Health board bosses at NHS Grampian have been compelled to apologize following a critical report by Healthcare Improvement Scotland (HIS) that highlighted significant failings in leadership and raised serious concerns about patient safety. The watchdog found that the board had not learned from previous errors.
Despite an order to halt pediatric surgery at Dr. Gray's Hospital in Elgin, the report states that the board continued to operate on children. Furthermore, an investigation into the death of a patient on the operating table was mishandled, an error the HIS report characterized as an "unjustifiable failure of governance" and a missed opportunity to enhance patient safety.
The report detailed "serious weaknesses in all aspects of leadership and management of the medical workforce" across NHS Grampian's acute sector. Laura Skaife-Knight, the board's chief executive, accepted the findings and pledged to address the identified problems, stating, "As a board we own and accept the findings, we apologize to our patients, families and communities for letting them down and we commit to putting things right."
HIS issued six recommendations for urgent changes. First Minister John Swinney described the report as "appalling reading" and expressed expectations for "dramatic changes" to rectify the issues. He noted that the directive to end specific surgeries for children at Dr. Gray's Hospital was not followed by NHS Grampian, which he deemed "reprehensible." While he understood there were "no negative consequences" for patients due to the delay, he emphasized the unacceptability of not implementing patient safety measures as intended.
NHS Grampian had suspended emergency pediatric surgery in June of the current year due to safety concerns, followed by the suspension of elective surgery the next month. However, the report found that senior management only discovered in August 2026 that the suspension had not been fully implemented and took steps to ensure consistent application. While no further harm to individual patients was evident from this delay, the HIS stated that the "inability to implement a patient safety measure as intended is itself concerning."
The report also scrutinized a Significant Adverse Event Review (SAER) conducted after a patient died from an operative complication. HIS found that the review "contained a major omission by not meaningfully examining the actions, clinical decision-making, operative techniques or judgments of the operating surgeons involved." The watchdog concluded this omission was a "notable, concerning and unjustifiable failure of governance and a missed opportunity to improve patient safety."
Scottish Labour leader Michael Marra commented on a perceived "cultural problem across the NHS of ministers and managers letting down patients, staff, and their families," suggesting managers at health boards often act with impunity and prioritize managing headlines over patient care.
Alexander Burnett, Scottish Conservative MSP, expressed dismay that "repeated failures within NHS Grampian have caused unnecessary harm to patients."
Health Secretary Angela Constance stated she expects "decisive and urgent action" from the health board, acknowledging the findings are "extremely serious and will be deeply concerning for patients, families, local communities and staff across Grampian." She described the report's findings as identifying "significant failings in leadership, governance, accountability and organisational culture" and stressed that this must be a "turning point for NHS Grampian."
Ms. Skaife-Knight, who commissioned the review, mentioned "some immediate changes to medical leadership" and stated the board's focus is now on responding quickly to the feedback and implementing necessary improvements. She took over as chief executive in September 2025. Other leaders in position during the investigation included Dr. Adam Coldwells (interim boss), Paul Bachoo (acute medical director), Dr. June Brown (executive nurse director), and Dr. Hugh Bishop (executive medical director). It is understood that Mr. Bachoo and Dr. Bishop are no longer in their roles.