NHS Grampian has ended a board-level "critical incident" declaration that was activated at emergency departments across Aberdeen and Elgin following a weekend of severe operational strain. The status, which was implemented on Saturday night, has now been stood down for both Aberdeen Royal Infirmary (ARI) and Dr Gray's Hospital, though a hospital-level critical incident remains in place at the Elgin facility.
The declaration came as both emergency departments faced what the health board described as "extreme pressure" on their services. According to reporting on the situation, the pressure was linked to the local public holiday on Monday 28 September, with NHS Grampian saying teams were facing a particularly challenging weekend because of hospital capacity and community care pressures. A small number of patients were transferred to Raigmore Hospital in Inverness from Dr Gray's late on Saturday, with NHS Highland providing support to the neighbouring health board.
This marks the first critical incident declared by NHS Grampian since December 2024. The Scottish government defines such a status as any localised disruption which results in a board "losing its ability to deliver critical services, or, where patients and staff may be at risk of harm". The last critical incident declared anywhere in Scotland was due to an IT fault at NHS Highland in June 2025.
What caused the weekend crisis?
The primary driver of the incident was a breakdown in patient flow across the health and social care system. Alex Stephen, who took over as NHS Grampian executive director on call, explained that the situation developed when Dr Gray's ran out of capacity to safely admit patients. He stated:
"The key area of pressure over the weekend came when Dr Gray's no longer had capacity to safely admit patients, compounded by staffing shortages, ambulance delays, lack of community capacity and increasing pressure at ARI."
According to NHS Grampian's account of the incident, the board was working with the Scottish Ambulance Service, NHS Tayside and NHS Highland to manage the crisis, with diversions of ambulances to be used only where absolutely necessary. However, by Sunday no ambulances had needed to be diverted, indicating that the situation had begun to stabilise.
How has the situation improved?
Hospital capacity at Aberdeen Royal Infirmary has improved since the weekend, allowing NHS Grampian to stand down the board-level incident. The health board said that while pressures across the health and social care system continued, both ARI and Dr Gray's were better positioned to support care. Stephen outlined the ongoing strategy for managing Dr Gray's:
"Retaining an incident management team approach for Dr Gray's will enable us to continue to focus on breaking the cycle of high bed occupancy at the hospital, including case-by-base reviews of all patients who are delayed in hospital and who are awaiting care in the community."
What support was provided to patients?
Stephen acknowledged the disruption caused to patients and the community during the crisis. He said:
"We are hugely grateful to colleagues across our local and regional health and social care system for being there to support us during a particularly challenging weekend."He also apologised to anyone whose care had taken "longer than we would like this weekend or who had to travel further to access hospital care". The board emphasised that despite the pressures, teams across the health and social care system continued to deliver excellent care throughout the incident.
What happens next?
NHS Grampian said it would stand down the hospital-level critical incident at Dr Gray's as soon as it was safe and practical to do so, though no fixed date has been given for this transition. The board will continue to use an incident management team approach at Dr Gray's to address the underlying issues of high bed occupancy and delayed discharges, working to break the cycle that contributed to the weekend crisis.
Stephen stressed that while teams remained stretched, the health board appreciated the support from across the local and regional system and remained committed to delivering safe, effective care to the population it serves.
