The next item of business is a statement by Neil Gray on NHS Grampian. The cabinet secretary will take questions at the end of his statement. Therefore, there should be no interventions or interruptions.
15:27
I wish to update Parliament on our decision to escalate NHS Grampian to stage 4 of the NHS Scotland support and intervention framework.
I once again acknowledge that staff in NHS Grampian continue to work tirelessly to deliver the high-quality healthcare that we expect. Our intervention is in no way a reflection on the excellent care and support that they offer local people each and every day, nor should we forget the significant health service innovations and improvements, which I have seen first-hand during visits to Grampian.
Indeed, the purpose of the intervention is to enable local staff to go further. We will do so by providing the right balance of scrutiny and support to stabilise the system, ensuring a robust basis for the wider local transformation that is required over the longer term. We are determined to do that in a way that is not detrimental to key, front-line services.
NHS Grampian has been experiencing significant financial and operational pressures for several months. That prompted the escalation of the health board to stage 3 of the NHS Scotland support and intervention framework for financial management in January this year.
Stage 3 is the first formal stage of escalation and, as such, NHS Grampian has been receiving a package of tailored support. However, significant concerns remain about the board’s financial position, plans, leadership and governance, and about any associated impact that they might be having on the delivery of local services.
We heard a number of those concerns during the members’ business debate on NHS Grampian that was secured by Douglas Lumsden on 22 April. At that time, I assured the chamber that I would keep the board’s escalation position under close review, and that, if required, I would not hesitate to act further in the best interests of local people.
Following careful consideration, the Government announced on 12 May that NHS Grampian’s escalation status had been raised to stage 4 of the framework for finance, leadership and governance.
NHS Grampian had the largest financial deficit of any health board in 2024-25. It reported a forecast outturn deficit of £65.1 million. Indeed, despite record funding of more than £1.34 billion in the current financial year, and the tailored support that is already offered under stage 3 of the framework, the board will be in receipt of cumulative brokerage from the Government in excess of £90 million across the past two years.
Concerns remain about future financial pressures for NHS Grampian, and there is insufficient confidence that the board’s current plans will arrest the rate of expenditure and deliver the sustainable recovery that is required. We cannot tolerate that position. It is therefore our judgment that further formal escalation is necessary. Along with the additional support and scrutiny that that will provide, we must seek to mitigate the significant financial risks to the local board and, more widely, the overall national health service.
Alongside financial management issues, NHS Grampian is being escalated due to rising concerns about local services. That includes the operational pressures that led the board to declare a critical incident for three days last November, diverting some activity to other board areas due to capacity constraints.
The board has since referred to a number of on-going “intolerable risks”, including with regard to its ability to respond effectively to persistent demand and pressures on local unscheduled and planned care.
The Government and the national centre for sustainable delivery have been engaging with and supporting the board for some time to help it to assess delivery and target sustained improvements in local unscheduled care performance. Indeed, I want to be clear that this is an escalation in support and scrutiny for NHS Grampian. As such, it will build on the previous support and improvement activity that has been undertaken.
The support provided to date has come from a range of providers, including the Government’s financial delivery unit and Healthcare Improvement Scotland. By way of an example, I note that the centre for sustainable delivery has provided bespoke clinical support to NHS Grampian and has identified opportunities that will support improvements. That includes a focus on reducing hospital occupancy to improve flow and reducing turnaround times for the ambulance service. There is the potential to build on the current local model of flow navigation, and work is under way with the board to develop that further.
I should reiterate that, by accessing extra funding from an additional £30 million national investment in planned care, NHS Grampian was able to deliver more than 23,000 additional appointments and procedures last year. We will continue to support the board in building on that work. Indeed, we are providing an additional £3.3 million to NHS Grampian in 2025-26 for two mobile MRI scanners and one mobile CT scanner. Those resources are set to deliver more than 19,000 additional scans over the course of the year.
Nonetheless, financial and operational issues persist, and it is right that we now act further. We heard in the recent members’ business debate on NHS Grampian about the long-standing demographic, demand and capacity pressures across the local health and social care system. We understand that those pressures will require a comprehensive local strategy to deliver the fundamental transformation that is required and that that will not happen overnight. The key focus of the further escalation will be to mitigate immediate concerns about the financial and associated operational pressures and to stabilise the local system.
Another concern that we heard during the members’ business debate in late April was about the leadership of the board, with the interim chief executive having announced his intention to retire earlier this year. I am advised that there is a strong shortlist of candidates for the chief executive post, with the final interviews scheduled for early June. As such, we are confident of making a successful appointment in the near future.
As I have said, the purpose of the intervention is to stabilise the system and provide a robust basis for the wider local transformation work that is required over the longer term and in support of the new leadership. One of the key initial elements of the package of enhanced support and scrutiny will be a whole-system diagnostic. KPMG has been appointed to carry out that work, and we expect it to report by the end of June.
The overarching goal of the diagnostic is to better understand how the whole system is operating and, in partnership with NHS Grampian, determine which changes the board could realistically effect within its financial envelope. The diagnostic will establish a shared, data-driven understanding of the current operation of the whole system and provide insight into the specific issues that NHS Grampian faces; review the existing service models and relationships with financial management, ensuring that assets are being optimised and care is being delivered effectively in the right place; and identify what further cross-boundary collaboration could take place with other NHS boards, particularly in the north of Scotland, to support NHS Grampian to mitigate its operational risks.
I am determined that the scope of the diagnostic and subsequent work will not be limited and that it should extend to all relevant areas of local service delivery and expenditure. The whole-system diagnostic will help to inform the board’s detailed improvement plan and the tailored package of scrutiny and support that will underpin it.
As with other stage 4 escalations in the past, the Government will establish an assurance board, which will report to the director general for health and social care and chief executive of NHS Scotland. That board, which will be chaired by a Scottish Government director, will be tasked with providing oversight of NHS Grampian’s progress against the specific actions in its improvement plan.
I also want to recognise the concerns raised in the members’ business debate about local management meaningfully engaging with, and properly listening to, front-line staff—a point that was alighted on in particular by Kevin Stewart, both in that debate and in his more recent topical question. Meaningful partnership working with local staff and their representatives will be necessary for NHS Grampian to successfully develop and implement its improvement plan.
We expect all boards, including NHS Grampian, to have robust systems and processes in place for engaging with and involving colleagues in their planning and strategies, in line with our NHS Scotland national staff governance standard.
NHS Grampian must work closely with its staff-side, trade union and professional organisation representatives in its area partnership forum to ensure that it listens and responds to concerns raised by staff and that their views help to inform future activity. Similarly, we expect the full engagement of local clinical views, not least through the NHS Grampian area clinical forum. The Government’s assurance board will look for evidence of that meaningful partnership working around the development and implementation of NHS Grampian’s improvement plan.
I hope that this statement assures members that we take the issues very seriously and that I will continue to keep them updated on the next steps, including on the specific actions required as part of the board’s improvement plan and the shape of the on-going support and scrutiny that will be provided by the Government.
I reiterate that we remain committed to supporting the new leadership of NHS Grampian to turn the position around. We need to mitigate the immediate risks around the financial and associated operational pressures that the board faces, and to help to stabilise the system. That will provide a robust basis for the wider local transformation required over the longer term, under the new board chief executive.
Foremost in our considerations of this matter must be the people who are served by NHS Grampian. I know that we are all united in wanting the very best for them.
The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow around 20 minutes, after which we will need to move on to the next item of business. I ask members who wish to ask a question to press their request-to-speak buttons.
I thank the cabinet secretary for advance sight of his statement.
Neil Gray visited Aberdeen royal infirmary in February this year. He promised that he would do everything that he could to improve the situation there. However, we have only to look at this week’s ambulance waiting times to see that it is getting worse. With lives at stake, it does not give a single person here any pleasure at all to point out that the Scottish National Party has failed NHS Grampian and its patients.
The reasons for such a dire performance and stage 4 escalation are not the junior doctors, nurses, paramedics and porters—they are trying their absolute level best. No, NHS Grampian is in such trouble because it has been hollowed out by successive SNP Governments. The health board has a history of chronic underfunding, persistent understaffing, the lowest bed base in Scotland per head of population and a national treatment centre on ice. There are massive cuts to health and social care partnership budgets for caring for the elderly and vulnerable. General practitioner practices are folding and major injuries units are on restricted hours.
The Scottish Conservatives have repeatedly warned the SNP Government about this perfect storm. With underfunding of a quarter of a billion pounds, how can NHS Grampian be expected to pay back a Government loan? What is the trigger point for escalation to stage 5?
I do not accept the characterisation that Tess White has set out. NHS Grampian is part of the same funding arrangements as the rest of the health boards across Scotland and has a similar level of funding to them through the NHS Scotland resource allocation committee.
I recognise that there are financial challenges, which is why we have escalated NHS Grampian through the framework and why we are supporting it with the whole-system diagnostic provided by KPMG to look at options for providing better financial stability. We have taken the step of escalating NHS Grampian to stage 4 because of the concerns about performance, ambulance turnaround times and unscheduled care pathways, to which Tess White referred, and because we were not convinced that a plan was in place that would be sufficient to improve that situation or to improve the financial position. That is why, as I committed to do on my visit in February, we are doing everything possible to support the health board. That process starts with escalation to stage 4.
NHS Grampian was escalated to stage 3 in January and, four months later, it has been escalated to stage 4. The Government knew that the situation was bad in January, and it was told that again in March, when the health board submitted its financial plans, so why on earth did the Government wait before acting and further escalating the board’s status? Why has the Government allowed 13,500 patients in Grampian to wait for more than a year for tests or treatment? Why have both the 31-day and 62-day cancer treatment targets been missed? In the interests of patients and staff, the Government really should have acted faster.
There are seven other health boards in the escalation framework because of poor performance. That means that more than half the health boards in Scotland are failing staff and patients. Will the cabinet secretary finally heed the warnings from Audit Scotland and cut the number of health boards to improve governance arrangements?
No, I will not, because I do not think that taking that top-down structural approach at a time when we need to deliver for people is the action that is required. We have set out the first stage of our plans for immediate delivery in the operational improvement plan, and we are doing further work on our vision for health and social care services in Scotland by developing a population health framework and a service renewal framework, which will look at reform and renewal and the way in which we deliver our services in Scotland.
I am committed to supporting the staff to deliver against the clear priorities that we have set on waiting times, planned care and access to unscheduled care pathways and general practice to ensure that, whether in NHS Grampian or any other part of the country, we continue to see improvement for the people of Scotland.
Reports earlier this year suggested that NHS Grampian faces additional costs to the tune of £20 million per year as a result of Labour’s careless decision to increase employer national insurance contributions. Will the cabinet secretary outline what assessment the Scottish Government has made of that issue in the light of what is already a difficult fiscal environment for NHS Grampian?
I thank Jackie Dunbar for her question, because she provides important context for the financial situation with which the Government is wrestling in relation to health services across Scotland. [Interruption.]
We know that the increase in employer national insurance contributions is a tax on public services in Scotland. The money that was provided allowed us to provide 60 per cent coverage for the directly employed staff, including those in NHS Grampian, and the remainder is having to be provided through savings or other efficiencies in services. I do not think that that is an acceptable position for Labour to defend. I do not want that tax on public services in Scotland to continue. The issue needs to be resolved at source at Westminster.
I encourage members to listen to the questions and the responses with a degree more respect than was the case for that exchange.
The disaster at NHS Grampian has not come out of nowhere. Brokerage has been provided to the board for the past two years, and there have been various stages of escalation over the past number of months. Indeed, a critical incident was declared as long ago as in November. Therefore, why has it taken until now for the cabinet secretary to engage KPMG? At what cost is KPMG being engaged? Will he commit to publishing KPMG’s report on receipt? What responsibility does the cabinet secretary bear for failing to get a handle on the situation before now?
We took steps to ensure that we responded to the situation, first by declaring a critical incident and then by providing NHS Grampian with support on its operational improvement plan to ensure that it was able to respond to the critical incident and to demonstrate that it had a plan that would ensure that such an incident would not happen again. I do not believe that such a plan has materialised to provide sufficient confidence on unscheduled care pathways in Grampian.
We escalated the board in relation to its financial position in January. We have not had confidence that the additional support and scrutiny have borne the fruit that they should have. That is why, in short order—within months—we have escalated the board further to stage 4.
KPMG was chosen to conduct the work after a competitive tender. The other bids that we received were in very similar ball parks, so we are confident that we have obtained good value for money and that the cost reflects the market value. We will continue to work to ensure that KPMG’s work delivers improvements for people in the NHS Grampian area.
This is not the first time this year that NHS Grampian has been discussed in the chamber, with members of all parties recently highlighting concerns about the specific issue of ambulance wait times in the board area. I welcome the cabinet secretary’s update on the work that is under way to reduce turnaround times for ambulances. However, how is the Scottish Government supporting NHS Grampian’s work to respond to the centre for sustainable delivery’s recommendations on the issue and to help to improve patient flow from the emergency department?
Audrey Nicoll alights on a particular area on which people served by NHS Grampian wish to see demonstrable progress and on which we have tried to provide support through the centre for sustainable delivery. On Audrey Nicoll’s example of ambulance triage, we are seeing movement happening. We need to see continued improvement in ambulance triage, including a reduction in the risk of patients waiting in an ambulance and more effective prioritisation and, where appropriate, redirection to other care pathways. The rapid ambulatory assessment centre is now seeing 25 to 35 patients daily, with an increased footprint and extended operating hours. There is increased respiratory and frailty capacity locally, with two extra wards having been opened as step-down areas for high-demand specialties. We need to build on that progress through this escalation to ensure that ambulance stacking, particularly at Aberdeen royal infirmary, and critical incidents such as the one before Christmas cannot happen again. However, we are seeing improvements in unscheduled care pathways.
Will the cabinet secretary guarantee that appointments and operations will not be cancelled to pay the costs of what his statement identifies as resource and, particularly, management problems, rather than just issues of demand?
The cabinet secretary makes much of the crucial appointment of a new chief executive. I point out that the previous chief executive lasted only 14 months before announcing his retirement. What confidence can Parliament have that a new chief executive will be able to get a grip of the situation, which appears to be rapidly deteriorating?
There are two areas there. First, Adam Coldwells, who I thank for his service, was an interim chief executive. The appointment was interim, and a substantive appointment was always going to need to be made. As I said in my statement, I am confident that a substantive appointment can be made and that we will see the leadership that is required to turn around the situation in Grampian.
On the first point, I have already set out, in response to a topical question the other week, that I want financial decisions to be taken that do not impact on front-line services and which ensure that we enhance service delivery. I would expect that for the patients of NHS Grampian, and I know that Mr Marra would, too.
Will the cabinet secretary provide an update on the activity that has been delivered through the additional £30 million that was allocated in 2024-25 to reduce waiting times in NHS Grampian? What further work will the Scottish Government undertake to ensure that reductions continue?
By accessing extra funding from the additional national investment of £30 million in planned care, NHS Grampian delivered more than 23,000 additional appointments and procedures last year. As part of our £100 million investment to clear backlogs and substantially improve waiting times, NHS Grampian has been allocated almost £7 million in funding to deliver additional appointments and procedures. That includes funding of almost £2.3 million for cancer services, £1.2 million for ear, nose and throat services, £600,000 for orthopaedics and about £330,000 for ophthalmology.
In addition, we have allocated £2.6 million for the national treatment centre Highland to deliver thousands of additional orthopaedic and ophthalmic operations for patients across the north of Scotland, including those from NHS Grampian.
As I have said, £3.3 million of funding has been provided for two mobile MRI and CT scanners in NHS Grampian, which will ensure that patients get the diagnostic tests that they need. Alongside the further £2.5 million that is targeted at endoscopies, that will deliver an additional 5,000 scans.
Yesterday, Aberdeenshire’s integration joint board voted through significant cuts to disabled and other people’s services. That comes on top of the UK Government’s cruel cuts to social security for disabled people and today’s worrying news about the state of NHS Grampian. What will the Scottish Government do to ensure that disabled people in particular are able to access the health and social care that they need in Aberdeenshire?
Lorna Slater highlights an issue that is of great concern to me. [Interruption.] I heard Conservative members say that it has nothing to do with what we are talking about, but it has everything to do with that. I am extremely concerned about capacity potentially being lost in community services in Aberdeenshire. I am committed to making sure that the Government is providing all the resource that is possible through our local authority funding, as well as through the funding for health boards that should be arriving with our integration joint boards to provide the services that are required. That will ensure that we retain greater capacity and support in communities to prevent people’s ill health from escalating to a point where they require secondary care services or where we have the unscheduled care demand that we are seeing in Grampian.
Many people will, understandably, be concerned by the cabinet secretary’s statement and the escalation at NHS Grampian, and none more so than pregnant mothers, people who are undergoing cancer care and surgical patients from Shetland and Orkney, all of whom rely on services at NHS Grampian. Beatrice Wishart asked the cabinet secretary about that earlier this month, but I ask him today to reassure residents of island communities who rely on NHS Grampian that they will enjoy the same access to services and care as mainland patients.
In response to Beatrice Wishart, I recognised that NHS Grampian serves more than just the Grampian geographical area. On the basis of a service level agreement, it serves other communities, including those in Orkney and Shetland.
In response to Karen Adam’s question, I set out some of the funding that is arriving this year to allow for increased planned care activity, and that will benefit those in Orkney and Shetland as well as those who are domiciled in the Grampian area. I am happy to furnish Mr Cole-Hamilton, Beatrice Wishart and you, Deputy Presiding Officer, given your interest, with that detail.
What are the expectations of the whole-system diagnostic that will take place in NHS Grampian? How will its results be used to inform next steps?
The work involves a team of independent healthcare consultants reviewing key areas of NHS Grampian’s performance, including financial grip and control alongside leadership and governance. KPMG, which is the contracted consultant, will work alongside NHS Grampian and report to Government. That will help to inform agreement, through working closely with NHS Grampian, about the next steps and the support that is required as part of the stage 4 escalation. We expect the initial findings from that consultancy report to be available by the end of June.
It is clear that NHS Grampian is suffering from a serious leadership crisis. I welcome the fact that there is at last progress on recruiting a new chief executive. The board has for far too long not had a permanent chief executive in place, with waiting lists spiralling and financial difficulties deepening.
Leadership comes from the top. I genuinely appreciate that the cabinet secretary met me and my colleagues to discuss the issues that we have raised. However, does he agree that it is time for the chair of NHS Grampian, who has presided over the mess, to be moved on immediately so that a leader who better understands the scale of the challenge can be appointed?
We will see new leadership coming into NHS Grampian in the form of a new chief executive. I want to work with the existing chair to address the issues that have arisen and the reasons for the escalation around leadership and financial control. We will keep working with the chair to ensure that that is the case.
Will the cabinet secretary outline how NHS Scotland’s support and intervention framework works as part of an evidence-based approach to monitoring performance and managing risk across the NHS?
The support and intervention framework is one of the key elements of our evidence-based approach to monitoring performance and managing risk across the NHS. It is important to recognise that territorial health boards are separate legal entities that have their own governance and performance management responsibilities. The Government’s role is to maintain an overview and hold boards to account for the significant public investment that is made in them.
We have to get the balance right in providing appropriate support and scrutiny. The framework has five stages in its ladder of escalation, which provides a model for appropriate support and intervention by the Government. Where it is required, as is the case in this instance and other instances of formal escalation, a detailed improvement plan is produced by the relevant territorial board, and a tailored support package is agreed to underpin that improvement plan, with progress against that overseen by Government. The framework is overseen by the national planning and performance oversight group, which is a sub-group of the Government’s health and social care management board.
Will the minister answer the question that he deftly failed to answer from Tess White? What, specifically, will the trigger point be to escalate this failing health board to stage 5?
That point is kept under review. Performance against the escalation and support that are provided under stage 4 is clearly kept under review. Should we not see significant progress, stage 5 remains an intervention of choice.
That concludes the ministerial statement on NHS Grampian.