NHS Grampian Assurance Board minutes: 18 August 2025

Attendees and apologies

• Stephen Gallagher, Director of Mental Health, Scottish Government (Chair)
• Donna Bell, Director NCS & SRO Service Renewal Framework, Scottish Government
• Fiona Hogg, Chief People Officer, Scottish Government
• Robert Kirkwood, Head of People, Governance and Appointments Unit, Scottish Government
• Fiona Bennett, Chief Finance Officer Health and Social Care, Scottish Government  
• Professor Graham Ellis, Deputy Chief Medical Officer for Scotland, Scottish Government
• Tracy Slater, Head of Performance and Delivery, Scottish Government
• Adam Coldwells, Interim Chief Executive, NHS Grampian
• Alison Evison, Board Chair, NHS Grampian
• Hugh Bishop, Medical Director, NHS Grampian
• June Brown, Executive Nurse Director, NHS Grampian
• Phil Tydeman, Interim Director of Improvement, NHS Grampian
• Laura Skaife-Knight, Chief Executive, NHS Orkney
• Alex Stephen, Director of Finance, NHS Grampian
• Fiona Mitchellhill, Chief Officer, Aberdeen City HSCP (for USC item)
• Geraldine Fraser, Chief Officer - Acute Services (for USC item)
• Judith Proctor, Chief Officer, Health and Social Care Moray (for USC item)

Items and actions

Welcome and apologies

The Chair welcomed members to Meeting Three of the Assurance Board (AB), noted apologies, and outlined the agenda. Substantive items on the Board’s agenda includes NHS Grampian’s month four finance position, unscheduled care plan and discussion on the draft  KMPG diagnostic report in relation to HIS/NES concerns. 

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 actions from Meeting Two.

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 has been on non-delegated services thus far). The AB were content for the Chair and Adam Coldwells to further discuss the action and confirm timescales. 

Action – Follow-up internal meeting for NHS Grampian  and to confirm intentions this with Chair. Laura Skaife Knight confirmed there has been an initial conversation and will follow up with the Chair in the next week.  

NHS Grampian month 4 financial position  

Alex Stephen presented slides which focused on NHS Grampian’s financial position at M4— an action from Meeting Two. With the operational position improving slightly from where it was in the previous month (and quarter). Grampian are still anticipating a £45m deficit and highlighted to the AB the financial recovery gap of £8.9m to deliver on the agreed end year position. Alex also updated on the areas with deteriorating positions discussed at CE team meeting on 12 August 2025. Grampian also identified some key next steps. 

The Chair thanked Alex and welcomed thoughts and feedback on the slides

Fiona Bennett welcomed the review and savings overview, noting the value of seeing best, medium, and worst-case scenarios. She supported continued progress on this work.

In considering the longer-term outlook, the need to balance recovery and sustainability was emphasised, with a greater initial focus currently placed on recovery.

The chair confirmed a more formal update is expected on 2nd September, and it was suggested that hearing the Board’s response to the latest financial position and progress on in-year savings would be helpful. 

Alison Evison noted that the Board received the update positively, recognising the progress and financial assurance being established. Further detail will be shared during the Finance session on Wednesday, where scrutiny will continue.

Value and sustainability programme

Phil Tydeman provided paper beforehand to the AB. An update was provided on the Value & Sustainability Programme. The Board was informed that the current savings forecast of £54.5 million requires an additional £7 million in savings. A pipeline of opportunities is being developed, with £2.2m–£3.4m of indicative savings identified, subject to QIA approval. Key initiatives include reductions in agency and non-clinical spend, improved vacancy control, and enhanced scrutiny of procurement. Broader opportunities were also outlined, such as digital transformation, estate rationalisation, and contract leakage mitigation. Since the last meeting, governance has been strengthened through the establishment of a Financial Recovery Board and a monthly Delivery Group. The Interim Director of Improvement has taken on a more active role in reviewing non-pay requisitions and vacancy panels, with weekly monitoring now in place. Resources have been reallocated within the Value & Sustainability team to focus on high-value and high-risk schemes. 

The Chair welcomed thoughts and feedback on the paper. 

Laura Skaife-Knight welcomed the strong governance arrangements but emphasised the need for clarity around what is being presented to each Board and the rationale behind it. She highlighted the importance of balancing assurance with delivery. The full package is expected to return by the end of August.

The Chair requested a clear outline of the scheme, including the remit of each group, their focus areas, and the frequency of meetings. 

Action: A ‘governance map’ to be produced (a high-level summary sheet to detail the financial governance process going forward where spend and savings were being considered —covering NHSG Board frequencies, the roles of the Financial Recovery Board and Performance Committee, and their respective responsibilities). 
Such a map could include suggested frequency of update to the Assurance Board. 

Donna Bell stressed the importance of understanding where decisions are being made within the governance structure, and how interdependencies are being identified and addressed. 

Grampian confirmed that assurances will be provided in the next Assurance Board return.

Action: detail of decision-making responsibilities for each board, and interdependencies between them to be included in the ‘governance map’

Alex Stephen confirmed that any funding received for Planned Care will be allocated directly to that area, in line with the Scottish Government’s priority to reduce waiting lists.

Alex Stephen confirmed there is a plan to go forward in October for AFC Reduced Working Week and would provide an update in future financial reporting. 

Action - Alex Stephen to update on AFC RWW impacts in October when the National return is made to Scottish Government and give further assurance that these are built into financial plans and projections.

On Mental Health, Hugh Bishop will contact Fiona Hogg. 

Action: Hugh to contact Fiona Hogg. 

Unscheduled care

Further to the work undertaken since the last Assurance Board Meeting, Adam Coldwells highlighted feedback which the board had received and shared slides highlighting the improvement ideas, intended outcomes, key themes, and how the USC planning would consider and adapt  to the feedback. ,

The Assurance Board was joined by Fiona Mitchellhill, Judith Proctor and Geraldine Fraser for this discussion. 

The chair welcomed comments on Adam’s presentation.

Related to USC, Graham Ellis noted that delivering effective planned care requires a minimal footprint and emphasised efforts to streamline the model to make it as lean as possible. 

Donna Bell committed to reviewing the feedback and expressed interest in understanding what specific changes are expected in the revised plan. She requested more detail to inform meaningful adjustments.

Grampian confirmed that feedback suggested the current plan broadly includes the right components, with feedback helping to refine the balance. One notable area of discussion was the ED observation ward, which represents a significant financial investment. Views differed on its overall prioity and value in the plan.

Fiona Mitchellhill commented that around 50% of patients referred to frailty services were successfully managed, supported by seven-day-a-week coverage. Plans for frailty at the front door are progressing.

Hugh Bishop noted limited time to review the proposed suggestions for changes but acknowledged that elements such as the ED observation ward, a firebreak approach, and enhanced care packages at home (alongside care home placements) are likely to be accepted.

Geraldine Fraser shared that advice had been sought from CfSD, and there was general agreement that data and diagnostics have not yet been effectively linked.

Judith Proctor provided feedback on governance and agreed that clarity needed to be improved in the next iteration of the plan.

Tracey Slater reflected on recent performance and asked what actions are currently being taken to begin implementing and embedding elements of the plan. 

A discussion followed on NHS Grampian's proposed interim target for UC within the plan and the identification of the aspects of  the plan that could improve this. 

The Chair summarised this discussion, noting that an updated USC plan had been drafted at pace and feedback sought on it. The Board felt that the plan was heading  in the right direction but that there was consistency in the feedback around the balance of hospital focussed improvements v out of hospital improvements with the Board not assured that the overall objective to optimise whole system flow had been achieved.

The Chair proposed that in line with the Assurance Board TORS a subgroup on USC/Flow be established to work with NHSGrampian to improve the plan and to support ongoing implementation as needed. This may involve the support of other expertise/systems and proposed this be chaired by Donna Bell, with the subgroup meeting as soon as possible and providing an update on the status of the plan to the next Assurance Board. The Board agreed the proposal. 

Action  - Donna Bell to establish a subgroup of the Assurance Board, convene relevant parties and provide an update to the next Assurance Board meeting. 

KMPG draft diagnostic HIS/NES Concerns 

As part of the diagnostic activity, KMPG have prepared a report covering what action NHS Grampian has taken to improve upon the concerns raised by HIS and NHSEducation which had resulted in a joint letter of concern from both Chief Executives, shared with Scottish Government. 

The KPMG draft report outlines that NHS Grampian have developed a comprehensive action plan, with 46 actions being tracked. While many are on track, several especially in cardiology are reported to be delayed or at risk. KPMG’s assessment finds the actions generally well designed but highlights the need for sustained implementation, ongoing governance, and improved clinical engagement.

The Chair reflected on the paper received by the Assurance Board and asked NHS Grampian if they were satisfied with the factual accuracy report. NHS Grampian confirmed they were content and felt it provided a fair summary of progress and actions to date.

The Chair then invited feedback from the Assurance Board.

Graham Ellis raised concerns about the timescales for cardiology services, noting that four actions were currently off target. He questioned whether cardiology care remained safe and what steps could be taken if it was not.

Hugh Bishop confirmed that a single, unified waiting list for cardiology services is now in place.

It was noted that there had been a number of historic challenges had delayed progress against the original plan. 
The chair confirmed this additional review will be input to the draft diagnostic report and this will then be shared once finalised. 

The Board noted that Dr Ellis would follow up the discussion at the Assurance Board with Hugh Bishop. 

Communications and engagement

The Chair asked NHS Grampian if there was any particular feedback on the direction of the recovery plan from the NHS Grampian Board meeting, or the recent CEO led staff briefings and the Townhall sessions which have taken place over the last week.

NHS Grampian commented on the positive feedback which they had received about being transparent. 

The Chair fed back Cabinet Secretary views for the publication of the TORs, minutes and any associated reports (including the diagnostic report) and a publication strategy was in formulation 

Alison Evison informed the AB there is a meeting of local MPs/MSPs in the diary for September 5th and that would be helpful to know of the publication strategy to inform handling of the meeting. 

Action – SG colleagues will liaise with the Chairs/CX office on this. 

Any other business

The Chair noted that a staffing group review paper had been on the draft  agenda however, on reflection,  Scottish Government advised it would be better to develop a broader paper and approach together. Fiona Hogg will link with colleagues to discuss t and scope out next steps. 

Action – Fiona Hogg to meet NHSG colleagues and report back to next Assurance Board. 

The Chair thanked colleagues for their contributions and closed the meeting. The next AB meeting will take place on Tuesday 2nd September at Grampian.