NHS Scotland Executive Group minutes: August 2025

Attendees and apologies

NHS boards

• Gordon James, Interim CE, NHS Ayrshire and Arran
• Peter Moore, NHS Borders
• Julie White, NHS Dumfries and Galloway
• Carol Potter, NHS Fife
• Ross McGuffie, NHS Forth Valley
• Adam Coldwells, Interim CE, NHS Grampian
• Jann Gardner, NHS Greater Glasgow and Clyde
• Fiona Davies, NHS Highland
• Louise Long, NHS Lanarkshire
• Caroline Hiscox, NHS Lothian
• Laura Skaife-Knight, NHS Orkney
• Brian Chittick, NHS Shetland
• Nicky Connor, NHS Tayside

Special health boards

• Robbie Pearson, Healthcare Improvement Scotland
• Karen Reid, NHS Education for Scotland
• Carolynne O’Connor, Interim CE, NHS Golden Jubilee
• Mary Morgan, NHS National Services Scotland
• Paul Johnston, Public Health Scotland (George Dodds attending)
• Michael Dickson, Scottish Ambulance Service (deputising for NHS 24)
• Gary Jenkins, The State Hospitals Board for Scotland

Scottish Government

• Caroline Lamb, DG HSC/Chief Executive NHS Scotland
• Christine McLaughlin, NHS Scotland Chief Operating Officer/DCE
• Fiona Hogg, Chief People Officer
• Fiona Bennett, Director of Health and Social Care Finance
• Robert Kirkwood, Head of NHS Executive Office

Other attendees

• Donna Bell, Director of Social Care (deputising for Angie Wood)
• Dougie McLaren, Deputy Chief Operating Officer - Performance and Delivery
• Paula Speirs, Deputy Chief Operating Officer – Planning and Sponsorship
• Jacqui Jones, NHS Lanarkshire, Director of HR (Agenda Item 5)
• Tom Ferris, Chief Dental Officer (Agenda Item 6)
• Neil Cardwell, Primary Care Strategy Unit (Agenda Item 6)
• Jonathan Watt, Senior Content Designer, DG Communities (shadowing DG HSC)
• Aislinn Ni Ghráinne, NHS Corporate Communications

Secretariat

• Laurie Whyte, Board Governance and Appointments Team
• Kat Dobell, Board Governance and Appointments Team
• Sarah Hobkirk, Board Governance and Appointments Team

NHS Chief Executive support team

• Claire Gilroy, NHS Executive Support Team

Apologies

• Jim Miller, NHS 24 (Jacqui Hepburn attending)
• Jacqui Hepburn, NHS 24, Deputy Chief Executive/Director of Workforce (Michael Dickson covering)
• Gordon Jamieson, NHS Western Isles
• Angie Wood, Director of Social Care Resilience and Improvement (Donna Bell attending)
• Gregor Smith, Chief Medical Officer
• John Harden, National Lead for Quality and Safety

Items and actions

Welcome, apologies for absence and attendees

Caroline Lamb, DG Health and Social Care/Chief Executive, NHS Scotland welcomed colleagues to the 8th meeting of the NHS Scotland Executive Group.

Caroline acknowledged apologies and changes across the Chief Executive cohort:

• Gordon James, Interim Chief Executive, NHS Ayrshire and Arran
• Carolynne O’Connor, Interim Chief Executive, NHS Golden Jubilee
• Laura Skaife-Knight’s last meeting as Chief Executive, NHS Orkney before taking up post on 22 September 2025 as Chief Executive, NHS Grampian
• Adam Coldwells was thanked for his tenure as Interim Chief Executive, NHS Grampian

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

Minutes of previous meeting, actions, matters arising (NHSEG/25/44)

The minutes from the last meeting of the Executive Group held on 9 July 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 additional information on actions which were not included on the agenda.

Peter Moore, Chief Executive, NHS Borders provided an update on the progress of the business systems transformation programme. Confirming this will come back to the October Executive Group (EG) meeting as a substantive item and that the board Chief Executive group would be looking to discuss the single operating model and resourcing of the programme board before the next meeting.

Christine McLaughlin, NHS Scotland Chief Operating Officer provided an update on the governance landscape review which is looking at the purpose and function of the planning and delivery board. A paper will come to the October EG meeting proposing an alternate structure ensuring all current work through that board is filtered to other appropriate groups. Karen Reid indicated that the NHS Scotland Executive group TORs have been updated and asked colleagues to offer feedback. This will be captured outside of the meeting, and will return to the October EG meeting for formal agreement.

Nicky Connor, Chief Executive, NHS Tayside provided assurance that the risks relating to vascular at NHS Highland have seen significant progress and reduction. Action NHSEG25/54 outlining the ask for a full day event with key stakeholders on vascular is now scheduled for 2 September 2025 and a further update will be provided at the October EG meeting.

Action no - action - lead - timescale

NHSEG25/58 - colleagues to provide comments/amendments to NHS Scotland Executive group TORs - all to OCENHS (ocenhs@gov.scot) - by Friday 26/09/2025

Feedback from board Chief Executives (verbal)

Caroline Hiscox, Chair of Chief Executives Group, asked colleagues to note the iterative board Chief Executive plan and planned care updates. Caroline additionally assured colleagues that current meeting structure of the BCE group is under review to ensure alignment with EG meetings.

Operational improvement plan (NHSEG/25/45)

Christine McLaughlin updated colleagues on progress against the operational improvement plan (OIP). It was previously agreed this would be a standing item to ensure colleagues have the chance to discuss the overall position across Scotland. Christine acknowledged governance arrangements have now been set up to support OIP, this will ensure the detail is reviewed appropriately and information is quality assured. The current data has been validated by Scottish Government however the narrative that colleagues in the system can provide will give greater clarity on the overall position. Validation and the programme board need to be joint owned and assured.

Caroline Hiscox provided context on the slides provided for the First Minister on assurances against the OIP and that there is a plan for Chief Executives to pivot their planned care meetings to include unscheduled care considering the recent dip in performance.

The discussion was opened to colleagues and the following points were noted.

• concerns were raised about the RAG status (red-amber-green) overly simplifying and not reflecting complexity. It was noted that currently several areas marked red or amber-red and there is a clear drive and aim to move towards green in the coming months. Colleagues questioned that CAMHS was flagged as red when it is on track, this was confirmed to be because of the need for further attention in systems. Discrepancies noted between internal data and Public Health Scotland figures. Importance of understanding RAG ratings and ensuring data accuracy
• planning is underway for waiting times, with some areas (eg digital dermatology) being straightforward, while others (eg frailty) require further clarity on what expectations are to reach this goal
• performance is declining across unscheduled care and there is a need for collective understanding and evaluation across Scotland
• risks identified in infrastructure and clinical decontamination units. Boards are exploring procurement alignment and variation orders. Productivity is not yet a KPI across boards, but there is interest in developing validated metrics
• positive examples of shared learning were outlined that are supporting productivity and improvement in some areas. (e.g., cancer, glaucoma, inFix). boards are increasingly collaborating, with formal buddying suggested for sustained progress
• emphasis on working as a whole system, especially in outpatient services. Calls for specific asks and formal responses to support struggling boards

Caroline Lamb concluded the discussion stating that further clarity was required on the RAG ratings and data and that this would be taken to the new OIP Programme board. It was reiterated that the OIP is about having clear aims and ensuring better outcomes and experience for patients and staff across Scotland.

Whole system executive recruitment (NHSEG/25/46)

Caroline Lamb introduced this item and discussion focused on the future of executive recruitment across the NHS in Scotland, set against the backdrop of reform and financial pressures. There is a shared recognition that the current recruitment model, particularly for some executive roles is unsustainable. Colleagues were asked to challenge and explore how to move towards a more collaborative, system-wide approach to leadership and recruitment, aligned with broader service reform frameworks and population health planning.

The discussion was opened to colleagues and the following points were noted:

• recognition that reform is required to transform the system and that colleagues need to think about challenges differently. Colleagues agreed there is uncertainty and as leaders they need to prepare the system for change and collaborate more closely. This includes on cross board, shared leadership, capability and resilience. Importance of aligning with SRF/PHF and ensuring consistent approaches across Scotland
• challenges in recruiting to executive positions has been noted across a range of boards, with executives often moving across the country to bigger boards. A new leadership programme has been developed at NES in a modular capacity with the hope to promote senior leadership skills. Noting there needs to be an emphasis on ensuring leadership roles in health are seen as attractive and aspirational
• colleagues discussed shared executive resources across boards, collaborative recruitment models and system-wide collaboration. It was noted that there are some concerns on a shared model about burnout but recognising the need to maximise existing and new talent
• colleagues also raised the implications these changes may have with integration across health and local authority boundaries, noting that it would be beneficial to address the duplication and inefficiencies in current systems indicating that this may require legislative and policy support to enable change

Caroline highlighted the need for boards to flex and collaborate on this. Recognising that current structures are not perfect, colleagues were challenged to reflect on how to work with those structures to maximise the capacity in executive leadership teams. It is noted there was need to for change and remain agile to ensure boards can deliver population health as well as is possible.

Caroline concluded the discussion agreeing this should be taken to a separate meeting to discuss fully and for colleagues to provide comments to Fiona on the paper provided. 

Action no - action - lead - timescale

NHSEG25/59 - colleagues to provide comments regarding the paper provided - all to Fiona Hogg/Jacqui Jones - by Friday 26/09/2025
NHSEG25/60 - colleagues to arrange a follow up session/deep dive focused on executive recruitment - NSS executive support - by Friday 26/09/2025

Primary care and innovation (NHSEG/25/47)

Neil Cardwell, Primary Care Strategy Unit and Tom Ferris, Chief Dental Officer shared a presentation with colleagues outlining what is being progressed regarding primary care reform and a specific example on dental services in Scotland.

Neil Cardwell outlined the commitment of Scottish government to primary care reform as a key strategic priority, including thinking differently about current delivery, governance, and assurance. The reform is grounded in the principles of the OIP, SRF and PHF, aiming to shift towards a more preventative, community-based system.

Reform must address access challenges and define collective roles and responsibilities. With internal Scottish Government analysis 90% of patient interactions occurring in primary care and community settings, reform must be grounded in demographics and resource optimisation. The SRF supports major changes in access and treatment principles, advocating for a nationally led but locally delivered model. Primary care must be embedded into whole-system planning and delivery. Board voices need to be prominent in shaping primary care and community health models, ensuring decisions are not just about shifting from acute care but about what is best delivered in the community.

Tom Ferris outlined the need for reform using dentistry as a case study to illustrate the complexity of reform. Strengthening the connection between strategic reform and practical delivery is essential. Boards must address workforce, digital infrastructure, and data access to shape a modern, fit-for-purpose primary care model.

The following points were noted:

• changes in service delivery, corporate ownership, and regulation have impacted community access and oversight. There is a need for clearer understanding of regulations, workforce alignment and social responsibility, especially in mixed NHS/private practices
• challenges include poor understanding of regulations, especially among international practitioners. A simplified refresher and a compliance statement are proposed, with NHS delivery playing a role in scrutiny and improvement
• there is significant concern about the impact of corporate ownership across primary care, not just dentistry. Market oversight and the consequences of corporate practice closures on communities need to be better understood and addressed
• assurance mechanisms must balance accountability and transparency. Integration of systems is key to improving access and ensuring the right stakeholders are involved in driving change

Colleagues agreed that there is an important shift required regarding the future model of primary care. With the clear direction set by the PHF colleagues need to address the practical requirements to actively the shape of primary care and community care for the future sustainability of health services. Improving access and ensuring the right people are making the choices necessary to support communities.

Caroline Lamb asked colleagues to provide any comments/questions to the primary care strategy unit and will ensure that a future item is brought forward on primary care and SRF.

Action no - action - lead - timescale

NHSEG25/61 - colleagues to provide comments regarding the paper provided - primary care strategic unit - by Friday 26/09/2025
NHSEG25/62 - co-Chairs to agree when to schedule an item on primary care and service renewal framework - Caroline Lamb/Caroline Hiscox - agenda planning meeting

Any other business

There were no items of other business.

Date and time of next meeting

The next meeting will take place on Wednesday 15 October 2025 as a hybrid meeting, 13:00-16:00.