Escalation to Stage 4, NHS Scotland support and intervention framework

The Scottish Government announced on 12 May our escalation to Stage 4 of the NHS Scotland support and intervention framework.

This escalation reflects concerns about our financial position, leadership, and governance. In making the announcement, Cabinet Secretary Neil Gray said:

“Staff in NHS Grampian continue to work tirelessly to deliver the high-quality care we expect”; and you can read the full announcement at the following link: Change to health board escalation - gov.scot

On 10 April, the Scottish Government also announced they were conducting an external review and the results of this will be key to the next steps in this process. The Scottish Government has established an Assurance Board that reports to the Director General of Health and Social Care, and Chief Executive of NHS Scotland. This board, chaired by Stephen Gallagher, Director of Mental Health, has been tasked with providing oversight of NHS Grampian’s progress against the specific actions in our Improvement Plan.

We will keep you informed via this page. We welcome this additional support and continue to work collaboratively with Scottish Government

UPDATE - 9th October 2025

What is the external review? The external review was commissioned by Scottish Government to coincide with our escalation to Level 4 of the NHS Scotland Support and Intervention Framework in May 2025.

What was reviewed? Three specific areas:

1. Our leadership and governance arrangements
2. Further analysis on the main causes of our deteriorating financial position
3. Potential opportunities for cost savings and optimising current services

What did the review find? The final review report can be read in full. The key findings are that we have more work to do in these core areas:

1. Strategic prioritisation
2. Leadership, culture, governance and workforce
3. Working with partners
4. Delegated decision-making in the organisation
5. How we set our budgets each year
6. Financial reporting and scrutiny, including of Integration Joint Board finances
7. Sharing learning and listening to and acting on feedback from staff
8. Visibility of strategic risks, controls and actions

While we have much to do, we can already evidence progress in each of these areas – as you can see with the Progress Update.

How have we responded to the review? Laura Skaife-Knight, our chief executive, said: “We welcome this independent assessment and the ongoing support we are receiving from the Scottish Government and wider Health Boards, all of which are informing and further strengthening our improvement plans, which we are focused on delivering. 

“We are confident our financial and savings plans will be achieved this year.  All savings schemes will continue to be carefully considered to ensure patient experience, clinical care and staff wellbeing is maintained or improved.  We are grateful to the Scottish Government for the additional funding provided to NHS Grampian to further improve access to our urgent and emergency services and reduce waiting times for operations and appointments (planned care) for the populations we serve. We also continue to benefit significantly from the learning and support we are receiving from other Health Boards.

“We are committed to working collaboratively with our local, regional and national partners, and to working as a whole system so that ideas for improvement are designed and developed together for the benefit of the local communities we serve, and to openness and transparency as an organisation, all of which are critical to taking our organisation forward.”

What next? Thanks to your hard work and our organisation-wide focus, we have already made a lot of progress since May 2025. We were not waiting for the outcome of this review to start taking action. This review and the resulting recommendations, serve to further inform and strengthen our improvement plans, which was already well developed. Along with support from Scottish Government, from other Health Boards in Scotland, and your dedication and expertise, we are confident our progress will only continue. In response to the review, we are focusing resources and energy on three priority areas:

1. Planned Care - reducing our longest waits so that no patient is waiting longer than 52-weeks by the end of March 2026
2. Urgent and emergency (unscheduled care) - reducing ambulance turnaround times, improving access to urgent and emergency care at Aberdeen Royal Infirmary and reducing the number of people in hospital who do not need acute care (delayed transfers of care)
3. Delivering our financial and savings plans – reducing our costs by improving efficiency and clinical productivity, and fully utilising procurement potential

Our commitment to you We will continue to carefully and thoughtfully consider all savings ideas to ensure patient experience, clinical care, and your wellbeing is maintained or improved, with support from our clinical leaders. 

We commit to improving access to services and reducing waiting times for the people we serve, and we are grateful for the additional funding received from the Scottish Government that enables this.

We will be open and transparent about our progress in delivering our ongoing improvements. This will include updates at our bi-monthly public Board meetings, the Scottish Government-chaired Assurance Board (fortnightly), and quarterly updates from us to you, summarising how we are doing against our plans. The minutes from the Assurance Board meetings being published and available online is a positive step and means anyone who wants to access the notes from the meeting. 

 

Published: 16/10/2025 11:20