Explained - Why NHS Grampian has missed targets on ambulance times and cancer care
New data shows that NHS Grampian has been ranked bottom in mainland Scotland for five key measures.
Released ahead of last week’s meeting of the health board, the organisation’s own data shows it was rated the worst in mainland Scotland against several important targets.
The statistics, from a report titled How Are We Doing?, highlight problems facing the region including patients forced to wait more than two years for treatment which should be delivered within 12 weeks, ambulances left waiting outside A&E for hours, and cancer patients facing delays to crucial early treatment.
According to the report, NHS Grampian received red ratings for nearly two-thirds of key targets between October and December 2024.
In total, 55 per cent of the health board’s key measures had declined compared to the previous quarter, with just 37 per cent improving.
We looked at the numbers in detail, to find out where NHS Grampian is struggling compared to the rest of the country - and whether any signs of improvement are on the horizon.
Ambulance turnaround problem ‘severely compromises’ performance
Stories about long queues of ambulances outside A&E departments are becoming more common, with some patients having reported waits of up to 12 hours.
NHS Grampian ranked worst of all mainland Scottish health boards for ambulance delays, the report has revealed, over the three months between July and September 2024 - the latest figures available.
The meeting report shows that one-in-ten ambulance journeys faced an average turnaround time of four hours.
As a result, NHS Grampian’s number is nearly double its target figure of 2.5 hours.
Delays have also risen steadily over the nine months between April 2024 to January 2025.
In response, the health board said it was “well established” that NHS Grampian has a low number of beds for the size of its population.
However, it added that the number of people waiting in beds was “nearly always” higher than the number forced to wait in queuing ambulances.
The report also argued that the biggest problem is the number of patients who are medically ready to leave hospital but cannot - because there is nowhere suitable to send them.
As a result, the “majority of the challenge” in solving ambulance queues will lie in creating more places for people to go after hospital stays, like care homes.
When considered seperately from the scale of delayed discharges, the report said, hospital facilities are actually “sufficient to manage the level of front door demand”.
Quoting Geraldine Fraser, executive lead for medicine and unscheduled care, the report said: “The trend continues to move in the wrong direction and this is likely to be sustained over the remainder of winter as occupancy pressure increased.
“The current level of performance severely compromises our ability to improve access to uncheduled care pathways, impacting both on patient safety and, too often, patient outcomes.”
The report also indicated that ambulance delays are closely linked to the number of patients who have to wait more than four hours to be seen at A&E.
NHS Grampian was ranked the third-worst in mainland Scotland on this measure.
Cancer treatment ‘continues to compete for resources’
Cancer treatment was also an area in which NHS Grampian performed poorly.
The health board placed last out of Scotland’s 11 mainland health boards for the how many patients received cancer treatment within two months of an urgent referral.
NHS Grampian missed the 72 per cent target in all three quarters of 2024 for which data is available.
However, from a low point of just 53.9 per cent between July and September, the figure recovered to 60.3 per cent in the latest figures.
The health board said, despite cutting the backlog in “some areas”, there had been no substantial improvement.
As a result, the report added, the backlog of cancer patients awaiting diagnosis and treatment had “remained static”, meaning that “performance has only marginally improved” since the low point between April and June.
Dr Paul Bachoo is the executive lead for the integrated specialist care portfolio.
Quoted in the report, he said the number of cancer referrals had increased and were frequently competing against treatment of other serious illnesses.
“Cancer care relating to the tracked pathways continues to compete for resources with many other unscheduled or urgent high priority non-cancer pathways,” he said.
“Whilst efforts continue to reduce the high number of backlog patients, this will result in a negative impact to the cancer performance and in turn the projected Q1 target of 72 per cent is not being met.
‘Insufficient resources’ to cope with sharp increase in cancer referrals
NHS Grampian also ranked worst for how many cancer patients received treatment within a month of the decision being taken.
Against the target of 95 per cent, the health board’s performance has dropped for three quarters in a row.
Starting at 89.96 per cent between April and June, it fell to 88.4 per cent before reaching 87.3 per cent in the latest figures.
As a result, the number now stands 7.7 per cent below the target.
The report blamed the treatment delays on “competing demands”, along with the problem of delayed discharges and the shutdown of the decontamination unit.
Dr Bachoo added that cancer referrals were now “50 per cent to 60 per cent” higher than pre-pandemic levels, despite the system having to rely on “insufficient resources” to cope with demand.
During the last NHS Grampian Board meeting, he said: “Our reports have very much indicated that it is capacity, not inefficiencies, that are driving our performance.
“I'm quite confident that, towards the end of this financial year, we will start to see the change in numbers that we're all desperate for.”
Two-year delays despite 12-week ‘guarantee’
NHS Grampian, according to the data, was ranked the worst out of Scotland’s 11 mainland health boards for the number of patients forced to wait more than two years for treatment, despite being subject to the Treatment Time Guarantee.
Under the TTG, patients should receive treatment within 12 weeks of agreeing to it.
Between October and December 2024, NHS Grampian missed the target by more than 500 patients, with a total of 2070 people waiting more than two years.
This was an increase of 171 compared to the previous three months, with the gap between the health board’s performance and the target rising from 199 to 570.
A meeting report blamed this result on the “inability to re-open short stay theatres” along with issues at the Central Decontamination Unit, which sterilises surgical equipment.
‘Continuous challenge’ over outpatient appointments
NHS Grampian was also named as mainland Scotland’s worst health board for the number of two-year waits for a new outpatient appointment.
Figures show that between the total between October and December last year, at 1747, was nearly twice the target of 900.
The health board explained this performance with reference to a “continuous challenge” across different types of care, along with the scrapping of a full elective care plan due to a lack of money.
‘I must admit I was disappointed’
At the NHS Grampian board meeting, interim chief executive Adam Coldwells expressed his “frustration” and “disappointment” over the health board’s performance.
Board member Dr Mark Burrell said: “When I read this report, I must admit I was disappointed in the performance declines.
“I can't shy away from that.
“I understand that it's quarter three and quarter three is a very difficult quarter for us, it comes into the the winter pressures.
“I can't shy away from having 61 per cent of KPIs in the red.
“Sorry, departing from my normal upbeatness on this one, it did make some difficult reading for me.”
