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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.

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.

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.

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.

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.

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.

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.

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.

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.

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.