NHS Scotland Executive Group minutes: April 2025

Attendees and apologies

NHS Board Chief Executives

• Claire Burden, NHS Ayrshire and Arran (V)
• Peter Moore, NHS Borders (V)
• Carol Potter, NHS Fife (V)
• Adam Coldwells, NHS Grampian (V)
• Jann Gardner, NHS Greater Glasgow and Clyde (V)
• Caroline Hiscox, NHS Lothian (IP)
• Laura Skaife-Knight, NHS Orkney (V)
• Nicky Connor, NHS Tayside (V)

Special Health Board Chief Executives

• Robbie Pearson, Healthcare Improvement Scotland (IP)
• Jim Miller, NHS 24 (V)
• Gordon James, NHS Golden Jubilee (IP)
• Mary Morgan, NHS National Services Scotland (IP)
• Michael Dickson, Scottish Ambulance Service (V)
• Gary Jenkins, The State Hospital for Scotland (V)

Scottish Government

• Caroline Lamb, DG HSC/CE NHS Scotland (V)
• John Burns, NHS Scotland Chief Operating Officer (IP)
• Fiona Hogg, Chief People Officer (IP)
• Alan Gray, Director of Health and Social Care Finance and Governance (V)
• Christine McLaughlin, Co-Director of Population Health (IP)
• Gregor Smith, Chief Medical Officer (V)
• Robert Kirkwood, Head of NHS Executive Office(IP)

Other attendees

• Kenneth Donaldson, NHS Dumfries & Galloway, Deputy Medical Director (on behalf of Julie White) (V)
• Frances Dodd, NHS Forth Valley, Executive Nurse Director (on behalf of Ross McGuffie) (V)
• David Park, NHS Highland, Deputy CEO (on behalf of Fiona Davies) (V)
• Chris Deighan, NHS Lanarkshire, Medical Director (on behalf of Colin Lauder) (V)
• Frances Robertson, NHS Western Isles, Chief Operating Officer (on behalf of Gordon Jamieson) (V)
• Karen Wilson, NHS Education for Scotland , Deputy CE (on behalf of Karen Reid) (V)
• Scott Heald, Public Health Scotland, Director (Data & Digital Innovation)/Head of Profession for Statistics (on behalf of Paul Johnston (V)
• Paula Speirs, Deputy Chief Operating Officer – Health Planning (IP)
• Douglas McLaren, Deputy Chief Operating Officer - Performance and Delivery (V)
• John Harden, National Led for Quality and Safety (V)
• Lorraine Cowie, NHS Scotland Professional Led for Sustainability/Health Planning (Agenda Item 7) (V)
• Karen Duffy, Delivery Director (Agenda Item 8) (V)
• Gregor Mcnie, Head of Cancer and Rehabilitation Team (Agenda Item 10) (V)
• Scott Davidson, Executive Medical Director (Agenda Item 10) (V)
• Aislinn Ní Ghráinne, Strategic Insights and Briefing Unit Head (V)

Secretariat

• Kat Dobell, Board Governance and Appointments Team (V)
• Sarah Hobkirk, Board Governance and Appointments Team (IP)
• Carol Hunter, Board Governance and Appointments Team (IP)

NHS Chief Executive support team

• Sam Martens, Executive Support Team (V)

Apologies

• Julie White, NHS Dumfries and Galloway, Chief Executive
• Ross McGuffie, NHS Forth Valley, Chief Executive
• Fiona Davies, NHS Highland, Chief Executive
• Colin Lauder, NHS Lanarkshire, Interim Chief Executive
• Brian Chittick, NHS Shetland, Chief Executive
• Gordon Jamieson, NHS Western Isles, Chief Executive
• Karen Reid, NHS Education for Scotland, Chief Executive
• Paul Johnston, Public Health Scotland, Chief Executive
• Angie Wood, Director, Social Care Resilience and Improvement, Scottish Government
• Anne Armstrong, Chief Nursing Officer, Scottish Government

Items and actions

Welcome, apologies for absence and attendees

Caroline Lamb, Director General Health and Social Care/Chief Executive NHS Scotland, welcomed everyone to the fifth meeting of the NHS Scotland Executive Group. 

Caroline welcomed Caroline Hiscox, Chief Executive, NHS Lothian to her first meeting as Chair of Chief Executives and Co-Chair of the executive group. Also recognising that Karen Reid, Chief Executive, NHS Education for Scotland is taking over the Vice Chair role of Chief Executives.

Caroline apologised that she wasn’t able to attend in person and advised she needs to leave the meeting early for a meeting with the First Minister.

Caroline advised colleagues in a slight change to the running order of the agenda items - the Services Renewal Framework (item 8) would be discussed after the Response to Collaboration (Item 4). 

A full list of attendees and apologies for absence is provided at annex A.

Caroline advised that dates had now been agreed, in May and August, to meet in person with the First Minister.

Minutes of previous meeting, actions, matters arising (NHSEG/25/19)

The minutes from the last meeting of the executive group held on 5 March 2025 were approved.

A copy of the action tracker was shared, which provided an update on the actions from the last meeting. Colleagues were invited to provide any further updates on actions not included as part of the agenda. 

Caroline Lamb invited Peter Moore to provide an update on the action from the last meeting around Business Systems Transformation Programme

Action: Peter Moore, to update the paper to include eRostering, prepare business case and bring back to a future EG meeting. Peter to arrange an SPF briefing on business system progress.

Peter Moore, Chief Executive NHS Borders provided a verbal update, noting that concerns have recently been relayed to the Directors of Finance Group and escalated to the NHS Chief Executives Group. Directors of Finance had met with the portfolio board on Friday 11 April to discuss the Portfolio and Business Programme. A timeframe had been agreed and more discussions would take place between Chief Executives and Directors of Finance over the next few weeks, with an expectation to sign off at an extraordinary meeting to be held on 5 May and then brought back to the executive group.

The programme board would issue a pack to each board providing information on:

• what the impact would be in their own board
• what the challenges, financial cost and risks would be
• what risks there would be to the programme
• what are the expected benefits

Caroline Lamb and Peter Moore are meeting next week to discuss what information is required for boards to make a decision and be confident on next steps. Colleagues reflected that they are encouraged by the level of engagement and work taken forward by Peter so far.

Once all facts had been collated EG will be asked to consider:

• what are the alternative solutions to upfront costs, as this won’t be viable in the current financial position?
• how could costs be recouped - looking at the volume of people needed to enable the savings required?

Action no/action/lead/timescale

NHSEG25/26: Once all information collated a paper to be submitted to EG outlining risks and alternative solutions regarding Business Systems Transformation Programme/Peter Moore/5 June 2025 EG meeting

Feedback from BCE action items

Caroline Hiscox provided an update from the Chief Executives’ private meeting on collective actions. This included:

• Scan for Safety – a dashboard has been endorsed and a report would be released on a quarterly basis
• cancer - ongoing work with Colin Lauder in NHS Lanarkshire
• NHS Education for Scotland - the services they provide for boards was discussed at a strategy session with specifics on the Academy and a bespoke model
• dental services - overview from the Co-Chairs of the Chief Officer Group with recommendations around sustainability; proposal for a paper to come to the next executive group meeting
• collective work plan – plan for Chief Executives and Executive Leads to underpin new ways of working on the Operational Improvement Plan and the anticipated renewal piece. CE Development session scheduled for May and an update will be provided at future executive group meeting
• Reduced Working Week - under commission from MSG, a national group, Chaired by Paul Johnston, Public Health Scotland is being stood up in May, looking at the risks, options and opportunities around implementation of the reduced working week by 1 April 2026. The ToR will be shared with BCE to include speaking with a collective voice on impact using data, risks to quality, safety and finance. A paper has been sent to all boards with the intention to collate themes from board dialogues and ensure all are responsive to concerns and opportunities of new ways of working

Action no/action/lead/timescale

NHSEG25/27: Paper on Dental Service Sustainability to come to future EG meeting/Caroline Hiscox/5 June 2025 EG meeting

NHSEG25/28: Update on Collective Work Plan for Chief Executives/Caroline Hiscox/5 June 2025 EG meeting

Response to collaboration (NHSEG/25/20)

Caroline Hiscox led this item assuring colleagues of boards commitment to collaboration. A paper was circulated prior to the meeting setting out a timeline for Chief Executives to take the Collaboration letter through boards and identification of thematic issues being captured. Initial feedback had been positive however there are some concerns in relation to governance arrangements supporting this.

Additional concerns were raised around equity of access to care in that proposals could inadvertently exacerbate existing health inequalities rather than reduce, particularly in rural/remote areas and whether the lived experience of patients experiencing unexpected or changed pathways was being heard at a national level. Travel had also been noted as a potential concern ie patients’ affordability to travel and the availability of transport.

Clarity was required on performance management arrangements to reflect the focus on collaboration and in particular, clarity around how planned care performance would be reported for out of area activity alongside local activity and what activity and performance the host board and local board would be held accountable to.

Service Renewal Framework (SRF) (NHSEG/25/23)

John Burns, Chief Operating Officer led this item. A paper was circulated to attendees in advance of the meeting which outlined key issues and the need for change and renewal in health and care.

The SRF would set the Scottish Government’s strategic policy intent for Health and Social Care Service reform in Scotland for the medium to long term; built around the vision laid out to parliament on 4 June 2024 for a Scotland where people live longer, are healthier and led more fulfilling lives, with the four parts of access: quality, prevention, people and place. The SRF is intended to give a clear vision and high-level strategic policy intent for service reform in the coming decade, with a focus on whole system coherence across services.

A presentation was shared during the meeting which set out the context of the work in progress, noting that discussions were still ongoing with the Cabinet Secretary for Health & Social Care and the First Minister. The presentation highlighted:

• the scale and complexity of the renewal required across the NHS in Scotland
• focus on NHS renewal within the whole system context – and how we work in partnership with others
• NHS Chief Executives operating under a clearer national and local mandate to make improvements that the public can see and trust across the breadth of acute, primary and community care
• the need for NHS service changes to take full account of primary and community care pathways, drawing from the need for enhanced national policy co-ordination with a stronger role for NHS boards and IJBs
  • the vision for a Scotland where people live longer, healthier and fulfilling lives with creation of renewal design and delivery principles
  • optimising the full role of Chief Executives
  • the Framework’s major change areas and enablers and
  • the changes for people and staff

The importance of collaboration was reiterated and colleagues were reminded that this is currently a work in progress with colleagues working at pace. Getting the right authorising environment for this framework is crucial to support Chief Executives and Chairs around accountability which could lead to the change needed. Ministers have been clear that they are supportive of the right service change if it is evidenced based, clinically supported and positively demonstrates the impact for those using the service.

Colleagues welcomed this approach and it was acknowledged there was a need and desire to be a collaborative group. Given the current challenges, financial and workforce, colleagues recognised this as a positive step forward to allow for a more connected, sustainable service.

Chief Medical Officer positively reflected on the alignment with the framework and annual report. However, raised the issue that this would require new data models to support a shift to prevention and primary care. He also outlined a need for a social contract with the population around people taking responsibility for their own health care, which he did not see in this current narrative. Caroline Lamb agreed that a new data model would be required and performance framework. Further discussion would be required on social contracts.

Colleagues are supportive of the SRF in principle and agreed that further work was required on data and future modelling. Colleagues agreed a paper should come back to EG on SRF including:

• an analytical piece that underpins and outlines changes and clearly demonstrates outcomes and interventions
• role of PHS, Scottish Government Analysts, CfSD and their roles relating to data, what is captured and how best to support this change

Action no/action/lead/timescale

NHSEG25/29: Paper on SRF focused on data, outcomes and performance framework/Karen Duffy/Paul Johnson/Gordon James/5 June 2025 EG meeting

Operational Improvement Plan (OIP) covering planned care and unscheduled care

Dougie McLaren, DCOO Performance and Delivery led the discussion of this item. This was a verbal update about next steps following the publication of the NHS Scotland Operational Improvement Plan (OIP) on 31 March 2025.

The OIP outlined how the specific commitments on renewal made by the First Minister on 27 January would be implemented and delivered. Chief Executives were thanked for their contribution so far and it was reiterated that there is a clear focus on clearing the 52 week waits. However, while lists are going down, there needed to be a demonstrated focus on the 52 week waits.

Gordon James, Golden Jubilee indicated that he could share a national view of validation data with colleagues on waiting lists. Chief Executives would review at their private meeting and look at the systematic reporting, flow, validation and variation to ensure learning and understanding of the unintended consequences of this work and feedback as appropriate to the executive group.

The expectation on boards is to support delivery of the OIP as a priority, and to facilitate the engagement and empowerment of staff as part of local planning and delivery. A Population Health Framework will be published later in the spring and the SRF by the summer. These publications will help frame and focus our work for the coming years, and in particular the collaborative and integrated working required across boards, Health and Social Care Partnerships and wider system partners.

Christine McLaughlin, Co-Director Population Health indicated that digital innovation implementation is variable across boards. It was acknowledged that there is a wider need to ensure consistent implementation through Chief Executives. Christine suggested that the Programme for Government data relating to Health and Social Care is shared with colleagues for clarity on key government priorities for 2025‑26.

Action no/action/lead/timescale

NHSEG25/30: CEs to feedback with a national perspective on waiting list validation and variation/Caroline Hiscox/Gordon James/5 June 2025 EG meeting

NHSEG/25/31: Programme for Government Health and Social Care Data to be shared with executive group quarterly/Christine McLaughlin/ongoing

2025-26 system pressures (NHSEG/25/21)

Alan Gray, Director of Finance led this discussion. An updated paper was circulated to attendees in advance of the meeting which set out the status in relation to key system pressures for 2025/26 and actions being taken in relation to each of the service pressures highlighted previously to the NHS Scotland Executive Group.

A number of system pressures were reported in 2024 to 2025 due to increases in demand or expansions of treatment provision for areas such as CAR-T, TAVI and Closed Loop. Additional funding was confirmed by Scottish Government to support services centrally, recognising the existing savings challenge and pressures being experienced by NHS boards and Directorates in this financial year. Moving into 2025 to 2026, NHS boards have received a baseline uplift and sustainability funding and there has been a significant increase in the transfer of SG Health and Social Care Directorates allocations to NHS board baseline funding. Any pressures or service requirements need to be managed within existing NHS boards budgets, therefore there is no additional central funding available to provide any further investment in growth of existing services or new developments.

Discussion centred around the need for collaborative planning to forecast and meet the costs of future service demand and within available NHS board resources; noting that NSD did not have additional funding for the specialist services. it is responsible for. Colleagues raised concerns on risks relating to Neonatal Units, in particular the cost and implementation risks. TAVI was also raised as a risk as there is no central funding for this work and boards would need to consider funding this themselves. Further work was also needed on Neonatal and TAVI for the next meeting.

Action no/action/lead/timescale

NHSEG25/32: Paper on Neonatal Services paper to come to next EG meeting/Jann Gardner/Carol Potter/Laura Skaife-Knight/5 June 2025 EG meeting

NHSEG25/33: Paper on TAVI to come to next EG meeting/Caroline Hiscox/Gordon James/Adam Coldwells/Jann Gardner/5 June 2025 EG meeting

Productivity and efficiency (NHSEG/25/22)

Lorraine Cowie, NHS Scotland Professional Lead for Sustainability/Health Planning led this item. The NHS Scotland Executive Group previously considered Productivity and Efficiency at the January 2025 meeting. An updated paper was circulated to attendees in advance of this meeting sharing progress on the following key areas:

• assurance on the effectiveness of current arrangements and processes which aimed to improve productivity and efficiency in NHS Scotland
• observations on how current arrangements could be strengthened to further improve productivity and efficiency and the prioritisation of these including the current levers for change
• review and overview of the current performance, benchmarking and system variability (workforce, performance and finance) which would also include other parts of the UK
• development of targets on productivity and efficiency and associated dashboards

The Productivity and Efficiency Group had met twice formally with wide representation on the group from Centre for Sustainable Delivery (CfSD), Medical Directors, Nurse Directors, Human Resource Directors and Directors of Finance as well as Scottish Government finance and planned care colleagues. 

A workforce sub-group was being established to provide a consolidated approach to workforce diversification. The intention would be to develop a data pack and work with boards to support self-assessment and a maturity index to help shape collaborative approaches to improvement.

Planned Care Performance colleagues and CfSD have been approached to support this work systematically with boards and use a self-assessment approach. Support was being sought from Director colleagues on national boards to help consolidate a plan and provide approval for a self-assessment approach to move forward together. The NHS Executive Group endorsed the proposals put forward.

It was noted that there were significant opportunities and extensive information and approaches available however this needed a focused, prioritised and targeted approach which made best use of our improvement resources and would require further collaboration and discussion before implementation.

Quality and safety Proposal (NHSEG/25/24)

John Harden, National Lead for Quality and Safety led this item. This agenda item followed earlier discussion on Quality and Safety at the October 2024 and January 2025 NHS Scotland Executive Group meetings. A paper was circulated to attendees in advance which:

• provided an update on the Quality and Safety Subgroup
• set out where we are in relation to the Scottish Patient Safety Programme and the ambition going forward
• set out how we measure quality and triangulate this with performance and value for money and
• set out the current position of the Scottish National Audit Programme (SNAP) and how this supports system wide improvements in specific areas

Work was underway on setting up a Quality and Safety Subgroup of the NHS Scotland Executive Group. Invitations have been sent to seek representation from Scottish Association of Medical Directors, Scottish Executive Nurse Directors, Allied Health Practitioners Directors Group, Directors of Pharmacy and Healthcare Improvement Scotland to join the group with an initial meeting scheduled for the end of April. Draft Terms of Reference had been produced and would be discussed as the first order of business. The group would have the remit to give system leaders of the executive group an overview of performance/quality of care across Scotland, and to discuss and challenge areas for improvement. The group would provide updates to the executive group quarterly, with the first of these ready for the June meeting.

Improvement through the Scottish Patient Safety Programme (SPSP) would remain a central part of this approach. Health Improvement Scotland would seek to hold the gains in improvement, ensure visibility of robust and timely improvement data and align SPSP to wider safety work. The SPSP should be utilised by boards to take forward improvement work in key areas to support renewal and react to the needs of the system. This will require input from leaders across the system to ensure support is tailored appropriately.

To properly monitor the quality of the care we deliver, we need to triangulate a suite of measures, and look at them through all the lenses of the components of quality. Triangulation would ensure there were no unintended consequences while working on particular challenges. Feedback on having a holistic look at the quality agenda and triangulation of data while also looking for collaborative improvements would be welcomed.  

Action no/action/lead/timescale

NHSEG25/34: Quality and safety sub-group group quarterly update to EG on performance/quality of care across Scotland/John Harden/5 June 2025 EG meeting

Oncology (NHSEG/25/25)

Scott Davidson, Executive Medical Director, NHS Greater Glasgow and Clyde led this item. Gregor Mcnie, Unit Head/Oncology Transformation Programme Sponsor joined the meeting to provide support. 

A paper had been circulated to attendees in advance of the meeting which set out the current situation, background and recommendations relating to rising oncology pressures and the initial response to date. Oncology services continue to experience 8-10% per annum rise in demand.

The Oncology Task and Finish group made recommendations to the NHS Scotland Planning and Delivery Board (PDB) in October 2024, which set out a proposal for a nationally supported target operating model (TOM) for NHS Scotland oncology services.

It was agreed to take the updated TOM to the NHS Scotland Executive Group as a nationally agreed basis for service configuration of non-surgical solid tumour oncology. An initial meeting of a Task and Finish Group to develop a full tumour site specific TOM as a test of change was held on Friday 28 March, which prompted reflection about taking a wider approach to population based planning and configuration of oncology services. The paper provided today, sought an NHS Scotland Executive Group view on proposed next steps.

Colleagues welcomed the discussion and reiterated the importance of this work. Chief Executives agreed with the proposed next steps acknowledging the magnitude of the work involved. There would need to be assurance that there was no duplication of work and the executive group would find it helpful to have clarity on the roles and responsibilities of this work and agreed that engagement with HIS would be beneficial. Governance arrangements on this project are coming through the Planning and Delivery Board and assurance was given that the Scottish Cancer Network is also involved. Acknowledging that this would be about service change, part of that decision making would need to be agreed with the Cabinet Secretary.

The executive group were asked to:

• agree to making future national decisions on proposed TOM changes, as recommended by Planning and Delivery Board
• note the current overall TOM as a proposed nationally agreed basis for service configuration of non-surgical oncology
• agree to the MD-chaired Oncology TOM Task and Finish Group developing the proposal as described in the assessment for consideration by NHS Scotland Executive Group at the end of summer

This was agreed.

Action no/action/lead/timescale

NHSEG25/35: T and F group on Oncology provide clarity on roles and responsibilities to EG/Gregor Mcnie/Scott Davidson/5 June 2025 EG meeting

Any other business

Christine McLaughlin would be writing out to Chief Executives regarding the Infected Blood Inquiry recommendations and response from boards. Responses have been variable and assurance is required that recommendations have been implemented across the system. SAMD and SEND have also been asked to ensure emphasis on this in boards.

Caroline Hiscox acknowledged this was John Burns last meeting with the executives group as Chief Operating Officer NHS Scotland and thanked him for his leadership, support to Chief Executives and his long service in the NHS.

There were no other items of business raised. 

Date and time of next meeting

The next meeting will take place on 5 June 2025.

Board Governance and Appointments Teams

24 April 2025