NHS Chairs Meeting: July 2025

Attendees and apologies

NHS boards – Chairs

• Lesley Bowie, NHS Ayrshire and Arran
• Karen Hamilto, NHS Borders
• Alistair Morris, NHS Fife, Vice Chair (on behalf of Patricia Kilpatrick)
• Allan Rennie, NHS Forth Valley, Vice Chair (on behalf of Neena Mehal)
• Alison Evis, NHS Grampian
• Lesley Thomso, NHS Greater Glasgow and Clyde
• Sarah Compton-Bishop, NHS Highland
• Martin Hi, NHS Lanarkshire
• John Connaghan, NHS Lothian
• Meghan McEwen, NHS Orkney
• Gary Robinson, NHS Shetland
• Carole Wilkinson, NHS Tayside (Interim) Chair of Chairs
• Gillian McCannon, NHS Western Isles
• Susan Douglas-Scott, NHS Golden Jubilee
• Evelyn McPhail, Healthcare Improvement Scotland
• Martin Cheyne, NHS 24
• Irene Oldfather, Scottish Ambulance Service, Vice Chair (on behalf of Tom Steele)
• David Garbut, NHS Education for Scotland
• Keith Redpath, NHS National Services Scotland
• Angiolina Foster, Public Health Scotland
• Brian Moore, The State Hospitals Board for Scotland
• Suzanne Dawson, Scottish Health Council

Scottish Government

• Neil Gray, Cabinet Secretary for NHS Health and Social Care
• Tom Arthur, Minister for Social Care and Mental Wellbeing
• Caroline Lamb, DG HSC/CE NHS Scotland
• Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Jane Hamilton, Deputy Director for HWF Culture Pay and Partnership (on behalf of Gillian Russell)
• Fiona Hogg, Chief People Officer
• John Harden, Deputy National Clinical Director
• Stephen Gallagher, Director of Mental Health (on behalf of DG)
• Richard Foggo, Co-Director of Population Health
• Gregor Smith, Chief Medical Officer
• Tim Mcdonnell, Director of Primary Care
• Jason Birch, Deputy Director Chief Nursing Officer (on behalf of Anne Armstrong)
• Alison Strath, Chief Pharmaceutical Officer
• Angie Wood, Co-Director, Social Care and NCS Development
• Aislinn Ni Ghrainne, Strategic Briefing and Insights Unit Head
• Robert Kirkwood, OCENHS Team

Other attendees

• Nicholas Thompson, Senior Health Planning Manager (for item on Single Authority Models)
• Jennie Marshall, Head of Planning Development and Business Support (for item on Single Authority Models)
• Derek Grieve, Head of Social Care Response (for OIP item)

Aspiring Chairs

• Colin Grieve, Aspiring Chairs, NHS Fife
• Maria McGill, Aspiring Chairs, NSS

Secretariat

• Kat Dobell, Board Governance and Appointments Team
• Carol Hunter, Board Governance and Appointments Team
• Claire Gilroy, Programme Director - NSS Executive Support

Apologies

• Marsali Caig, NHS Dumfries and Galloway – no deputy available
• Patricia Kilpatrick, NHS Fife (Alistair Morris attending)
• Neena Mahal, NHS Forth Valley (Allan Rennie attending)
• Tom Steele, Scottish Ambulance Service (Irene Oldfather attending)
• Maree Todd, Minister for Drugs and Alcohol Policy and Sport
• Jenni Minto, Minister for Public Health and Women's Health
• Christine McLaughlin, NHS Scotland Chief Operating Officer (Angie Wood covering)
• Gillian Russell, Director of Health Workforce (Jane Hamilton attending)
• Stephen Gallagher, Director of Mental Health 
• Donna Bell, Director of Social Care and NCS Development
• Anne Armstrong, Deputy Chief Nursing Officer (Jason Birch attending)
• Fiona Bennett, Chief Finance Officer Health and Social Care
• Andrew Watson, Director for Children and Families

Items and actions

Welcome, apologies for absence and attendees

Neil Gray, Cabinet Secretary for NHS Health and Social Care welcomed colleagues to the meeting. He expressed a warm welcome to aspiring chair colleagues, and also extended a welcome to Tom Arthur who was attending his first NHS Chairs meeting as Minister for Social Care and Mental Wellbeing.

The Cabinet Secretary noted that this was the last meeting for Angiolina Foster as Chair of Public Health Scotland (PHS). He thanked her for her leadership and contribution to this forum and wished her well for the future.

Apologies were noted, and a full list is provided at annex a.

Minutes and actions from the previous meeting

The minutes from the previous meeting held on 14 May 2025 were approved and it was noted there were no overdue actions.

Matters arising

There were no matters arising from the previous meeting.

Cabinet Secretary’s remarks 

Including an update on single authority models (NHSC/25/11)

The Cabinet Secretary noted that he and Mr McKee, Minister for Public Finance, met with colleagues from Argyll and Bute, Orkney and The Western Isles yesterday to discuss ongoing work on singular authority models (SAMs). SAMs represent an opportunity for significant reform to help bring local authorities and health boards closer together and to local communities, improve outcomes and help the shift to a focus on prevention.

The Cabinet Secretary recognised the interest from Chairs and assured the group that there is opportunity to learn from this exercise and ensure ongoing input as appropriate.  The Cabinet Secretary outlined that SAMs is part of the local governance review with COSLA, with the programme for government (PfG) committing to publishing preferred models for each of the three geographies, with at least one area transitioning to shadow arrangements. SAMs feature in the recently published public service reform strategy, service renewal framework (SRF) and population health framework (PHF). Discussions have been led locally and have recognised that involving a wider set of functions such as transport, housing and skills could further develop proposed models.

The Cabinet Secretary invited Paula Speirs, Deputy Chief Operating Officer – Health Planning to give more detail on the work of the SAMs. Paula confirmed that Chairs had been provided the background paper and additional parameters guidance which was signed off by the Cabinet Secretary and Mr McKee on Monday 21 July 2025. The parameters guidance was requested by local partners and sets out what is possible within existing legal and financial frameworks. This supports the locally led policy development while ensuring service quality and accountability will be maintained. It was noted if legislative change is required, it would be looked at as part of the evaluation.

Three different models are being developed across the localities to take into account the different needs and opportunities in these areas. This is to ensure that local models are designed around what would best improve outcomes in these localities. Draft models are currently being developed with drafts to be agreed in September 2025, with more detailed models by December 2025. 

The Cabinet Secretary invited reflections from the NHS Chairs group. Carole Wilkinson, NHS Tayside (Interim) Chair of Chairs advised that the Chairs welcomed the clarification provided through this discussion on the single authority model and requested Chairs continue to receive updates and feedback from meetings with Mr McKee on SAMs. Chairs also offered to be more involved in this space and were clear about how they could strategically add value to shape SAMs.

The NHS Chairs group met recently to discuss how the concept was likely to be applied and to share their ambition around the benefits of a single authority model. Chairs wanted a sense of the eventual vision around expectations and were mindful about the timelines set. Timelines were thought to be tight in particular to enable public engagement or consultation. Chairs offered their support to those actively taking this forward, and the need for agile governance to support the required pace of reform work was also highlighted. Chairs acknowledge that although initially discussed with Island and rural boards, the concept has a much wider relevance. Colleagues highlighted the importance of workforce needs to support models and ensuring general practice involvement to support population based approach. The Cabinet Secretary assured Chairs there would be opportunity to continue discussions on SAMs, noting the offer of Chairs to be further involved.

Before moving to substantive items the Cabinet Secretary impressed on Chairs the importance of boards to deliver against key priorities. Noting that while planned care is showing some progress there needs to be a continued drive to increase capacity to reduce waiting times and optimise delivery. A key enabler of this is the impact unscheduled care has on planned care capacity. unscheduled care requires boards’ attention and a grip on performance in local areas. The Cabinet Secretary challenged Chairs to work within their local systems to look at all possible opportunities to improve performance in unscheduled care.

The Cabinet Secretary spoke of the importance for boards to adopt innovation and the role of digital innovation in supporting reform and sustainability of services. Highlighting the range of work across boards and the clear need to ensure this operates on a ‘once for Scotland’ basis. Innovations coming through should be implemented as quickly as possible ensuring staff are adequately supported to deliver these.

Update from Chairs

Carole reported that the group last met on 23 June 2025 for a joint session with NHS Chief Executives and Scottish Government colleagues. This session was focused on collaborative leadership and discussion on the recent frameworks and reform publications. For Chairs, the emphasis was on leadership and influencing and ensuring boards were prepared for the challenges ahead. An action plan is being created for the Chairs and Chief Executives to clearly outline some key actions to support reform.

Gillian Russell, Director of Health Workforce, had provided an update on plans for NHS delivery. Carole and Caroline Hiscox, NHS Lothian and Chair of Chief Executives Group, met with SG colleagues yesterday to discuss next steps and how Chairs and Chief Executives could be part of the development of the programme.

The Cabinet Secretary acknowledged that any reform and change comes with uncertainty. He reflected that he has received positive feedback from people working within NHS Education for Scotland (NES) and NHS National Services Scotland (NSS) around the way the changes have been communicated and the way staff are being involved. He expressed his gratitude to both organisations for bringing staff with them and ensuring strong positive leadership. It was also acknowledge that the collaborative working relationship between NHS24 and the Ambulance Service (SAS) has provided some good opportunities and showed an example of well supported change.

The Cabinet Secretary recognised that this was Carole Wilkinson’s and Alison Evison’s, NHS Grampian last meeting as Chair and Vice Chair of Chairs Group, respectively. He passed on his thanks and appreciation for their leadership of the group and noted work was underway for the transition to a new Chair and Vice Chair.

Operational improvement plan (NHSC/25/12)

The Cabinet Secretary introduced this item, reiterating extensive work had been undertaken on planned care and the need for visible improvements in unscheduled care. While acknowledging the challenges and pressures, he asked Chairs to ensure that the health service was in the best possible position around hospital occupancy, delayed discharged and the 4 hour standard. He invited Derek Grieve, Programme Lead Operational Improvement Plan to provide a more detailed update on progress.

Derek presented slides on OIP and system performance. The main elements included:

• a RAG system showing the status of actions from the OIP
• changes to OIP Governance and Reporting
• planned Care, waiting times statistics and programme
• cancer performance, actions and improvement opportunities
• urgent and Unscheduled Care performance, actions and available support
• delayed Discharge statistics, actions and support

Derek highlighted the governance structure of the OIP programme and how colleagues were regularly reporting against key elements. Chairs were offered the option to receive more regular updates if required, national performance metrics are currently shared to NHS Chairs before each meeting. The data highlighted the need for further improvement in cancer performance on the 62 day standard and in unscheduled care in particular long delays and the 4 hour standard and decreasing delayed discharge numbers. Derek encouraged colleagues to focus on OIP delivery to address these issues and if there are additional barriers to contact SG for support.

The Cabinet Secretary recognised the challenges across the system highlighting delayed discharge and the need for system wide collaboration with partners to address this. Colleagues were challenged to raise issues with partnerships. He encouraged territorial boards to come together on a regional basis to work more collaboratively, particularly in the planned care aspects to see improvement for everyone, patients and staff.

John Connaghan, NHS Lothian provided a composite national overview on behalf of Chairs addressing the asks of the OIP. John gave assurances that the OIP is embedded across boards and included at subcommittee and board level for scrutiny. He assured that this is being reflected in core corporate objectives with alignment to Chief Executive objectives including delivery, innovation and transformation. The improvement trajectories were currently being signed off by boards and the funds from the Scottish Government were being deployed to build capacity for sustainable delivery. It was noted that some boards had been able to repurpose funds from their 25-26 allocations to supplement the funding going into tackling the OIP.

John noted that there may be a requirement for further support from the national elective coordination unit (NECU) and flagged the need for permanent staffing to deliver improvements.  Boards recognise the need for a broad whole system approach and work was being done to free up capacity. He assured colleagues that boards were also embedding the CfSD improvement programmes to drive productivity. Patient initiated review, active clinical referral triage, adoption of digital pathways and, in particular, digital dermatology have been part of this response. Infix (theatre utilisation scheduling system) would be fully rolled out soon and is expected to increase capacity in theatres. Whole system work had been adopted to build community resilience and capacity, including supporting hospital at home service, moving patients across boundaries, glaucoma training, supporting pharmacy first and frailty teams.

The Cabinet Secretary thanked John for his response on behalf of NHS Chairs recognising the importance of having the correct assurance processes on progress against the OIP. He appreciated the comprehensive update from colleagues and reiterated for Chairs to raise concerns with Christine McLaughlin, Chief Operating Officer for NHS Scotland and Derek Grieve.

Board governance (NHSC/25/13)

The Cabinet Secretary introduced this item inviting colleagues to provide assurances that their governance arrangements are pivoting to ensure a population health focus and for Chairs to share learning across systems. The blueprint for good governance states it is the responsibility of Chairs to keep the governance arrangements and Boards effectiveness under review and give leadership to the boards. Planning for population progress was also Chairs’ responsibility, ensuring the processes and assurances were in place to support delivery.

Carole stated that boards had learnt a lot regarding adjusting and flexing governance arrangements through COVID to ensure boards were fully engaged and kept pace with change. Colleagues were also working closely with IJBs to ensure there are clear expectations on the implications of population planning. The public service reform paper acknowledged the importance of planning partnerships for reform and colleagues were thoughtful that not all of these partnerships are as far forward with this agenda as they could be. Colleagues challenged if national messaging to these partnerships may add value. The group added that an action needed to be considered, within a revised blueprint on the role of boards within the broader context of public service reform.

The Cabinet Secretary noted that when addressing the financial challenge facing boards previously savings were found in the prevention or population health space. It is clear that this needs to be prioritised and protected. Boards have responsibility to align their population health priorities through their community planning partnerships and IJBs to protect that preventative activity in order to have improvement, prevention and long term sustainability.

NHS Shetland have taken a community planning approach to public health, introducing the Director for Public Health into the community planning partnerships management and leadership meetings which has been positively received. The Cabinet Secretary recognised that there were critical roles needed in planning meetings and challenged Boards to ensure the right people are in these to ensure the best outcomes for staff and patients.

It was noted that further work is also needed in this space regarding health inequalities and driving improvements for communities of deprivation. The overarching goal in the population health framework was welcome but specific health inequalities targets need to be embedded to push forward change required. There were formal partnerships with CPPs and Grampian, Lanarkshire and Ayrshire and Arran Health Boards and Michael Marmot’s Institute for Health Equity. This has given local intelligence around shared accountability and learning will be shared nationally to further this work.

The Cabinet Secretary recognised the work with the Marmot Institute and how learning could be shared to positively influence across Scotland. He underlined the point that the First Minister has made about ensuring a whole family approach across government and that a collaborative, whole system approach is needed to address population health.

Any other business

There was no other business raised.

Date and time of next meeting

The next NHS Chairs meeting will take place on 10 September 2025.