NHS Grampian faces tougher oversight rules after ‘insufficient’ cuts
A health board has been censured by the Scottish Government over its “financial deterioration”, with tougher oversight measures imposed.
However, at an NHS Grampian Board meeting on Thursday (February 6), Councillor Ian Yuill (Aberdeen City) posed the question: “Has anybody asked the Scottish Government how to get blood out of a stone?”.
The Scottish Government’s decision to escalate NHS Grampian to Stage Three of its “support and intervention framework” means the health board’s plans will now face more scrutiny.
In the letter announcing the escalation, addressed to NHS Grampian chief executive Dr Adam Coldwells, the decision was blamed on the “deterioration” of NHS Grampian’s finances.
The health board had forecasted a £77 million overspend, the letter said, which was “the highest overall deficit in NHS Scotland” and broke the £15.3 million limit.
In December, NHS Grampian agreed a cuts package of £17.5 million in response to Scottish Government criticism.
But the escalation letter said: “Whilst I appreciate the measures set out in your letter dated December 19, 2024, we have significant concerns in relation to the financial performance of NHS Grampian during 2024-25.
“However, there has been insufficient improvement in the financial position, therefore further escalation has been deemed necessary.”
Eight of Scotland’s 14 health board are also currently under Stage Three measures, with NHS Highland among them.
The letter adds that the health board’s three-year financial plan, which was due in draft form by the end of January, should feature “realistic financial recovery milestones”.
It warns: “Further escalation to Stage Four or beyond may be required without tangible improvements in the underlying financial position.”
Stage Four would see a Scottish Government-led “assurance board” put in place, whereas Stage Five would see the government take direct control of NHS Grampian.
In a report presented at Thursday’s board meeting, Dr Coldwells said that the health board continues to face an “extremely challenging financial environment”.
He also confirmed that a new delivery plan to balance NHS Grampian’s budget, due at April’s board meeting, would be the “contract” with the Scottish Government setting out what the health board must deliver.
A draft had already been submitted to government with feedback due “any day”, he added.
The meeting also heard that the forecasted overspend for 2025 to 2026 was now £140 million, described by Dr Coldwells as a “huge number”.
The chief executive also argued that NHS Grampian had to find a solution that is unprecedented “anywhere in Scotland, in the UK, even worldwide”.
“How do we, as a country, think about what really fundamentally different health and care provision looks like?,” Dr Coldwells added.
“How do we act as a pathfinder for Scotland to think about what a different model of health and care would look like?
“I don't think I've seen that described anywhere in Scotland, in the UK, even worldwide.
“But maybe - if we can get the right thinking, the right brainpower around that - we could be at the forefront of trying to describe a really different model that's still really good, absolutely delivers what people want and is of a high quality.
“But is organised in a way that enables it to be delivered at a much lower cost.
“Basically, you know, that's the real goal everyone's after.”
However, board member Joyce Duncan emphasised that NHS Grampian had to be realistic when setting out its plans.
“I'm very concerned that staff are being pressured to do things that are virtually impossible,” she said.
“There comes a certain financial level at which you cannot improve any more - and I think we must be getting very close to that.”
Cllr Yuill said the situation would be very different if NHS Grampian received a similar funding per head of population as NHS Tayside.
He added: “I did write down: ‘Has anybody asked the Scottish Government how to get blood out of a stone?’
“But that's maybe, you know, too dramatic.”
Ms Duncan also argued that NHS Grampian receives far less funding than it should.
“I am concerned that, sometimes, it's forgotten that we are the second-lowest-funded health board per head in the country,” she said.
“If we can make it work at that level, there should be some amazing things going on elsewhere.
“And if others, elsewhere, are not making it work with almost double what we get, there should be more questions asked.”
