NHS Grampian Assurance Board minutes: 7 October 2025

Attendees and apologies

• Stephen Gallagher, Chair, Scottish Government
• Robert Kirkwood, Head of People, Governance and Appointments Unit, Scottish Government
• Jack Gillespie, Deputy Director of Finance, Scottish Government
• Professor Graham Ellis, Deputy Chief Medical Officer for Scotland, Scottish Government 

• Laura Skaife-Knight, Chief Executive, NHS Grampian, NHS Grampian
• Alison Evison, Board Chair, NHS Grampian
• Hugh Bishop, Medical Director, NHS Grampian
• Phil Tydeman, Interim Director of Improvement, NHS Grampian
• Alex Stephen, Director of Finance, NHS Grampian
• June Brown, Executive Nurse Director, NHS Grampian
• Geraldine Fraser, Chief Officer for Acute Services (Unscheduled Care item)
• Hussein Patwa, Vice-chair Aberdeen City IJB
• Fiona Mitchelhill, Chief Officer, Aberdeen City IJB
• Paul Bachoo, Medical Director for Acute Services, NHS Grampian (Planned Care item)

• [redacted], Head of Unit, Scottish Government 
• [redacted] Private Secretary Office of the Executive Team

Meeting Apologies

• Donna Bell, Director NCS, Scottish Government
• Fiona Hogg, Chief People Officer, Scottish Government
• [redacted], Policy Officer, Scottish Government
• Tracy Slater, Head of Performance and Delivery, Scottish Government

Items and actions

Welcome and Apologies

The Chair welcomed members to Meeting Six of the Assurance Board (AB), noted apologies, and outlined the agenda.

Actions/Update from Meeting Five

The Chair confirmed that the minutes from Meeting Five had been circulated and invited any final comments. The AB approved the minute without changes.
Two actions were noted:
•    Workforce update to be scheduled for the 21 October 2025 meeting, led by Fiona Hogg.
•    KPMG Diagnostic Report Review – Phil Tydeman and [redacted] to undertake a review of collective and individual activities associated with the report to ensure no recommendations “fall between the cracks” and the Board is assured that each is considered by the relevant party. Contact had been made since the last meeting and the Chair requested a joint paper will come to the Assurance Board on 21 October 2025. 

Governance update

Laura Skaife-Knight presented the governance update, supported by a paper from Phil Tydeman. The update focused on the three priority areas: Unscheduled Care, Planned Care, and Value & Sustainability. It outlined recent developments to further strengthen governance and reporting in each of these areas, including Board and Board Committee oversight and scrutiny and assurance processes.
Key highlights include: 
•    Strengthening of internal controls and risk management frameworks.
•    Enhanced reporting mechanisms to improve transparency and Executive accountability.
•    Clarity of Chair, SRO, Terms of Reference and reporting forums for each of these Boards
The report also notes ongoing work to embed a culture of continuous improvement and collaborative leadership across governance functions. 
The Chair welcomed the update and invited comments from AB members. 
Laura Skaife-Knight provided an update on the governance arrangements aligned to the three priority areas identified in the KPMG report: Unscheduled Care, Planned Care, and Value and Sustainability. Following constructive discussions with the Chief Executive Team, the work has progressed and is now ready for implementation. This marks a significant shift and a step change in governance and oversight across these areas and for Executive Director accountability.
NHS Grampian has drawn on learning from NHS Lothian, particularly regarding governance structures for Unscheduled Care. Roles and responsibilities have been clearly defined, with all three Programme Board scheduled to meet by 23 October. Each Board will report to the Chief Executive Team and subsequently to the NHS Grampian Performance Assurance, Finance and Infrastructure Committee (PAFIC)  and NHS Grampian Board. Laura will attend Programme Board meetings as she needs to and Chairs the Chief Executive Team weekly meeting.
The Assurance Board was invited to provide feedback on the Terms of Reference and supporting papers. Robert Kirkwood welcomed the update while also raising a query about the balance between executive leadership and broader Board engagement. He emphasised the importance of ensuring constructive challenge and clear read-through to the NHS Grampian Board.
Laura confirmed that a clear pathway has been established from the three Programme Boards to the Health Board, and the paper would be further developed to reflect this. Additionally, there is a monthly informal briefing session for the Board which currently focuses on financial performance and which will be expanded to cover the three priority areas (Planned Care and Unscheduled Care).
Alison Evison agreed that the papers be updated to reflect onward reporting to PAFIC and the NHS Grampian Board.
The Chair requested an update on the IJB Chief Officer recruitment for Aberdeenshire and Laura confirmed that she was pleased to let colleagues know that Leigh Jolly had been successful at interview for the substantive role. The Chief Officer of Aberdeenshire IJB and will fulfil the role of Chair of the Unscheduled Care Programme Board. Safeguards within the Value and Sustainability Programme such as the Quality Impact Assessment process were discussed, including the composition of balanced panels and chairing arrangements.
The Chair noted that each Programme Board operates to different timescales for meetings (one weekly, one fortnightly, one monthly) and asked if a monthly meeting schedule for Planned Care provides a sufficient route for oversight and reporting. The Chair queried if alternative governance mechanisms are in place for addressing any issues that arise out with the meeting cycle that need urgent attention. Laura confirmed that weekly meetings with specialities take place re: Planned Care, and any escalation points come through to the Chief Executive Team on a weekly basis, as well as to the monthly Planned Care Programme Board, so it was felt that a monthly Programme Board was sufficient on this basis, however it would be kept under review. It was agreed to set out more clearly in the paper how more urgent issues on planned care would be considered to allow escalations/decisions to be made at pace. It was also noted that Cancer waiting times were considered under the Planned Care Programme and associated performance reporting. 
The Assurance Board noted the progression, membership, ToR’s and the Assurance Board and subject to the above points discussed were encouraged by the progress to date. 

Finance Update
Month 5 Financial Position:
Alex Stephen reported a projected full year overspend of £45 million, consistent with the Financial Recovery Plan. Key achievements included reductions in waiting times and progress in community health initiatives. Challenges remain around budget pressures and recruitment, with mitigation plans underway.
It was noted that early work has begun to consider the financial position for 2026/27, and this will be brought back to a future Assurance Board for further discussion. The financial position for the current year remains unchanged from the last meeting, with NHS Grampian reporting a £4.2 million variance above the projected £45 million overspend. 
The Chair welcomed the update and invited comments from Assurance Board members.
Jack Gillespie raised a query regarding preparations for the reporting of the upcoming external audit. Laura Skaife-Knight confirmed that a detailed response has been developed and that an update will be shared at the closed NHS Grampian Board meeting scheduled the following day. She also noted that a meeting was held with external auditors last week, and many of their comments have been taken on board and regarded as helpful. The process and next steps are now clearly understood, and preparations for the reporting of the external audit are underway.

Value & Sustainability Programme:

Phil Tydeman provided an update on the savings programme. The paper outlines the current status and progress of NHSG’s Value & Sustainability programme. It identifies a savings target of £77.7 million, with £44.3 million already achieved or on track. 
Key areas contributing to savings include: 
•    Workforce optimisation
•    Prescribing efficiencies
•    Service redesign
•    Estates rationalisation
Risks to delivery are acknowledged, particularly around workforce capacity and inflationary pressures. The report calls for continued leadership focus and cross-system collaboration to meet remaining targets.

The Chair invited comments from AB members.

Jack Gillespie welcomed the update and emphasised the importance of the upcoming Quarter 2 financial review in identifying areas of volatility, particularly in relation to the IJBs. He requested assurance that the follow-up actions from the Quarter 1 meeting had been addressed.
The Chair queried the nature of the £5.6 million in newly identified savings schemes, asking whether the figure reflected a full-year effect or part-year impact. Phil Tydeman confirmed that the savings are in-year and noted that associated risks have been highlighted.
The Chair requested an update on the medical efficiencies meeting and asked whether this area would be further developed and how it would be taken forward. 
Hugh Bishop provided an update, noting that the Finance Recovery Board (FRB) had held a constructive discussion. He confirmed that there is robust challenge across all directorates, with a focus on testing the validity and feasibility of savings schemes. Overall, the conversation was positive and demonstrated a strong commitment to scrutiny and assurance.
The Chair queried the spike of projected saving scheme yields towards the end of the financial year, seeking clarity on the risk to delivery. Phil Tydeman confirmed that NHS Grampian made a strategic decision re Month 12, and discussions with IJBs have taken place. There is also a high level of confidence in the delivery of the three identified schemes that mature at the year end.

Planned Care Improvement Plan – External Review

Paul Bachoo provided a verbal update on the progress of the external review.
The review is advancing well, with offers of support from other Boards currently being considered. A steering group has been established to oversee the process, and it has been confirmed that the next steps in relation to the Dermatology procurement exercise falls within the scope of the review.
NHS Grampian has been identified as having significant challenges with long waiting times, particularly for outpatient services. The team welcomed the opportunity to collaborate, learn and shared the  substantial work already undertaken.
The external review team commenced their work during the week of the 20 September 2025, covering a range of topics including reporting, governance, infrastructure, financial modelling and workforce planning. Their involvement was positively received, and contributions from other Boards were also appreciated.
Verbal feedback from the review team is expected on Friday, with the intention to present findings at a future Assurance Board meeting once the report and its conclusions were finalised.
It was formally noted that Scottish Government has confirmed funding of £900,000 to support the Dermatology work.
The Chair acknowledged that this is a fast-paced piece of work and confirmed it will be revisited to be updated on progress once the plan has been formally signed off.
Paul Bachoo provided further updates, highlighting some movement in appointment scheduling, with variability noted
A significant risk was raised regarding the Central Decontamination Unit.
Three COV sterilization units are currently affected. The root cause of the issue remains unclear, and further investigation is required to determine how it occurred and what corrective actions may be needed.
Laura Skaife-Knight provided an update on the Boards NHS Grampian is actively following up with re: mutual aid and support. In the meantime, revised trajectories have been submitted to Scottish Government and reflect that 52-week waits for New Outpatients have reduced from just over 10,000 to just under 5,500, considering the additional funding received for dermatology and additional welcome support received from the Golden Jubilee re: Ophthalmology.
The Chair thanked Paul Bachoo for his update, noted the concerns and risks around CDU and noted the support of other Boards. 

Unscheduled Care (USC) Improvement Plan – Progress Report

Geraldine Fraser provided a verbal update. The USC Sub-Group has met four times and signed off Version 3 of the USC Improvement Plan. Weekly meetings of the USC Programme Board commenced on 1 October 2025. KPIs have been developed, and reporting will be made to the NHS Grampian Board and PAFIC.
There has been a significant level of activity, with refreshed governance arrangements now in place. It now operates under a revised Terms of Reference and new chairing arrangements, which have been positively received, with the Chief Officer for Aberdeenshire IJB to Chair the USC Programme Board. Two Senior Responsible Officers (SRO) have been confirmed, with leadership spanning both acute and community services. There has also been strong engagement from the Integration Joint Boards (IJBs) and Scottish Ambulance Service.
The Chair welcomed the range of actions against the USC care including the extended pharmacy hours.  
Professor Graham Ellis queried how closely the current work aligns with the CfSD report and whether it meets the expectations set out in its recommendations. It was noted that NHS Grampian has welcomed the opportunities identified and is actively considering the report’s recommendations, particularly around flow-based models and ways of working and confirmed the close alignment between the CfSD report and USC Improvement Plan.
The Chair asked about clinical engagement and buy-in to the plan.
Geraldine Fraser confirmed that clinical engagement is progressing well and is central to successful delivery. A recent walkaround provided an opportunity to speak directly with clinicians involved in the workstreams. 
Professor Graham Ellis welcomed the update, particularly the emphasis on clinical expertise, and thanked Geraldine Fraser for her contribution. 
Laura Skaife-Knight reflected on a recent walkaround of the emergency pathway, noting that feedback from colleagues she spoke to was that this feels like a system-wide plan that has been actively discussed with clinical teams. She highlighted that beyond Phase 1, there are a number of emerging ideas, and the walkaround was both valuable and positive, with colleagues optimistic that this plan feels different and will deliver the improvements that are needed to the timeliness of patient care.
The Assurance Board noted the ongoing work around flow pathways and welcomed the strong clinical engagement the plan is generating, along with the visible support from senior leadership. 
Communications and Engagement
The Board discussed the upcoming publication of the KPMG Diagnostic Report. A Government Initiated Question will be lodged in Parliament on Thursday 9 October 2025 at 10:30 and letters will be sent to the Health and Sport Committee and local MPs/MSPs.
Laura Skaife-Knight confirmed that NHS Grampian is as prepared as possible for both internal and external communications, and has actively engaged with staff-side colleagues, including the Employee Director and Chair of the Area Clinical Forum, to ensure alignment and input on the materials themselves. 
The Chair emphasised the importance of robust communication channels across the system. 
Alison Evison noted the NHS Grampian Board meeting on 9 October 2025 and will have press interested and so will be part of the theme afterwards. The Board will be having its regular update with local MSP’s and MPs on 17 October 2025. 
The Chair queried whether the draft report had been shared with the Non-Executive Board membership and how well engaged they are to support engagement on publication. Alison confirmed that Non-Executives have had detailed briefing but have not seen the document itself.
Laura Skaife-Knight shared an update on the constructive feedback received from staff-side colleagues about engagement and follow through of actions as well as how staff are currently feeling, which had been discussed in full with the Executive Team during a productive session. It was agreed that the Employee Director and Chair of the Area Clinical Forum would be invited to join a future Chief Executive Team meeting as a dedicated agenda item to share reflections, with a view to jointly agreeing a way forward and Laura confirmed this meeting had happened. The feedback has been carefully considered, and a clear way forward has now been established which will involve a joint meeting of the Grampian Area Partnership Forum and Area Clinical Forum is planned to support continued collaboration and engagement.
Alex Stephen noted that while some key themes under management and leadership were difficult to hear during the session, the overall discussion was constructive. He emphasised the need to revisit and ensure that staff governance processes are functioning effectively.
Hugh Bishop added that any improvements through the leadership team should begin with the Executive Team, highlighting the importance of collective knowledge and reflection on individual roles and leadership responsibilities.

Delegated Budgets – Aberdeen City

Fiona Mitchellhill provided a financial overview of Aberdeen City IJB, noting that the 2024/25 outturn variance of £17.035 million was addressed through reserves and partner contributions. A balanced budget for 2025/26 has been approved, supported by additional funding and tracked savings projects, with Quarter 1 showing a small underspend. The Board was updated on priorities for the remainder of the year, including audit implementation and budget adjustments. Looking ahead, a budget gap of £17.558 million is forecast through 2028/29, with £14.045 million in savings required for 2026/27. Budget planning will be compressed due to the timing of the Scottish Budget announcement.
Hussein Patwa joined the Assurance Board to support Fiona with this update, adding that the IJB are mindful about the need for robust business intelligence about how the finances are working, and really drilling down into the operational aspect. 
The Chair thanked Fiona Mitchellhill for her update and invited comments from AB members. 
Jack Gillespie queried whether a Chief Finance Officer (CFO) is now in post. It was confirmed that interviews are currently underway for a Deputy CFO position, and there is confidence that an appointment will be made shortly.
Jack also raised a question regarding the financial outlook for 2026/27 and beyond, noting the existing gap and asking whether NHS Grampian is taking steps to consolidate savings planning. Fiona Mitchellhill confirmed that there are no plans to request additional contributions for the next financial year. 
Alex Stephen added that no agreement has yet been reached with the IJBs for 2026/27, but a system-wide approach is being considered. A financial planning framework was issued by the system’s Chief Executives last week to support this work.
Laura Skaife-Knight informed the Board that on 7 November 2025, NHS Grampian will host a joint session with Chief Executives of the Local Authorities, IJB Chief officers and all Directors of Finance to review assumptions, savings plans as they are emerging and to help to have a shared understanding of any decisions by all partners on other parts of the system, to ensure no unintended consequences. The session will provide system-wide oversight and consider the broader implications of financial decisions, reflecting a joint commitment to collaborative leadership.
The Chair raised a query regarding the savings for the current financial year, noting that delivery appears to pivot around two key schemes. Further information and assurance were requested, particularly regarding the level of oversight and security within the IJBs, given their critical role in the financial plan.
Fiona Mitchellhill provided an update on premises rationalisation, confirming that NHS Grampian has vacated one site as part of ongoing efforts to streamline estate usage and identify savings opportunities. She also highlighted work underway with the social work team to review care needs for older adults, enabling more targeted support and improved resource allocation. Regular meetings are being held with the Grant Care Consortium, with a clear direction on the use of allocated funding.
Progress on IJB reporting was noted, with quarterly updates now being submitted to the Integration Joint Board.
The Chair welcomed the update from Fiona and also feedback from the meeting which is scheduled on 7 November 2025. 

Any Other Business

The agenda was agreed for the next meeting which is taking place in Grampian on Tuesday 21st October. 
•    Future Support 26-27 (Laura Skaife-Knight)
•    Workforce and engagement between NHS Grampian and Scottish Government (Fiona Hogg) 
•    KMPG recommendations and actions (Phil Tydeman/ redacted) 
•    Reflections on the publication of the report or address any concerns (All)
•    Standing updates from the three boards (SROs)
•    Q2, Month 6 from finance (Alex)

The Chair thanked colleagues for their contributions to the sixth assurance meeting and closed the meeting