NHS Scotland Executive Group minutes: February 2026

Attendees and apologies

NHS boards

• Gordon James, NHS Ayrshire and Arran (IP)
• Peter Moore, NHS Borders (IP)
• Carol Potter, NHS Fife (IP)
• Laura Skaife-Knight, NHS Grampian (IP)
• Jann Gardner, NHS Greater Glasgow and Clyde (IP)
• Fiona Davies, NHS Highland (IP)
• Louise Long, NHS Lanarkshire (IP)
• Caroline Hiscox, NHS Lothian (IP)
• James Goodyear, NHS Orkney (IP)
• Brian Chittick, NHS Shetland (V)
• Nicky Connor, NHS Tayside (IP)
• Gordon Jamieson, NHS Western Isles (IP)

Special health boards

• Robbie Pearson, Healthcare Improvement Scotland (IP)
• Paul Johnston, Public Health Scotland (IP)
• Mary Morgan, NHS National Services Scotland (V)
• Karen Reid, Chief Executive, NHS Education for Scotland (IP)
• Jim Miller, NHS 24 (V)
• Michael Dickson, Scottish Ambulance Service (IP)
• Gary Jenkins, The State Hospital for Scotland (IP)

Scottish government

• Caroline Lamb, DG HSC/CE NHS Scotland (IP)
• Christine McLaughlin, Chief Operating Officer (IP)
• Fiona Hogg, Chief People Officer (V)
• Aisha Holloway, Chief Nursing Officer (V)
• Gregor Smith, Chief Medical Officer (V)
• Robert Kirkwood, Head of NHS Executive Office (V)

Other attendees

• Jacqueline Totterdell, Director General Health, Social Care and Early Years/NHS Wales Chief Executive (IP)
• Ken Donaldson, NHS Dumfries and Galloway, Interim Chief Executive (IP)
• Derek Grieve, Director for Health and Social Care Performance and Delivery (V)
• Neil Harrison, Strategic Communications Lead (V)
• Lynne Nicol, Deputy Director Planning and Quality (for Maternity Item) (V)
• Donna McLean, Chief Inspector, Healthcare Improvement Scotland (for Maternity Item) (V)

Secretariat

• Laurie Whyte, Board Governance and Appointments Team (IP)
• Sarah Hobkirk, Board Governance and Appointments Team (IP)
• Carol Hunter, Board Governance and Appointments Team (V)
• Tim Andrew, Interim Programme Director Executive Support (IP)

Apologies

• Julie White, NHS Dumfries and Galloway
• Ross McGuffie, NHS Forth Valley
• Carolynne O'Connor, NHS Golden Jubilee
• Fiona Bennett, Chief Finance Officer
• Richard Foggo, Director of Population Health
• Angie Wood, Director, Social Care Resilience and Improvement
• Paula Speirs, Deputy Chief Operating Officer (Health Planning)
   

Items and actions

Welcome, apologies for absence and attendees

Caroline Hiscox, Chief Executive of NHS Lothian and Chair of NHS Board Chief Executives Group welcomed colleagues to the 11th meeting of the NHS Scotland Executive Group.  

Caroline welcomed Jacqueline Totterdale, DG Health, Social Care and Early Years/NHS Wales Chief Executive to the meeting who was shadowing Caroline Lamb for the day. Jacqueline introduced herself and outlined the current position in Wales, noting the sensitive political context and strong similarities with the challenges in Scotland.

Caroline welcomed Ken Donaldson to his first meeting as Interim Chief Executive for NHS Dumfries and Galloway, and congratulated Karen Reid on her appointment as Chief Executive of Public Service Delivery Scotland (PSD Scotland), effective from the beginning of April 2026.

Caroline thanked Mary Morgan for her work and commitment to NHS National Services Scotland since becoming Chief Executive in April 2021. Colleagues wished Mary well for the future.

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 10 December 2025 were approved.

A copy of the action tracker was shared, which provided an update on the actions from the last meeting. Caroline reminded colleagues to be pro-active in providing OCENHS team with updates on progress with actions, when they are completed or if anything changes.

Caroline Lamb, DG HSC and Chief Executive of NHS Scotland, provided a further update on the review of the executive senior management (ESM) pay reward system. Several actions are now underway, including a review of the operation of the national evaluation committee, where Caroline will meet with the Chair of NHS Chairs next week to discuss the work needed to be taken forward by Chairs. Work is ongoing to provide advice to Ministers on a review of the grading structures and the actual pay levels, given the announcement of a new local government pay scale.  That work would have First Minister approval with a view to having it presented to incoming Ministers.

NHS Scotland executive group terms of reference update

The terms of reference have been updated (section 4: membership – roles and responsibilities) to reflect that the executive support team may share papers with executive leads for information as agreed by colleagues at the last DG catch-up meeting. Chief Executives were content, however asked for any changes to be highlighted in the paper for ease of review.

Board Chief Executives group strategic update

A paper was shared with colleagues in advance of the meeting. Karen Reid, Chief Executive, NHS Education for Scotland provided a strategic update on the work of board Chief Executives to deliver against national priorities including the operational improvement plan (OIP), service renewal framework (SRF) and population health framework (PHF).

There has been continued focus on improving planned and unscheduled care, supported by weekly management meetings running until the end of March which include co-ordination of mutual aid across boards — particularly those recently impacted by bad weather, unscheduled care pressures, the CDU outage, and waiting time challenges. Paul Johnston, Chief Executive, Public Health Scotland has led work on the reduced working week (RWW) and financial planning for 2026 27 continues - including consideration of RWW implications. Over the coming months, leadership development sessions would focus on planned and unscheduled care, CDU resilience, mental health, population health (including poverty), and the implementation of the RWW.

CE national weekly check-in

A paper was circulated to attendees in advance of the meeting which provided colleagues with an update on the CE national weekly check-ins and next steps. Tim Andrew, Interim Programme Director Executive Support advised that the proposal is to continue the work already undertaken, with progress being reviewed each Monday to a substantial level of detail. The indicative timescales align with the OIP, but there is a need for greater clarity at a sub national level on any required changes and the supporting infrastructure. The system shift affects around 200,000 people in the community, reinforcing the importance of a coordinated national approach.

Caroline and colleagues agreed that any commitment should be a collective decision, and if the timing is not right to standdown these meetings, they would continue at this time. The item is included because it is considered part of the formal governance structure, and members were invited to raise any comments or concerns.

Operational improvement plan update

A paper was circulated to attendees in advance of the meeting which provided colleagues with an update on progress against the OIP. Christine McLaughlin, Chief Operating Officer was invited to talk to this item. Christine noted the overall programme RAG for January 2026 remains amber, with waiting times still challenged. Several deliverables remain amber red or amber green and >52 week waits continue to exceed March 2026 trajectories in some boards. January activity focused on reviewing March 2026 trajectories, supporting boards with targeted interventions, and mitigating slippage through redirected investment to keep deliverables on track.

Recently published data showed strong improvement in waiting times, with new outpatients down 52.6% since July and TTG down 30%; work now centres on confirming the 31 March position ahead of a likely ministerial statement on 18 March and securing clarity on 2026 27 funding.

Flow remains a concern as investment has not yet translated into performance improvement, requiring short term grip and continued support through sub national planning with support from the centre for sustainable delivery (CfSD) and others.

Digital progress, including My.Care rollout preparation, remains positive alongside strong prevention activity and continued progress in CAMHS. Christine thanked colleagues for their ongoing work.

Derek Grieve commented that the 2026 27 approach worked well without a formal OIP, highlighting the benefits of focusing on fewer priorities, collaborating effectively, and being open with Ministers about challenges and opportunities. He suggested mainstreaming this approach within the organisation and thanked colleagues for their continued work.

Caroline noted the value in pausing to reflect on earlier points and confirmed that Chief Executives have successfully delivered on their objectives, supported by a more collaborative way of working. She thanked colleagues and advised that an additional Executive Leads meeting would be held to pick up outstanding issues, with all submissions now with relevant leads.

Tim Andrew reported that the aggregated landing position is complete, with final TTG and outpatient figures to follow, and that Boards are returning the data needed to differentiate the 78–104-week cohort. Caroline noted assurance around delivering the 104-week position and highlighted the need for revised national modelling, which Katie Cuthbertson, National Director (CfSD) will lead. She also updated on productivity work, noting progress over the past year and plans to establish consistent core measures across boards. She stressed the importance of clarity on the financial envelope and urged boards to maintain momentum given the recent slowdown in improvement.

Louise Long, Chief Executive, NHS Lanarkshire and Laura Skaife Knight, Chief Executive, NHS Grampian highlighted the valuable support from SAS, NHS 24, CfSD and Scottish Government, which has enabled significant scoping of collaborative activity. Longer term opportunities exist to improve consistency and system wide planning, while a focused 12 week recovery effort is needed in the short term. Regardless of sub national planning outcomes, the OIP could be used to reprioritise activity, with boards taking greater ownership and building on existing work with Chief Officers. Chief Operating Officers were commended for progress in the sub national space, with encouragement to pursue more radical thinking, including shared approaches across east and west. Immediate priorities included establishing command centres, standardising flow navigation, strengthening escalation frameworks, and shifting from single site pressures to a regional flow model.

Colleagues noted that work had begun to gather more granular data, such as frailty unit use, discharges before 11am, and weekend activity, which showed significant variation across organisations. Delays relate not only to social care capacity but also diagnostics and internal processes, highlighting the need to use the right data to drive change, as most issues stem from flow rather than demand. The group also discussed the need to raise ambition around prevention; while current plans offer some assurance, they may not deliver the required pace of change, and long term funding remained uncertain.

Colleagues highlighted the importance of capturing recent declines in cervical screening uptake and concerns about vaccination trends, including measles outbreaks, stressing that prevention and screening were fundamentally about people and their behaviours, communities and the places we need to reach them. Clinicians were key assets in activating the system, but uptake depended on workforce encouragement and engagement.

Sub-national planning

Two papers were shared with colleagues in relation to this agenda item - paper NHSEG/26/04a provided updates from Scotland east and Scotland west groups and paper NHSEG/26/04b outlined the work of the sub national planning oversight group.

Paper NHSEG/26/04a shared progress, with clear understanding of the main geographies and three priority areas: national dl priorities, regional work, and vulnerable services. The programme is addressing immediate needs while capturing learning to support a more stable and agile system. Work was progressing toward a consolidated plan, recognising dependencies across the once for Scotland landscape and balancing regional differences with a national approach. Improvements continued in fragile services, cross‑board governance, and financial triangulation, alongside strong engagement with trade unions and staff. Weekly consolidated communications to specialty groups were planned, with growing clinical involvement. Data and outcomes remain central, supporting a model focused on keeping people at home where possible. Three golden thread themes (rural and island needs, deprivation and tackling inequalities, and innovation) continued to guide the work. Digital developments, including flow navigation and virtual beds, were progressing well, with clear milestones set for delivery by the end of March.

Caroline recapped, noting that the national oversight group would consider where best to locate the plans. Further discussion would take place regarding this and an agenda prepared.

A point of note was raised by Fiona Davies, NHS Highland regarding the east minute: the assurance attributed to NHS Highland on vascular services was inaccurate, as boards providing mutual aid must also provide assurance. It was also noted that, should performance monitoring feed into sub‑national planning and the workstream, additional support would be required due to capacity implications. In discussion on deprivation, colleagues highlighted that this remained a key thread within wider prevention work. They stressed the need to consider not only the delivery of health and prevention activity in deprived communities, but also the broader anchor role of boards in economic regeneration. This included how organisations build, employ and invest in communities, rather than focusing solely on individual‑level interventions.

Caroline noted medical directors continue to meet weekly on mutual aid, and written assurance would be submitted ahead of the next group meeting. Caroline Lamb confirmed the proposal that two representatives would be nominated to join the oversight group. Colleagues discussed the need to engage with national partners while recognising the political context and the importance of that platform for both partnership engagement and expectations around timelines. It was noted that we must work within the policy and political cycle, which may require developing an initial, high level framework that could be refined as the national position becomes clearer.

While early external engagement would be welcome, the group recognised that meaningful engagement with staff could only begin once there was a clearer sense of what Ministers may be prepared to accept. The importance of continuing to progress the work while remaining flexible around timing was emphasised.

Maternity Services

A slide pack on maternity services was shared with colleagues in advance of the meeting. This agenda item addressed the themes from the review and focussed on the future model for maternity services following a recent discussion with NHS Chairs. Caroline Hiscox and Nicky Connor, Chief Executive, NHS Tayside spoke to this item.

Robbie Pearson, Chief Executive, Healthcare Improvement Scotland advised that the findings were consistent across multiple reviews and were not isolated.

Jacqueline Totterdale shared experiences in NHS Wales, noting that local leadership was the key to managing services and without that it was difficult to penetrate issues. Training, culture, individual responsibility, well embedded duty of candour and engagement with women who have suffered loss are all equally as important.

Culture, risk and demographic change are creating challenges for nurses, and boards are not yet prepared. Colleagues stressed the need to avoid inspections becoming part of a blame culture. NHS Greater Glasgow and Clyde are developing a resolution framework to address inter professional tensions and support open, honest dialogue. The group highlighted the importance of understanding the health of young women and prioritising early intervention before pregnancy to reduce future high risk demand. Parallels were noted with mental health, where culture, risk and individual clinicians’ perceptions strongly shape organisational behaviours. Regional variation was discussed: for example, island women routinely travel to Glasgow for weeks before birth without complaint, while other areas react strongly to much shorter travel distances. Historic service changes in Caithness continue to influence local expectations. Colleagues stressed that system reform (including SRF) must consider whole pathways, not just maternity services. Wales will publish an independent neonatal and maternity assessment tomorrow, with eight recommendations, contributing to the wider evidence base.

Colleagues noted the importance of ensuring Scotland is fully prepared to respond to forthcoming national reports and recommendations, and that early engagement would be essential. It was recognised that the system has known for some time that mental health remained a blind spot, and that earlier action would have been beneficial. The group emphasised the need to strengthen the focus on data and analysis to better understand where issues sit, and to use this intelligence to shape the work ahead. Colleagues agreed that activation - supporting people to engage with services - must not be overlooked, and that data‑driven insight should guide future decisions.

Business systems infrastructure

Peter Moore, Chief Executive, NHS Borders briefly spoke to this agenda item providing a short update on issues. He advised that a paper would be shared with the executive group providing more detail.

Reduced working week

A paper was shared with colleagues in advance of the meeting, providing an update on the current status of reduced working week preparations in NHS Boards.

Paul Johnston, Chief Executive, Public Health Scotland advised colleagues that most returns had been received from the February data gathering with a small number outstanding; no significant changes from previous iterations had been reported. The programme remained in a position of reasonable assurance for delivering the Reduced Working Week from 1 April. Approximately 71% of lost capacity will require backfill, with around 30% being met through innovation and service redesign. Between 25% and 100% of backfill was expected to be in place by 1 April, with remaining gaps covered through measures such as overtime, extended contracts and use of the independent sector. While some redesign and improvement work could not be fully delivered by April, maintaining momentum would help reduce reliance on additional capacity over time. Funding remained a significant factor; confirmation of the £300m envelope provided clarity.  However, Directors of Finance were clear that the total sum required to resource the full package of agenda for change reform was well in excess of £300m, and therefore financial risk remains. Discussions continue with Health Finance on this matter.

Christine McLaughlin, Chief Operating Officer advised that the Cabinet Secretary was keen to have assurances from the executive group and a letter would be sent out to each board. It was emphasised that this ongoing process - requesting updated information from every board remains essential to ensuring an accurate, collective understanding of readiness. Colleagues also stressed the importance of ensuring any forthcoming letter or communication aligns with, and complements, this established process, rather than creating a parallel or disconnected request.

Colleagues highlighted that while innovation, service redesign and pragmatic decisions have helped identify backfill solutions—particularly in non-24-hour services—this may unintentionally drive investment toward acute care rather than prevention. It was noted that these consequences should be acknowledged and considered in future planning, as system changes could shift the balance between prevention and acute treatment.

Contract reform negotiations

This agenda item was postponed to a future meeting.

Band 5 – thematic analysis on progress of B5 reviews (NHSEG/26/07)

The executive group noted the item on the band 5 reviews.

CE of Wales reflections

Caroline Hiscox invited Jacqueline Totterdell, DG Health, Social Care and Early Years/NHS Wales Chief Executive to share her thoughts from the morning’s discussions.

Jacqueline reflected on the comparison with Wales and noted the value of data driven approaches in identifying normal variation and understanding where true variation requires action. It was observed that a lack of robust data in some papers limits the ability to make these distinctions. She also recognised shared challenges across systems, including the difficulty NHS boards face in trying to address the full spectrum of population needs—from preventing ill health, to supporting community based care, to managing hospital demand.

She added that organisational structures, largely unchanged since 2009, may no longer fully support the strategic population health role expected of boards. She reflected on work underway in Wales to develop a clearer clinical plan defining future functions and enabling Boards to focus on strategic leadership rather than being pulled into day to day operational pressures. She agreed that Scotland faces similar questions about how best to structure and support population health functions nationally and locally.

Any other business

Caroline Lamb reminded Boards of the need to implement the Supreme Court Judgement on the definition of ‘woman’ in the equality act 2010, following the letter issued on 30 September 2025. Gillian Russell attended a board Chief Executives meeting in October 2025 where Chief Executives confirmed that implementation work was underway. Boards were again asked to ensure full compliance with the judgement and the law, seeking independent legal advice from Central Legal Office (CLO) where needed. They were also reminded to maintain strong information governance practices, ensuring appropriate oversight of all related information requests and exchanges.

Next meeting date

The date of the next NHS Executive Group Meeting is 22 April 2024.