Reflecting on my first year as Chief Executive

Published: 21/09/2026 09:00

Hi everyone,

This week it’s a year since I had the privilege of becoming Chief Executive of NHS Grampian.

When I joined last September, I made a commitment to lead with openness and honesty and be a visible and compassionate leader so I stay connected to you and how it feels working here. I also said I would lead with hope and optimism and inject belief as we face the task ahead of us and create our future, together.

I listen very carefully to what matters most to you and to our patients. I have met many of you across our hospitals, health centres and communities. Each conversation has shaped my understanding of both the difficulties and challenges we must face head on and has shown the incredible strengths that exist in abundance at NHS Grampian.  

People often ask me what NHS Grampian means to me. NHS Grampian is its people. I consistently meet staff who make a difference and who care deeply about doing the best possible job for our patients. I see extraordinary dedication and compassion and outstanding care being delivered every single day.

Feedback I receive from our patients and families about where we are aren’t getting things right presents learning and improvement opportunities for us. I equally receive countless letters and emails about where we you are doing a great job. Sharing this feedback with you matters so we remember what we are doing well. Balance is really important.

It has been a hugely challenging year with pressures and demands unrelenting. We have both clinical and administrative backlogs to address in a number of key areas and we are well on the way to developing how this will be done.

Our Stage 4 escalation under the NHS Scotland Support and Intervention Framework comes with significant regulatory scrutiny – all of which can feel overwhelming for people - and I want to recognise this. Throughout it all, I have seen extraordinary determination, professionalism and resilience from colleagues across Grampian as difficult as this is.

I know there are days it may not feel like it, however, we are making progress. There are also times you have to take a few steps back to go forward also, and these last few months have certainly felt like this, including for me. I’ve made mistakes and got it wrong many a time over the last year. I learn every day too. I don’t have all of the answers, but collectively we have many of them. Where we need support, we are much better at reaching out to ask for help (including increasingly outside of NHS Grampian to learn from others), with many examples of this in relation to our improvement and transformation work.

Let me highlight just some of the areas we I feel we can point to which evidences the right foundations are being laid and with this, where I believe we can show we are starting to turn the corner.

Over the past six months, we have consistently met our financial savings targets through a relentless focus on productivity, efficiency and value. We have moved from managing multiple improvement programmes to working through a single improvement plan and we have six clear strategic priorities, creating greater alignment and with this strengthened accountability across the organisation.

We have continued our efforts to improve urgent and planned care, reducing waiting times, improving ambulance turnaround performance and tackling delayed discharges. While there is still much more to do, we are seeing encouraging signs that our collective efforts are making a difference. Four-hour emergency access performance is slowly improving and corridor care and boarders are reducing. Last Thursday, at 60%, ARI’s 4- hour performance was the best it has been in 14 months. And we have the lowest number of 21-day length of stay patients in our hospitals than in the previous two years. This shows that while we are still nowhere near where we want to be for our patients, we are moving forward, and it proves what is possible when we pull together and get behind a collective goal.

Staff engagement is beginning to improve based on our iMatter scores, both via response rates to the survey and some of the questions indicate our targeted efforts are in areas such as visible leadership and keeping you better informed, are making a positive difference. Our iMatter Action Planning completion rate was 72% compared to 58% in 2025, reflecting your commitment to engage in more meaningful conversations with your teams about people’s working experiences and identify actions for improvement. All of these are encouraging signs.

Recognising we need light at the end of the tunnel, we have also agreed our de-escalation criteria so we have a path to move from Stage 4 to 3 escalation status. We also have much-strengthened relationships with ourpartners locally, regionally and nationally, which is absolutely critical to our success.

Perhaps most importantly, we have started to change how we work together. When I first arrived, it immediately became clear to me that you wanted more than opportunities to talk and be listened to. You wanted us as an Executive Team to be more connected to you, you wanted your feedback to lead to more positive change and you wanted to influence decision-making and planning. We have worked hard to keep you better informed, to break down barriers, to be open and transparent with you and to begin to create a culture where people feel able to speak openly, raise concerns and contribute ideas for change.  The focus on culture, behaviours and accountability is vital as we look to the year ahead because it is critical to moving us forward.

Our weekly decisions and key discussion points from the Executive Team meetings are shared in the Daily Brief. We have introduced monthly all staff briefings (open to all staff) to give regular access to the Executive Team and a place to ask us anything as well as quarterly senior leaders meetings to ensure we are all pulling in the same direction and have a safe space to challenge.

Creating psychological safety remains one of my most important priorities. Being open and honest, particularly when circumstances are difficult, is essential if we are to build trust. We will not always have easy answers or sometimes answers at all and sometimes we will not always agree with decisions that are made. That’s part and parcel of working in an organisation the size and complexity of NHS Grampian. But what I can promise you is we will always be transparent, respectful and people-focused in how we respond and deal with things.

Balancing the immediate needs of patients today with the longer-term transformation required to create sustainable services for the future is not easy. One of the biggest lessons I have learned over the last year is remembering the importance of local solutions – and the best ideas coming from staff who are delivering care and running services because you know your areas of work and the opportunities for improvement far better than we do. The most effective changes come directly from frontline teams and the communities we serve.

Listening to our patients and communities has also reinforced what matters most to them. Our patients want timely access to services, much-improved communication, meaningful involvement in decisions, joined-up care and services and care that is delivered as close to home as possible. These conversations continue to inform our priorities and planning.

For me, success is about building momentum. It is about creating an organisation that is stable, sustainable and safe, with strong foundations that will serve our communities well into the future. It’s about continuous improvement,

Looking ahead, our focus remains on the six priorities that are already making a difference:

• Clinical Quality and Safety – maintaining the highest standards of care for patients and creating safe environments for staff.
• People – supporting our staff and improving outcomes for our communities.
• Prevention – helping people stay healthy and independent through earlier intervention, support and self-management.

• Planned Care – reducing waiting times and improving access to treatment.

• Urgent Care – ensuring people receive the right care, at the right time, in the right place.
• Value and Sustainability – making the best use of resources and working more efficiently across our health and care system, including exploring pan-Grampian opportunities for improvements.

Transforming services and delivering sustainable change will take time, and there will undoubtedly be further challenges ahead. It is also reliant on operating in and engaging well and proactively in three spaces, locally (NHS Grampian and in the North-East of Scotland), in the sub national East space and nationally. We are moving in the right direction as a result of proactive and meaningful engagement and leadership in all three spaces. We have a clearer sense of purpose, stronger partnerships, and growing opportunities through regional and national collaboration which are key to our future clinical and financial sustainability. Most importantly, we have the commitment, expertise and determination of you - Team Grampian.

Thank you for all you do. I see the support you give each another and just how dedicated you are to improving the health and wellbeing of the people we serve every day. I am incredibly proud to be part of Team Grampian and to be leading this organisation. I look forward to seeing what we can achieve together in the year ahead and building further on our progress to date. I recognise the uncertainties that the reform agenda brings following Programme for Government, and we will contribute to discussions nationally on this. For now, the show goes on and I ask that we remain focused on the improvement journey we have set out on. Let’s keep believing we can do this – because I absolutely do.

Let’s keep going and working together for our patients and those we serve; who deserve nothing less. We are moving in the right direction.

Take care and thank you for all you do.

Laura Skaife-Knight
Chief Executive