NHS Scotland Executive Group minutes: December 2025

Attendees and apologies

NHS Boards

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

Special Health Boards

• Carolynne O'Connor, NHS Golden Jubilee
• Paul Johnston, Public Health Scotland
• Mary Morgan, NHS National Services Scotland
• Jim Miller, NHS 24
• Michael Dickson, Scottish Ambulance Service
• Gary Jenkins, The State Hospital for Scotland

Scottish Government

• Caroline Lamb, DG HSC/CE NHS Scotland
• Christine McLaughlin, NHS Scotland Chief Operating Officer
• Fiona Hogg, Chief People Officer
• Fiona Bennett, Chief Finance Officer
• Gregor Smith, Chief Medical Officer
• Robert Kirkwood, Head of NHS Executive Office

Other Attendees

• David Rowland, NHS Dumfries & Galloway, Director of Strategic Planning and Transformation
• David Park, NHS Highland, Deputy CE
• Ann Gow, Healthcare Improvement Scotland, Deputy CE
• Karen Wilson, NHS Education for Scotland, Deputy CE
• Claire Pearce, Deputy Chief Nursing Officer
• John Harden, Deputy National Clinical Director
• Daniel MacDonald, Head of NHS Pay (Agenda Item 8)

Secretariat

• Laurie Whyte, Board Governance and Appointments Team
• Kat Dobell, Board Governance and Appointments Team
• Carol Hunter, Board Governance and Appointments Team
• Tim Andrews, Interim Programme Director Executive Support

Apologies

• Julie White, NHS Dumfries and Galloway
• Carol Potter, NHS Fife
• Robbie Pearson, Healthcare Improvement Scotland
• Karen Reid, Chief Executive, NHS Education for Scotland
• Richard Foggo, Director of Population Health
• Paula Speirs, Deputy Chief Operating Officer (Health Planning)
• Douglas McLaren, Deputy Chief Operating Officer (Performance and Delivery)
• Angie Wood, Director, Social Care Resilience and Improvement
• Neil Harrison, Strategic Communications Lead
• Sarah Hobkirk, Board Governance and Appointments Team

Items and actions

Welcome, apologies for absence and attendees

Caroline Lamb, Director General Health and Social Care and Chief Executive of NHS Scotland welcomed colleagues to the 10th meeting of the NHS Scotland Executive Group. 

Caroline acknowledged apologies which are recorded in the minutes of the meeting.

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

Minutes of previous meeting, actions, matters arising (NHSEG/25/60)

The minutes from the last meeting of the Executive Group held on 15 October 2025 were approved.

A copy of the action tracker was shared, which provided an update on the actions from the last meeting. 

Caroline Lamb provided a verbal update on the following action:

• action NHSEG/25/64: Chief Executives sought clarification on the ESM pay and wider review. Caroline confirmed that initial work on ESM reward system and areas for potential modernisation has been paused; with the position remaining under review
• the ESM pay uplift was agreed at 4.25% for 2025/26 and 3.75% for 2026/27, in line with agenda for change. The group agreed that proactive messaging and engagement are essential to manage expectations and maintain trust. Colleagues noted that COSLA had reviewed local authority executive pay and that the NHS Executive pay structures would need to take this into account as a part of the review
• Fiona Hogg, Chief People Officer advised executive recruitment review had been successfully concluded. A streamlined, light-touch process was agreed upon in the previous meeting, involving consultation with Human Resources Directors (HRDs). Communication regarding this approach has already been issued to relevant stakeholders

Matters arising

Two matters arising were noted from the previous meeting and updates were provided.

Business systems (NHSEG/25/61)

• Peter Moore, Chief Executive NHS Borders updated on the pre-circulated paper on business systems. He highlighted to the group the risk of a four-month delay in contract development. Mitigation processes are being explored, but delays are impacting other elements
• the first of two development days on business systems was held with a presentation from the UK Governments Department for Work and Pensions (synergy system). This highlighted that anticipated issues with the system were expected to be more straightforward than current challenges, helping maintain programme progress
• an update was provided on recruitment of an Executive Programme Director
• the implementation programme’s alignment with the single authority model and sub-national planning directions requires consideration. Workforce implications, which are not currently detailed in the outline business case will be discussed through the partnership forum and included in the full business case as it progresses
• the programme is working to a very challenging timeframe for the ministerial requirement to submit plans on a once for Scotland basis showing full implementation by October 2028 aligns with the end of life of existing systems. There is a complex programme of work already in train however, more clarity is required to understand the specific reporting requirements in the DL for March 26.  PM to write to CMc to clarify this.  It was noted that further work was also required on maximising payroll system efficiencies, with boards needing to prioritise full implementation of direct payroll through e-rostering.  A review of our current status would be carried out and report back to BCEs in February.

Action no - action - lead - timescale

NHSEG25/74  clarification in writing to be sent to Christine McLaughlin regarding the understanding of specific reporting requirements - Peter Moore -  For the DL in March 2026
NHSEG25/75  a review of our current status would be carried out and report back to BCEs in February - Peter Moore - February 2026

Quality and Safety

Christine McLaughlin, NHS Scotland Chief Operating Officer provided a verbal update advising that colleagues have commenced work to review the processes around quality and safety.  Noting that John Harden, Deputy National Clinical Director previously contributed a supporting paper outlining variation, Christine confirmed that a paper would be provided in February, setting out the future direction of embedding quality and safety assurance into service delivery.

Board Chief Executive group strategic update and HIS update on maternity scrutiny (NHSEG/25/62 and NHSEG/25/62a)

Ann Gow Deputy Chief Executive, Healthcare Improvement Scotland was invited to provide an update on maternity scrutiny. Ann reported that by the end of 2025/26 a further two NHS boards will have undergone inspection activity totalling eight for this financial year with a commitment to inspect a further 10 boards throughout 2026/27. Common issues were noted to include: maternity triage, standardisation, cultural factors, governance and board oversight, and staffing.

Work is underway to develop maternity standards with publication in early spring. These standards are being developed with clinical input to help boards to undertake self-assessments on services and are based on the quality of care approach.

Christine provided an update on the national ministerial task force being established, which would be chaired by Ms Minto. She emphasised that Ministers regard this task force as a priority and are keen to drive improvement.

The Chief Executives collectively affirmed their commitment to reviewing challenges within local maternity services and sharing learning, with full support of the establishing of the ministerial task force.

Caroline Hiscox Chief Executive NHS Lothian and Chair of NHS Chief Executives Group, provided an update on the board Chief Executives’ delivery plan, confirming progress against key priorities and assurance on work done in the service of Scotland.

Collective leadership work continues, supported by an external facilitator, which has been helpful to foster collective leadership on navigating change and enhancing collaboration. Assurances were given on key priorities including but not limited to: mental health, prevention and population health, workforce, performance and quality, finance and governance.

Operational Improvement Plan (NHSEG/25/63)

Christine provided an update on the operational improvement plan (OIP), noting a number of deliverables in green and performance data highlighting that boards are working hard and are clear on expectations.

Recognition was given for work in frailty, with valuable learning emerging. Despite flu pressures, elective activity is being maintained, though Accident and Emergency performance is showing the impact of winter pressures. Colleagues assured that these areas remain on Chief Executives’ agendas, with a positive approach to recovery heading into February/March 2026. Work continues on defining system occupancy measures for the coming year, and opportunities for mental health improvement.

Paul Johnston, Chief Executive Public Health Scotland expressed appreciation for colleagues’ engagement on flu performance. He noted that detailed discussions have taken place over the past two Mondays and will continue. A weekly flu performance pack has been developed, providing epidemiology data and comparative performance across boards.  Work is continuing across boards to increase vaccination rates, with a particular focus on health and social care workers where declining uptake has been seen in previous years.

Hospital at Home was noted as requiring input from colleagues to agree a clear definition for the long term that reflects a wider and more innovative range of patient pathways that embrace digital technology.

Christine highlighted the need to ensure the 2026/27 OIP draws out appropriate priorities for the system including clear alignment to the service renewal framework (SRF), population health framework (PHF) and public sector reform (PSR) publications. She requested input on these areas and suggested the Chief Executives’ group providing representatives to work with SG on developing a robust set of indicators.

Action no - action - lead - timescale

NHSEG25/76  hospital at home definition and patient pathways discussion - Christine McLaughlin - end of February 2026
NHSEG25/77  BCE group to agree representatives for a short life working group on the 2026/27 OIP - Caroline Hiscox/Karen Reid - end of February 2026

Continuity of national planning workstreams during transition to sub-national planning (NHSEG/25/64)

Caroline Hiscox presented a summary paper outlining interim governance arrangements to ensure continuity during transition from the three regional structures to sub‑national planning groups. Workstreams requiring interim arrangements were identified, with vascular services to transition first to ensure progress continues at pace.

Nicky Connor Chief Executive NHS Tayside, leading the implementation of tactical operating model (TOM), has requested clarity on leadership expectations. It was proposed to confirm the safety position in writing via Medical Directors and to consider TOM within a sub‑national, business‑as‑usual context rather than through direction/DL, recognising system fragilities and emergent IR issues. A vascular discussion is required to support Highland with Nicky in the Senior Responsible Officer role and to ensure that the vascular services TOM is evaluated in the sub-national context to ensure the best use of services for Scotland.

Caroline Hiscox reported that Chief Executives in the east sub-national planning group proposed, for their first committee meeting on 19 December, to establish an explicit workstream addressing rurality and connectivity between east and west regions. A paper has been drafted for the east committee, and Chairs of both regions are in dialogue, recognising remote and rural as a critical workstream. The matter will be considered at the first national oversight group meeting on 16 December.

Action no - action - lead - timescale

NHSEG25/78    written assurance on vascular services - Caroline Hiscox - update at next meeting

Progress of health and social care reform portfolio (NHSEG/25/65)

Christine provided an update on governance arrangements relating to the reform portfolio, noting progress on defining clear priorities. There are some tangible measures for the PHF however the SRF requires further clarity. It would be helpful to have a development session with Chief Executives on this.

The reform oversight board is now in place, co-chaired by the Cabinet Secretary for Health and Social Care and Cllr Kelly, COSLA spokesperson with representation from three boards, Chairs, and Chief Executives. The introductory meeting was helpful in establishing direction. Immediate progress has been made on the PHF, with good measures identified for next year. Investment in primary care requires further engagement with Chief Executives to clarify expectations.

Louise Long, Chief Executive, NHS Lanarkshire, highlighted the digital opportunities across the three frameworks, in particular the adoption of MyCare. Thanks were extended to Louise and the NHS Education for Scotland team for the MyCare launch, with emphasis on accelerating progress and cascading learning. Chief Executives expressed enthusiasm, and Louise confirmed GP engagement is strong. Colleagues raised the need to embed these initiatives into mainstream business and welcomed collaboration with Christine. Christine agreed to share programme definition documents and follow up with Gary Jenkins and Karen Reid on how to appropriately commission the service.

Action no - action - lead - timescale

NHSEG25/79  development session with CEs on the SRF and PHF priorities including primary care - Christine McLaughlin/ Richard Foggo/ NSS Executive Support - end of February 2026
NHSEG25/80  documents to be shared, including accelerating digital option and follow up discussion with Gary Jenkins and Karen Reid - Christine McLaughlin/ Gary Jenkins/ Karen Reid - end of February 2026

Collective approach to sub-natioinal planning (NHSEG/25/66)

Jann Gardener, Chief Executive NHS Greater Glasgow and Clyde provided an update on the Chief Executives collective approach to sub-national planning, including governance, planning to date and next steps.

The need for clear partnership representation at the national oversight level was emphasised. Work is underway to identify directors to support delivery, with practical steps being developed. professional groups have begun self-selecting leads, and letters will be issued to Directors of Finance and other key contacts to coordinate peer group work across east and west.

Continued engagement was encouraged to explore opportunities and new approaches. Staffside and partnership colleagues will be supported through national forums to find appropriate solutions together. A strong appetite for reform was noted, with partnerships and unions keen to participate. Feedback from Chairs and partnership colleagues was positive, recognising the need for change and collaboration between boards and SG. Chairs and Chief Executives expressed joint commitment to creating opportunities for 2026/27.

Colleagues agreed it would be important for remote and rural to be a key aspect of sub-national planning with a positive focus on quality of service. The importance of learning from previous regional work and maintaining alignment between Chief Executives and SG Directors was highlighted to manage uncertainty and support staff during transition. Colleagues recognised the importance of communications and a communications handling plan will be developed, including questions and answer sessions at board and national levels, with an initial verbal update to the oversight group on 16 December. Agility and clarity in communications were highlighted as essential, and distributed leadership will underpin delivery.

There is a clear requirement to keep Ministers informed about progress and if other areas are to be delivered sub-nationally in addition to the 4 priorities in DL(2025)25. A proposal was made to review PHF actions to identify those suitable for sub-national delivery versus local or national implementation, with agreement on prioritising initial actions. Emphasis was placed on understanding concerns and providing alternatives. Early discussions on priorities were supported.

Opportunities for external learning were noted, including formalising collaboration with Denmark. Denmark has experience in sub-national planning and responding to variation across the country. Colleagues welcomed the opportunity to share learning in this way.

Action no - action - lead - timescale

NHSEG25/81  consider which PHF actions may be appropriate for delivery sub-nationally - Paul Johnston/ Christine McLaughlin - end of February 2026
NHSEG25/82  colleagues offered to share learning with Medical Director of Denmark - Gregor Smith/ NSS Executive Support Team - end of February 2026

Reduced working week (NHSEG/25/67)

Paul Johnston outlined the collective role that Chief Executives have to ensure the narrative around the reduced working week continues to recognise the importance of improving workforce health and wellbeing and that reducing annual working time by 52 hours is intended to support greater work-life balance.

It was noted that a circular from SG issued on 8 of December 2025, confirming that boards have local flexibility on delivery, to be agreed in partnership locally, provided the 1 April 2026 implementation date is met.

Colleagues noted that clarity on budgets was required to ensure that all action that is being taken at a board level is affordable.  Recruitment priorities are being progressed, but service delivery risks remain from 1 April. Indicative funding will allow targeted recruitment to minimise risk. While colleagues appreciate the ability to address concerns locally there was agreement that there needs to be a national picture of fragile services for boards to come together and make joint decisions on how best to support these. Colleagues agreed that the employers reference group that Paul Johnston chairs should commission an updated assessment of risk from all boards and present the results of this at the next meeting of the Executive Group.

Action no - action - lead - timescale

NHSEG25/83 RWW ERG to commission an updated assessment of risks from all boards - NSS Executive Support Team/ OCENHS - by end Jan 2026/24 February 2026 EG meeting

AOB

33.  No other business was raised.