NHS Chairs Meeting: September 2025

Attendees and apologies

NHS Boards – Chairs

• Leslie Bowie, NHS Ayrshire and Arran
• Karen Hamilton, NHS Borders
• Patricia Kilpatrick, NHS Fife
• Neena Mahal, NHS Forth Valley
• Mark Cook, NHS Dumfries and Galloway
• Alison Evison, NHS Grampian
• Lesley Thomson, NHS Greater Glasgow and Clyde
• Sarah Compton-Bishop, NHS Highland
• Martin Hill, NHS Lanarkshire
• John Connaghan, NHS Lothian
• Joanna Kenny, NHS Orkney, (Vice Chair)
• Natasha Cornick, NHS Shetland (Vice Chair)
• Carole Wilkinson, NHS Tayside (Interim)
• Gillian McCannon, NHS Western Isles
• Susan Douglas-Scott, NHS Golden Jubilee
• Evelyn McPhail, Healthcare Improvement Scotland
• Tom Steele, Scottish Ambulance Service
• David Garbutt, NHS Education for Scotland
• Keith Redpath, NHS National Services Scotland
• Ann McKechin, Public Health Scotland, (Vice Chair)
• Brian Moore, The State Hospitals Board for Scotland

Scottish Government

• Christine McLaughlin, NHS Scotland Chief Operating Officer
• Paula Speirs, Deputy Chief Operating Officer - Planning and Sponsorship
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Fiona Bennett, Interim Deputy Director NHS Scotland Finance
• 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
• Mark Richards, Associate Chief Nursing Officer for Mental Health (attending for Deputy Chief Nursing Officer)
• Alison Strath, Chief Pharmaceutical Officer
• Aislinn Ni Ghrainne, Head of NHS Scotland Communications
• Robert Kirkwood, OCENHS Team

Other Attendees

• Daniel MacDonald, Head of NHS Pay (Reduced Working Week Item
• Jennie Marshall, Head of Planning Development and Business Support, SAMS (for item on Single Authority Models)
• Allan Stewart, Policy Officer, SAMS (for item on Single Authority Models)
• Brian Logan, Place Based Services and Reform, SAMS (for item on Single Authority Models)
• Derek Grieve, Head of Social Care Response (for OIP item)

Aspiring Chairs

• Nigel Henderson, Aspiring Chairs
• Madeleine Smith, Aspiring Chairs

Secretariat

• Kat Dobell, Board Governance and Appointments Team
• Dom Ellice- Freeman, Board Governance and Appointments Team

Apologies

NHS

• David Campbell, NHS Orkney
• Ally Boyle, Public Health Scotland
• Martin Cheyne, NHS 24
• Gary Robinson, NHS Shetland 
• Suzanne Dawson, Scottish Health Council
• Claire Gilroy, Executive Support to NHS Board Chairs and Chairs

Scottish Government

• Maree Todd, Minister for Drugs and Alcohol Policy and Sport
• Tom Arthur, Minister for Social Care and Mental Wellbeing
• Jenni Minto, Minister for Public Health and Women's Health
• Caroline Lamb, DG HSC/CE NHS Scotland
• Gillian Russell, Director of Health Workforce
• Fiona Hogg, Chief People Officer
• Donna Bell, Director of Social Care and NCS Development
• Angie Wood, Interim Director, Social Care Resilience and Improvement
• Anne Armstrong, Deputy Chief Nursing Officer
• Tim Mcdonnell, Director of Primary 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 deputies attending on behalf of chair colleagues.

The Cabinet Secretary noted a range of changes to the chair cohort including;

• Mark Cook Chair of Dumfries and Galloway as of 01 August 2025
• Ally Boyle Chair of Public Health Scotland as of 01 September 2025
• Davie Campbell interim Chair of NHS Orkney as of 01 September 2025
• Neena Mahal as substantive Chair of NHS Forth Valley as of 01 October 2025

The Cabinet Secretary also noted that this is the first meeting of John Connaghan and Lesley Thomson as the Chair and Vice Chair of Chairs and welcomed them in this capacity. Reiterating thanks to Carole Wilkinson and Alison Evison for their tenure and the support provided in these roles.

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

Minutes, actions and matters arising from the previous meeting

The minutes from the previous meeting held on 23 July 2025 were approved and it was noted there were no overdue actions.

There were no matters arising.

Cabinet Secretary’s remarks - reform

The Cabinet Secretary emphasised the continued focus on reform and renewal. Stating that since the introduction of the population health framework (PHF) and service renewal framework (SRF), the strategic landscape is framed by the population health agenda. Clearly demonstrating the need for change to shift from an illness-based system to a wellness-focused model which will in turn help to address inequalities and reduce pressures on the acute system.

The Cabinet Secretary recognised the progress being made, in particular in relation to the operational improvement plan (OIP) and planned care but needing the same response on unscheduled care. It was reiterated the need for services to be responsive to evolving community needs and take steps to improve now before the added impact of winter. Chairs were reminded of their role in learning and informing future approaches. Ensuring the right people are involved in discussions on reform, including staff, patients and the formal arrangements with COSLA and integration authorities. The Cabinet Secretary reiterated the importance of Chairs to provide leadership to their non-executives actively taking part in integration authorities to ensure alignment with national and local imperatives.

The Cabinet Secretary invited reflections from the NHS Chairs group on the progress against the OIP, SRF and PHF recognising aspects of this would be covered later in the agenda. Colleagues discussed and reflected;

• there is a shared understanding of the need for sustainability and targeted efforts. Despite competing priorities, the focus remains on patient and community outcomes. Systems must adapt to demographic and societal changes, with a shared responsibility across sectors
•  engagement with trade unions and employee directors is essential to support service renewal and manage conflict. Staff must be empowered and involved in shaping change, not simply recipients of it
• it was noted that there is optimism about the coherence of reform efforts, drawing on principles from public service reform and the christie commission. The necessity for change is widely recognised, with alignment across government, boards, and executive teams
• valid data was recognised as essential for reform, particularly in digital transformation and clinical decision-making. Noting that marmot principles and upstream interventions are guiding the direction of travel and that further work is being done to ensure GP practices have the right data to demonstrate impact and inform funding decisions
• the engagement and communications around reform was discussed recognising that a coordinated approach to public engagement is needed, with Chairs influencing local messaging and national messaging required to be translated into local action

Update from Chairs

The Cabinet Secretary invited John Connaghan and Lesley Thomson to provide an update from the NHS Chairs Group. John recognised the contribution of Carole Wilkinson and Alison Evison as the previous Chair and Vice Chair of Chairs before asking Lesley to provide the update from recent Chairs meetings.

Lesley Thomson updated that the Chairs meeting included items on;

• cyber security, with assurance that collaborative efforts will not compromise threat management. Emphasis was placed on cross-organisational sharing and resilience, particularly in light of recent challenges
• updates were provided on financial matters and the safe delivery of care programme led by Healthcare Improvement Scotland (HIS), reinforcing the importance of continued efforts to strengthen service delivery and realise savings
• discussions on how Chairs support key priorities was covered as a discussion on the Chairs portfolio areas ensuring alignment with Scottish Government products to enhance future support and delivery
• the upcoming Chairs development day in late September will centre on leadership and collaboration, supporting strategic alignment and shared learning

The Cabinet Secretary thanked colleagues for their positive energy and commitment to the national agenda, reiterating the importance of fostering positivity throughout the reform process with particular emphasis on staff engagement and working closely with employee directors. The importance of cyber security was noted with the Cabinet Secretary having recently visited the national centre in Dundee. This highlighted the need for daily vigilance and assurance that Boards are resilient and prepared in the face of cyber threats.

Colleagues raised issues regarding delays in the public appointment process and ensuring boards are quorate. The Cabinet Secretary agreed to take an action to ensure progress is made. It was noted that the Supreme Court decision had impacted and delayed appointments across the public sector and that appointment processes were now being restarted.

Action: Cabinet Secretary to receive assurances from the public appointments team on appointments and the impact of the Supreme Court ruling.

Reduced working week

The Cabinet Secretary introduced this item, stating that he requested this discussion to get assurance from Chairs that this is a focus for boards. The reduced working week (RWW) commitment was agreed in previous pay negotiations and boards must have this fully implemented by 01 April 2026.

Colleagues provided assurance that it is clear to boards that April implementation is non-negotiable and it was suggested that this item should return to the December meeting for further discussion once the initial October pans are considered. It was noted that there needs to be an exploration on how technology, skills exchanges, innovation and sharing best practice could support this change.

Colleagues recognised the challenges financially for bbut also the potential workforce benefits and challenges regarding recruitment and retention. Noting the importance of balancing delivery needs alongside workforce impact.

Action: reduced working week to come to the December Chairs meeting for further discussion and sharing learning following boards submitting their implementation plans.

Operational improvement plan

The Cabinet Secretary introduced this item, stating that OIP is showing progress in several areas, particularly in planned and scheduled care, with regional collaboration through hubs and national treatment centres (NTCs). While not yet on a trajectory to zero for long waits, there is evidence of list reduction. However, unscheduled care requires similar rigour and focus to achieve meaningful improvement.

Christine McLaughlin, Chief Operating Officer and Derek Grieve, Programme Lead Operational Improvement Plan were invited to provide a more detailed update on progress. Christine McLaughlin noted that boards are demonstrating incremental progress, with some showing strong performance in areas like flow navigation and frailty pathways. There is a growing sense of confidence and momentum, but further work is required. Data and understanding of flow are key to understand occupancy and provide clarity on what is required for sustained change.

Derek Grieve provided colleagues with an overview of performance against the OIP and specific metrics on planned care, unscheduled care including delayed discharge and cancer waits. It was reiterated that boards are expected to deliver against the commitments in the OIP and that a programme board and governance structure has been set up to support clearer goals and accountability.

Colleagues were invited to reflect on their collective and individual board performance the following was noted;

• unscheduled care and flow remains a major issue, with ambulance stacking, non-clinical treatment spaces, and delayed discharge impacting performance. Budgetary pressures are affecting care packages and social work support, increasing costs to acute services. Leadership from integration joint boards (IJBs) is needed to understand and manage total system costs. Winter pressures are expected to exacerbate these challenges, requiring pre-emptive capacity creation
• monthly statistics for cancer show continued challenges with the 62-day standard, while the 31-day standard is largely being met. Diagnostic capacity is a key factor influencing cancer performance. There have been some positive stories that should be shared at local level about the quality and speed of cancer treatment
• positive developments in ambulance service innovation and workforce expansion. Across the sector however recruitment challenges persist, particularly in social care
• NHS England has models of care that promote evidence based models to deliver different across different care systems. Colleagues questioned whether a once for Scotland model of care could be published to clearly demonstrate best practice to clinical and communities to help shift the balance of care

The Cabinet Secretary recognised the challenges across the system but also wanted to thank colleagues for the work undertaken so care. The data on performance has been showing continued improvement and it is important to recognise that while still looking at greater opportunities for efficiency and productivity. While the statistics are tell an important story it is the personal stories of patients and staff that remind us why this is so important.

ACTION: CfSD to consider what a once for Scotland model of care could be to support decision making at boards with clinical and community input.

Single authority models

The Cabinet Secretary introduced this item acknowledging that at the last Chairs in July there was significant discussion on the single authority model (SAMs). Recognising that as SAMs evolve, NHS Board Chairs have a key leadership role in shaping their development and assessing implications for wider system reform.

Paula Speirs, Deputy Chief Operating Officer Planning and Sponsorship and Sarah Compton-Bishop, Chair NHS Highland were invited to provide updates from the Scottish Government and Chairs group on progress and risks.

Paula Speirs contextualised the progress outlining that each area is currently developing governance options aimed at strengthening decision-making processes, co-designed with local authorities. These developments are at varying stages, reflecting local contexts and pressures. It was reiterated that the government is not mandating a single approach but encouraging local areas to shape models that align with NHS priorities, population health needs, workforce considerations, and other relevant factors to the local areas.

A key milestone is the submission of initial governance options by the end of September. These will be reviewed against the agreed parameters, with final proposals expected in December for consideration by COSLA and Ministers. Leadership from Chairs has been instrumental in bringing this work together.

Sarah Compton-Bishop provided assurance that boards are engaged across the three area and committed to applying these changes in real-world systems. Noting that leadership and stakeholder buy-in remain critical, especially amid uncertainty. The staged approach has been beneficial in managing this complexity, however timescales are still consider as a risk.

Local areas are progressing at different speeds due to varying pressures and integration relationships. Despite this, there is a collective consensus to simplify complexities and maintain an outcomes-focused approach.

Discussion was opened up to colleagues and the following points were raised and discussed:

• representation parity across boards and integrated authorities/local partners is imperative to ensure all parties are equally informed and engaged
• the staged approach is helpful, but the pace of delivery is challenging. Timescales need to allow appropriate scrutiny at board and integration level. This has caused some challenge as pace should be balanced with appropriate scrutiny
• a compelling case must be made to justify the effort and cost of the change proposed, with a clear link to improved outcomes for people. Data and evidence should be included as much as possible. Acknowledgement that the timescales pose a challenge on this
• appetite for legislative and structural change has been discussed with Highland and Argyll and Bute
• acknowledgement of the importance of clinical governance and maintaining this in different models while enabling transformative change is a key concern

The Cabinet Secretary acknowledged that there are time pressures but was encouraged to hear that colleagues are working collaboratively to bring forward models for consideration.

Any other business

John Connaghan advised that colleagues would provide a write up and action plan to the Cabinet Secretary after the NHS Chairs away day which is scheduled for the end of September.

Date and time of next meeting

The October meeting of the NHS Chairs group was cancelled due to diary pressures of the Cabinet Secretary, it was assured that a meeting with John and Lesley would take place before the next NHS Chairs meeting on 3 December 2025 to ensure continued alignment and assurances against key priorities.