it to be informal. 

Alison Evison added she agreed with Laura on the less-formal visits and would be encouraging board members to do the same.  

Agenda for 17 November

It was agreed the agenda for 17 November meeting would include:
 
•    Unscheduled care programme update 
•    Feedback from the planned care formal review report
•    Update on the day-case unit opened and planned use
•    Q2 finance meeting feedback to include the IJB issues 
•    Update on Baird and Anchor project 

The chair thanked colleagues for their contributions to the eighth assurance meeting and closed the meeting.