Scotland’s watchdog finds leadership failures across NHS Grampian

Healthcare Improvement Scotland’s 12 November 2026 review found major problems at Dr Gray’s Hospital in Elgin and leadership failures across the wider NHS Grampian region, including a failure to learn from mistakes and recurring patterns of harm. The BBC said the watchdog found that an investigation into a patient’s death during surgery was inadequate and that NHS Grampian chief executive Laura Skaife-Knight subsequently gave it misleading information about the investigation.

NHS Grampian was already under additional financial oversight: the Scottish Government placed it at stage 4 of its support and intervention framework in May 2025 because of serious financial problems. The arrangement provides extra support and oversight to address financial risks.

A death investigation and misleading information

Skaife-Knight, who commissioned the watchdog review, told it that senior executives had not seen or signed off the review of the surgical death. Former executive medical director Dr Hugh Farrow Bishop had been sent that review and discussed it at a meeting, but said he had no recollection of doing so. He left his post in recent weeks.

The misleading information caused significant distress to lower-level staff, who felt management had tried to shift blame onto them. Skaife-Knight apologized earlier in 2026 to the watchdog and affected staff and took steps intended to rebuild trust.

The watchdog described its review as the most serious it had undertaken. It found weak leadership across the health board, leading to failures in recruitment, management and governance, as well as repeated failures to act on patient-safety warnings or learn from mistakes.

Government response

Constance said she retained confidence in Skaife-Knight, who she said had been candid and acknowledged her mistakes. The health secretary said almost half the board had changed, a new chair was about to take over, and she expected the board to hold senior executives accountable.

The BBC’s analysis said further escalation was inevitable. Constance has promised to update the Scottish Parliament the following week on what further action the government will take.