Cover-ups and a "culture of fear and blame" are putting patient safety at risk in NHS Grampian, according to leading healthcare professionals.

Scotland's patient safety commissioner and the previous chairman of BMA Scotland made the remarks in the wake of a damning report about senior leadership failings in the health board.

The report revealed that a failure to learn from mistakes had caused "repeated and unavoidable harm" to patients, and that one hospital continued to operate on children despite an order to halt all paediatric surgery.

Health Secretary Angela Constance insisted that patients were safe. She said she would demand "full transparency" at every level.

NHS Grampian chief executive Laura Skaife-Knight said the board accepted the findings and apologised to patients.

Constance, who is visiting the health board, said quick action had resulted in a change of medical leadership - including a new medical director who will start on Monday and more than a 50% turnover in the NHS Grampian board.

The report, published on Thursday, identified systemic issues and recurring weaknesses across the health board, including at Dr Gray's Hospital and Aberdeen Royal Infirmary. Issues ranged from patient safety to a lack of workforce planning.

Skaife-Knight, who commissioned the review, was appointed as chief executive in June 2025 and started the role in September. Her title is mentioned in the review.

Other people who were in leadership positions at the time of the investigation include Dr Adam Coldwells, who acted as interim boss between November 2023 and September 2025; Paul Bachoo, acute medical director; Dr June Brown, executive nurse director from November 2020 until September 2026; Dr Hugh Farrow Bishop, executive medical director.

It is understood Bachoo and Bishop are no longer in the roles.

Prof John Connaghan was appointed interim chairman in October.

Speaking to the BBC's Radio Scotland Breakfast programme, patient safety commissioner Karen Titchener said "the warnings were there" - that trainee doctors and staff spoke up about problems which were not actioned by the leadership team.

"They actually told the boards that everything was ok, and the boards just accepted that," she said.

"When people at the top can't trust what they're being told that's a real patient safety risk."

Titchener said the report was a "deep dive" into the culture at NHS Grampian, and had exposed "the goings on of leadership covering up things that were going on".

A change in the people at the top was just the start, she said, adding that the health board did not have time to "mess about and take a two-year plan" to address problems.

She said more money for the health board was not the answer because "this is a deep-bedded cultural problem in leadership, defensiveness, in covering up when harm has happened".

Dr Iain Kennedy, the previous BMA Scotland chairman and a GP in the Highlands, shared scepticism towards new strategies, saying "culture eats strategy for breakfast".

"That's the fundamental problem," he said. "We have a culture of fear and blame in the NHS in Scotland and we need to move to a culture that is positive, a learning culture, a supportive culture, so that doctors, other health care staff can speak freely – so that we can get a health service that is safe and is a health service that can deliver the needs for the population of Scotland."

Kennedy said the problems in Grampian had echoed the problems seen in NHS Highland.

Recently the Scottish Public Services Ombudsman upheld two whistleblowing complaints about patient safety concerns in Highland's vascular service.

The GP cautioned against cost-cutting measures and raised concerns that the Scottish government's plans to reduce the number of health boards could result in the "diminution of clinical services in the north of Scotland".

A parent from Elgin has told BBC Scotland News she was "horrified" to learn that her daughter could have been operated on at Dr Gray's Hospital after NHS Grampian had been told to suspend paediatric surgery there.

The woman, who wants to remain anonymous, took her daughter to the hospital in June with suspected appendicitis.

The teenager was admitted to a children's hospital ward, before doctors decided against surgery, and she was sent home.

Her mother said: "There were young people there having surgery and there was no mention that this shouldn't be happening."

Upon hearing the news about the HIS report, the woman said: "It makes me feel sick, that's my child."

She added that there were serious questions for NHS Grampian and the Scottish government.

"They give the impression they are scrabbling around in the dark and have no idea what they are doing," she said.

"I feel the Scottish government is just sleeping at the wheel, instead of grabbing this with both hands and showing good leadership."

Health Secretary Angela Constance told the BBC that while the report findings were "extremely serious", patients should not be reluctant to seek NHS services in the region.

She said all options - including escalating the health board to Stage 5 in the government's intervention framework - remained "on the table".

"I will be demanding full transparency at every level within NHS Grampian," she said.

"And I've been very clear with the chief executive and the new chair that if there are further changes that are required in terms of leadership, that my expectation would be of any board to make the necessary changes because we have to rebuild patient trust and the trust of the community."

Constance will set out a full range of actions in a statement to parliament on Tuesday.