NHS Grampian Assurance Board minutes: 5 August 2025

Attendees and apologies

Members

• Stephen Gallagher, Director of Mental Health, (SG) Scottish Government (Chair)
• Donna Bell, Director NCS & SRO Service Renewal Framework
• Fiona Hogg, Chief People Officer
• Robert Kirkwood, Head of People, Governance and Appointments Unit
• Jack Gillespie, Deputy Director of Finance NHS Scotland, Deputising  
• Professor Graham Ellis, Deputy Chief Medical Officer for Scotland
• Tracy Slater, Head of Performance and Delivery

Attendees – NHS Grampian

• Adam Coldwells, Interim Chief Executive
• Hugh Bishop, Medical Director
• June Brown, Executive Nurse Director
• Phil Tydeman, Interim Director of Improvement 
• Ritchie Johnson, Non-Executive Board Member, Deputising for Alison.
• Laura Skaife-Knight, Chief Executive, NHS Orkney
• Alex Stephen, Director of Finance

Attendees – SG/other 

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

Meeting apologies

• Alison Evison, Board Chair

• Fiona Bennett, Chief Finance Officer Health and Social Care 

Items and actions

Welcome and apologies

​​​​​​The Chair welcomed members to Meeting Two of the Assurance Board (AB), noted apologies, and outlined the agenda. The meeting focused on NHS Grampian’s Q1 financial position, validation of the 2025/26 savings programme, associated risks and mitigations, priorities, and grip and control. It also covered NHS Grampian’s current unscheduled care plan and potential financial improvement actions.

The Chair noted that the minutes from the previous meeting had been circulated with the meeting papers. The AB approved the minutes.,

An update was provided on outstanding action from Meeting One.

Action: Scottish Government (SG) members to convene a discussion on the support available for unscheduled care (UC) and safer staffing levels. A collective support package will be developed, with tailored options available if required.

On Thursday 31, SG colleagues met to discuss unscheduled care. This will be addressed further in the agenda.

NHS Grampian Q1 financial position

Alex Stephen presented an overview of NHS Grampian’s financial position at Q1 of 2025-26 together with progress against the forecast £45 million deficit. An update was also provided on NHS Grampian’s savings delivery as requested by the AB.

NHS Grampian are currently tracking above the expected year-to-date overspent at Q1, but remain committed to the £45 million deficit set out in the financial recovery plan. Identifying additional savings is a key focus for the NHS Grampian Executive Team, particularly the new Interim Director of Improvement

The Chair welcomed thoughts and feedback on the paper.

A discussion followed, with Jack Gillespie noting NHS Grampian’s formal Q1 review will take place next week. AB colleagues noted asked what steps have been taken to improve the financial resilience within the IJBs, and NHS Grampian provided assurance that work in ongoing to improve collaboration with IJB and LA partners.

The KPMG report has also been shared with IJB Chief Officers to consider recommendations and improvements. Laura Skaife Knight confirmed that steps were already in place to strengthen relationships with HIS, NES, and SAS. The Chair stated that any invitations to IJB Chief Officers to participate in the Assurance Board should be directed from NHS Grampian.

Action –NHS Grampian to discuss internally who should join AB meetings and inform the Chair in advance. For example, IJB Chief Officers may join in future.

Savings programme 25/26 validation, risks and mitigations

Phil Tydeman presented an overview of their papers outlining their initial priorities in-post.

Phil has now met with all executive directors, workstream leads, and finance managers across NHS Grampian to review 106 schemes in the programme. This provided additional assurance where written documentation had not met good practice standards.

The Chair welcomed the paper and accompanying presentation, particularly the emphasis on grip and control within the programme. A discussion followed, with the AB requesting that areas of savings are clearly triangulated with key performance metrics, providing a stronger basis for assurance. The AB agreed Phil’s savings analysis should be added to NHS Grampian’s routine financial reporting to provide transparency over savings delivery.

The Chair emphasised the importance of transparency of any SG ring-fenced allocations and robust governance arrangements, particularly in relation to the financial recovery programme.
Phil set out NHS Grampian’s plans for the 2026/27 savings programme , and the Chair requested that IJBs be included in this work and aligned to the same timelines to ensure a whole-system approach to savings delivery.

Action - NHS Grampian to provide information on savings plans for delegated services to get a better understanding of the full range of pressures and savings plans at a future meeting (noting the detailed focus been on non-delegated services thus far).

Financial improvement next steps

Jack Gillespie provided an overview of the immediate priorities to improve financial sustainability as identified in the KPMG report. These included:

1. An in-depth review of gaps in the Financial Recovery Plan
2. Improving relationships with IJB partners
3. Reconciling headcount increases with productivity and bed base
4. Incorporate a zero-based budgeting approach; and

Confirming which KPMG-identified opportunities will be implemented, and when.

NHS Grampian accepted these priorities and agreed to progress in earnest.

The AB noted the importance of the strategic shift towards patient-level costing in NHS Scotland, and the financial insight this will provide for NHS Grampian.

The Chair expressed disappointment at NHS Grampian’s recent withdrawal from the national mental health benchmarking tool. Given NHS Grampian’s financial and performance pressures within mental health, recommended the Board re-engage.

The Chair noted that NHS Grampian will provide a formal update on any additional support needs in mid-September alongside its regular financial report to Scottish Government.

Priorities, grip and control

Adam Coldwells provided an overview of slides issued to the AB which focussed on NHS Grampian developing a delivery plan to improve performance and financial sustainability, with Q2 and Q3 priorities focused on unscheduled care, reducing long waits in planned care (including cancer targets), and delivering efficiency savings. Emphasis is placed on patient safety, colleague experience, and financial sustainability, with a shift toward patient-level costing and improved governance.

Adam Coldwells described how NHS Grampian would share information around aspects of prioritisation and what the Board should focus on a routine basis during turnaround and the delivery capacity for performance improvement.

The Chair welcomed comments from the AB:

Robert Kirkwood welcomed the inclusion of the governance and controls item and acknowledged the issues that had been highlighted. He requested an update on the level of confidence NHS Grampian has in maintaining the grip and control measures that have been set out and ensuring that these do not deteriorate over time. This reflection underscores the importance of sustained oversight and assurance mechanisms to support the financial and operational recovery programme.

The Chair also provided observation around regaining confidence with external bodies which will help with priorities and having hope moving forward by not losing sight of key plans relating to service renewal and transformation.

The framing of the prioritisation approach and the suggestions shared were broadly welcomed, with a sense that the direction of travel feels appropriate.

There was emphasis on the need to align with the NHS and Operational Improvement Plan across Scottish Government, with a recommendation to take a step back and review the overall coherence of the approach.

The concept of early warning and surveillance was discussed as well as potential mechanisms for gathering broader intelligence on system performance and how, if a streamlined set of priorities is reported to the Board, how NHS Grampian will assure itself that it has measures in place that would allow it to detect if any service was significantly off-track of quality, safety or performance requirements. NHS Grampian agreed to consider this point as it refined this approach to focus and grip on priorities.

The Chair also welcomed information from Laura around governance and collaboration on priorities and the focus on the Frameworks in 26/27. Laura will also welcome external support if required, for example around governance, but timing around this is key as Laura will focus on this when taking up post.

Unscheduled Care Plan

Adam Coldwells provided an overview of slides issued to the AB which focussed on NHS Grampian’s Unscheduled Care programme and how this was being developed shifting from reactive crisis management to a more sustainable, system-wide approach. He emphasised that this built upon a lot of action already in hand but which had not of itself resulted in improved performance to date, despite some positive metrics such as low conveyancing rates. Building on lessons from NHS Lothian, the plan being developed focuses on rebalancing care capacity, improving patient flow, and reducing hospital occupancy through targeted actions like enhancing frailty services, expanding weekend therapy, and increasing downstream capacity. The strategy includes a clear set of priorities and performance projections, aiming to reduce pressure on acute services and improve outcomes across the system.

The Chair queried how NHS Grampian will develop a more robust flow plan in partnership with IJBs and other stakeholders, considering the CfSD report, NHS Lothian’s plan, and feedback on NHS Grampian’s current approach.

The AB asked how SAS is involved in this work and explained improvements made from NHS Lothian which includes how the used extra funding to make improvements and how local teams have extremely good grip and control over the whole system. NHS Grampian confirmed that they think they have good plans that mimic the Lothian experience however it does come with resource commitments especially around Social Care.

The AB welcomed the pace of work and noted that the direction aligns with the whole-system flow plan SG is seeking. There was encouragement for NHS Grampian to actively engage with IJBs, recognising the crucial importance of IJB ownership—particularly given the Lothian experience, where the plan is fully owned by all and led by the IJBs and reflects the social care dimension.

The Chair indicated that, based on a credible and jointly agreed plan with NHS Grampian, there may be scope for further investment beyond the amount allocated to date for the unscheduled care plan. However, any additional investment would need to demonstrate clear added value, have whole system commitment and impact.

Given the positive experience of the NHS Lothian plan, the Chair suggested some supportive input from NHS Lothian’s Chief Executive to review NHS Grampian’s plan prior to submission, to provide additional assurance from a system that has already progressed area whole system flow plan.

Looking ahead, the Chair will speak with Adam and Laura to coordinate next steps, with the intention of NHS Grampian bringing the plan back for sign-off at the next Assurance Board meeting given the pace required to implement the plan

Communications and engagement

Adam Coldwells presented a slide on NHS Grampian sharing next steps.

NHS Grampian’s communications and engagement activity includes a series of internal sessions across three weeks, targeting key stakeholders such as council CEOs, non-executive board members, clinical and partnership forums, and executive team members. The programme culminates in a whole-system leadership event involving around 200 participants, alongside three open virtual town hall sessions and anticipated media engagement with NHS Grampian Board members. This link will be shared with AB members if they wish to join the town hall meetings. A recording of the town hall session will also be shared so everyone can access.

The Chair confirmed clearance has been sought from Cabinet Secretary for the publication of the TORS, minutes and any associated reports (including the diagnostic report).

Any other business

The Chair referenced the KPMG NHS Grampian diagnostic report in relation to HIS/NES concerns and confirmed that this additional content (which has recently been completed) will be on the agenda as a substantive item for the next meeting.

The AB Chair thanked colleagues for their contributions and closed the meeting. The next AB meeting will take place on Monday 18 August 1–3pm.