NHS Scotland Executive Group minutes: October 2025

Attendees and apologies

NHS Scotland Executive Group - Attendees

NHS Boards

• Gordon James, Interim CE, NHS Ayrshire and Arran
• Peter Moore, NHS Borders
• Carol Potter, NHS Fife
• Laura Skaife-Knight, NHS Grampian
• Jann Gardner, NHS Greater Glasgow and Clyde
• Louise Long, NHS Lanarkshire
• Caroline Hiscox, NHS Lothian
• James Goodyear, Interim CE, NHS Orkney
• Brian Chittick, NHS Shetland
• Nicky Connor, NHS Tayside

Special Health Boards

• Jim Miller, NHS 24 
• Karen Reid, NHS Education for Scotland
• Carolynne O’Connor, Interim CE, NHS Golden Jubilee
• Mary Morgan, NHS National Services Scotland
• Michael Dickson, Scottish Ambulance Service
• Gary Jenkins, The State Hospitals Board for Scotland

Scottish Government

• Caroline Lamb, DG HSC/Chief Executive NHS Scotland
• Fiona Hogg, Chief People Officer
• Fiona Bennett, Director of Health and Social Care Finance
• Angie Wood, Director of Social Care Resilience and Improvement
• Gregor Smith, Chief Medical Officer
• Robert Kirkwood, Head of NHS Executive Office

Other Attendees

• David Rowland, Director of Strategic Planning and Transformation, NHS Dumfries and Galloway (deputising for Julie White)
• Kevin Reith, Director of People, NHS Forth Valley (deputising for Ross McGuffie)
• David Park, Deputy CE, NHS Highland (deputising for Fiona Davies)
• Frances Robertson, Chief Operating Officer, NHS Western Isles (deputising for Gordon Jamieson)
• Ann Gow, Deputy CE, Healthcare Improvement Scotland (deputising for Robbie Pearson)
• George Dodds, Chief Officer, Public Health Scotland (deputising for Paul Johnston)
• Paula Speirs, Deputy Chief Operating Officer – Planning and Sponsorship
• John Harden, National Lead for Quality and Safety
• Derek Grieve, Programme Director, Operational Improvement Plan
• Daniel MacDonald, Head of NHS Pay (for Agenda Item 6 and 7
• Kenny Nairn, Cloud Engineer, Directorate for Digital (for Agenda Item 7)
• Scott Davidson, Medical Director, NHS Greater Glasgow and Clyde (for Agenda Item 8)
• Lily Green, Cancer and Rehabilitation Team Leader (for Agenda Item 8)
• Rishma Maini, Joint Interim lead of Clinical Health Intelligence and Research Division, Public Health Scotland (Observer)

Secretariat

• 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

• Julie White, NHS Dumfries and Galloway (David Rowland deputising)
• Ross McGuffie, NHS Forth Valley (Kevin Reith deputising)
• Fiona Davies, NHS Highland (David Park deputising)
• Gordon Jamieson, NHS Western Isles (Frances Robertson deputising)
• Robbie Pearson, Healthcare Improvement Scotland (Ann Gow deputising)
• Paul Johnston, Public Health Scotland (George Dodds deputising)
• Christine McLaughlin, NHS Scotland Chief Operating Officer/DCE
• Anne Armstrong, Chief Nursing Officer
• Richard Foggo, Director of Population Health
   

Items and actions

Welcome, apologies for absence and attendees

Caroline Hiscox, Chair of Chief Executives Group/Chief Executive, NHS Lothian welcomed colleagues to the 9th meeting of the NHS Scotland Executive group. 

Caroline acknowledged apologies and welcomed James Goodyear, Interim Chief Executive, NHS Orkney to his first meeting. 

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

Minutes of previous meeting, actions, matters arising (NHSEG/25/48)

The minutes from the last meeting of the Executive Group held on 19 August 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.

The business systems programme is progressing well, with system coverage targeted for 2028 and major workstreams on track. While governance has been revised, further strengthening and improved communication across boards are required. The full business case and operating model will transition to board-level oversight during implementation, with final comments expected shortly.

Key challenges include funding clarity, risk-sharing, and aligning cost-benefit profiles. Boards must collectively ensure accountability for savings and integrate financial planning into national strategies. Development events are planned to address programme gaps, with mitigation plans due by February and additional resources under consideration.

Strategically, the programme represents a transformative shift in digital systems and links with wider public service reform. Chief Executives acknowledged the importance of this work and the impact it will offer. A further update would be provided at the next NHS Scotland Executive Group meeting.

• discussion on this update included
• importance of consistency across boards and clarity on transition
• risks of delay versus benefits; financial implications need balancing
• collective accountability for savings and reporting
• sustainable business model and common operating model alignment
• digital transformation impact and systemic implications
• long-term financial balance and infrastructure updates

Action no action lead timescale

NHSEG25/63 - provide further update on business systems transformation programme - Peter Moore, NHS Borders, SG secretariat - EG meeting 10 December 2025

Fiona Hogg, Chief People Officer, Scottish Government provided an update on executive recruitment.

• Caroline Hiscox contextualised this update by outlining the Chief Executives joint position regarding the paper on executive recruitment that was discussed at the August meeting. While Chief Executives support the intent to be thoughtful and collaborative around executive recruitment across the system, they acknowledge the importance of maintaining the accountability for decision making within the board. There was consensus on the need for a balanced approach that considers risks and benefits for roles, avoids unnecessary bureaucracy, and supports system-wide collaboration and a commitment from Chief Executives to work together on this
• in response, Fiona Hogg suggested a light touch approach for sharing and collaborating on executive recruitment without introducing formal approval processes, facilitated by Fiona and the HR directors, with the goal of ensuring opportunities are not missed and to map ongoing recruitment activity across the system. By engaging in succession planning and sharing of intelligence in this way, we can strengthen existing collaboration and ensure that local boards benefit from system-wide insights and strategic alignment as well as understanding opportunities for shared roles and different approaches that are being taken
• it was acknowledged that executive recruitment faces challenges related to remuneration and grading and disparities with agenda for change and local council pay. The planned review of the approach to Executive pay and grading has been paused, with no information on when this may be restarted. There is also a delay in agreeing the ESM pay award from 1 April 2025 and no clear timescale for this either. Caroline Lamb agreed to take an action to provide clarity for colleagues on the timescales for both

Action no action lead timescale

NHSEG25/64 - provide clarification on timings for ESM pay uplift and wider review - Caroline Lamb/Daniel MacDonald 14 November 2025

Nicky Connor, Chief Executive, NHS Tayside provided an update on vascular following previous agenda items and the whole day strategic workshop that took place on 2 September 2025.

• significant progress has been made in addressing vascular service risks, particularly in Highland, which was previously identified as high-risk. Phase 1 implementation is underway, risk levels have reduced, and stability has been achieved. Full consensus is expected following further engagement and workshops. Key areas requiring continued focus include financial modelling, data sharing, interventional radiology (IR) implications, and communications strategy
• colleagues were reassured that progress was made through this work and that key issues are being addressed. A comprehensive update will be provided in at the December NHS Scotland Executive Group meeting.

Action no action lead timescale

NHSEG25/65 - provide further update on vascular - Nicky Connor, NHS Tayside, SG Secretariat - EG meeting 10 December 2025

John Harden, National Clinical Lead for Quality and Safety talked to the paper that had been shared in advance of the meeting.

• the quality and safety report highlights significant variation in clinical performance across Scotland, with key areas requiring urgent attention. Infection control remains a concern, with rising rates of C.diff and E.coli infections, prompting a need to reinforce protocols and ensure consistency across boards. Inspection reports continue to flag issues in fundamental care standards, requiring renewed focus
• maternity and neonatal services present a flat or deteriorating picture, with a continued increase in C-section rates and associated complications, alongside notable changes in neonatal care. Paediatric data remains limited at a national level, though effectiveness appears stable with scope for improvement. These trends raise questions about both local and national responses and the strategic use of quality and safety data to drive improvement
• transparency and consistency in quality and safety data remain challenging. Current reporting is fragmented, with no unified national dashboard, limiting the ability to benchmark and identify systemic risks. Boards must commit to sharing data openly and addressing outlier performance through local clinical governance structures. The quality and safety subgroup’s role is to monitor and inform strategic decisions only, with assurance and mitigation measures managed locally within boards
• discussions emphasised a lack of consistent data available from boards on quality and safety. Much of the data collection still requires manual input and is captured differently across Scotland. Further work needs to be done to ensure this variation is address to accurately capture this information. A national dashboard for quality and safety is being proposed however there needs to be a clear cultural shift towards openness on this data to help inform strategic decisions on services
• clarity is required on the role of the Executive Group for this information and making sure there is a clear improvement focus to allow for issues to be addressed before action is required through HIS. Improvement and scrutiny need to be separated and clearly demonstrate a culture of continuous improvement in service delivery

Action no action lead timescale

NHSEG25/66 - colleagues to discuss how to best utilise the information available to ensure an improvement focus. Including the proposal for quality and safety as a standing item with annotated charts and highlighting board variation - John Harden/ Gregor Smith and Claire Gilroy, NSS Secretariat - 14 November 2025
NHSEG25/67 - CEs to review local data through appropriate channels, identify outliers, and confirm mitigation actions - all Chief Executives - 14 November 2025

Feedback from board Chief Executives (verbal)

A paper was provided for colleagues outlining a summary of the BCE meetings in August and September 2025. Karen Reid, Vice Chair of Chief Executives Group was invited to provide colleagues with further updates on key items including from the 14/15 October Board Chief Executives meetings. These covered:

• supreme court judgement on single sex
• business services
• population health
• NHS delivery consultation
• CDU SBAR
• payroll services
• finance
• national referral protocol
• Scottish approach to change
• digital front door
• dental records
• adverse events
• mental health advocacy
• young person gender services
• late stage abortion

Colleagues are currently considering a joint response from Chief Executives on the NHS delivery consultation and have confirmed boards are to provide individual responses.

Operational improvement plan (NHSEG/25/53)

Derek Grieve, Programme Director, OIP, updated colleagues on progress against the operational improvement plan (OIP). 

He highlighted that planned care continues to demonstrate reductions in long waits and positive movement in projected dates. The programme is transitioning from a grip and control phase to an assurance approach, reflecting the improved stability. However, the immediate priority remains addressing long waits, particularly 78 week and 104 week cases, and focusing on individual specialties.

A clear and renewed emphasis is needed on accident and emergency performance, in particular flow improvement is critical. There is a minimum expectation that boards work towards a 5 percentage point improvement; this will require targeted action, especially in boards with high volumes.

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

• clarity on data and how activity is reported, including removal from lists through validation or alternative pathways including hospital at home and virtual beds
• assurance was provided that unscheduled care is adopting a similar grip and control approach, as planned care. With weekly reporting to the collective group and national data alignment with PHS. Strategic priorities include: enhancing system-wide flow, leveraging hospital-at-home and virtual bed models, with governance requirements under review. Addressing frailty pathways to reduce hospital admissions
• it was noted that additional data could be provided to highlight community care trends, in particular on increased prescribing at pharmacy rather than through GP settings. This demonstrates the desired shift toward closer-to-home delivery

Winter preparedness (NHSEG/25/54)

Paula Speirs, Deputy Chief Operating Officer (Health Planning) introduced this item stating that winter preparedness remains a critical annual agenda item. Boards have provided assurance that plans are in place, with final returns due tomorrow. The Cabinet Secretary has emphasised 2 priority areas: vaccination uptake and delayed discharge, both essential for system resilience and maintaining public confidence.

Chief Executives were challenged to ensure proactive action on system oversight including active engagement with CRAG (Collaborative Response and Assurance Group), strengthen assurance functions for effective data sharing and align local and national messaging.

It was highlighted that this is no longer standalone winter planning but that planning for surge in demand for services should be embedded across whole system plans throughout the year, and linked to broader system resilience. 

Industrial action preparedness (NHSEG/25/55)

Karen Reid, Chief Executive, NHS Education for Scotland, provided an update to colleagues on the preparedness guidance for boards relating to resident doctors and dentists in training NHS Scotland. BCEs now will undertake local scenario planning using the guidance. A resilience group has been stood up to look at planning and links have been made to better support SG primary care policy colleagues should GPs ballot.

Daniel MacDonald, Head of NHS Pay Scottish Government provided an update that the current offer for resident doctors and dentists is with the BMA. 

Action no action lead timescale

NHSEG25/68 - BCEs to undertake local scenario planning using the industrial action preparedness guidance - all Chief Executives - 14 November 2025

Reduced working week (NHSEG/25/56)

Daniel MacDonald was asked to lead this item with the Chief Executive lead on leave. It was reiterated that the implementation date of 1 April 2026 remains non negotiable for RWW. Noting that while work is progressing nationally with plans submitted by boards there is variation across these plans. 

Plans have been reviewed by STAC highlighting the need for further detail from some boards, particularly around local action plans, risk mitigation, and cost implications. Those that have included costs vary significantly across boards. Finance teams are engaging to clarify assumptions, particularly regarding like-for-like replacement versus service redesign. Engagement with staff side partners is ongoing, with feedback awaited on flexibility options and alternative approaches.

Colleagues acknowledged there is a need for Chief Executives to come together to share learning and best practice before escalation to STAC and MSG, including how best to utilise opportunities for flexible rostering and innovative workforce models. Ensuring alignment with wider flexible working priorities.

Colleagues asked for analysis from Scottish Government on the plans to be shared with the Chief Executive cohort and for a Extraordinary Chief Executives meeting to take place to discuss.  

Action no action lead timescale

NHSEG25/69 - sharing of themed analysis on RWW plans to all CEs - Daniel MacDonald/ Claire Gilroy - 14 November 2025
NHSEG25/70 - extraordinary CEs meeting on RWW - Claire Gilroy - November 2025

Oncology TOM (NHSEG/25/57)

Scott Davidson, Medical Director, NHS Greater Glasgow and Clyde led on the oncology task and finish group provided context on the comprehensive review of oncology services which was undertaken to develop a target operating model (TOM) for NHS Scotland. 

The proposed model outlines four-tiered levels of care, with treatment centres organised by complexity and patient volume. Detailed population data analysis underpins the recommendations, with broad clinical and discipline-wide engagement informing options, risks, and operational considerations.

Key principles include:

• patient-centred care: deliver care as close to home as possible, while recognising that rare cancers may require travel to optimise patient outcomes
• integrated approach: emphasis on multidisciplinary teams (MDTs), digital solutions, continuity of care, and patient preference
• standardisation: the report demonstrates TOM feasibility but highlights the need for standardised pathways, strong leadership, and sustainable systems
• future pathways: includes remote consultations, national prescribing systems, and sustainable workforce planning aligned with realistic medicine principles

Colleagues noted the quality of work undertaken to draw out options and thanked Scott for his leadership on this. Colleagues endorsed the oncology TOM recognising the importance of learning from the vascular TOM and addressing key concerns appropriately. Further work is required on the leadership required for implementation and the implications of resourcing.

Action no action lead timescale

NHSEG25/71 - discussion with vascular lead to share learning and discuss next steps to transition to implementation - Nicky Connor/ Scott Davidson/ John Harden - asap

Financial risk management (NHSEG/25/58)

Fiona Bennett, Chief Finance Officer, Scottish Government, asked the group to note and endorse an approach to corporate risk management that looks at how this is managed across Scotland and draw out common risks. Risk leads approached Fiona regarding the variation across Scotland, this is not to change individual boards approaches but look at the national picture.

Colleagues noted that variation had been a theme coming through regarding data at boards and for those outliers for this it would be helpful for conversations on this to understand against other boards positions. It was agreed that Chief Executives should look at variation and ensure alignment across boards. Colleagues endorsed the approach to be taken. 

Action no action lead timescale

NHSEG25/72 - Chief Executives to look into variation of data in private meeting - NSS secretariat/ Claire Gilroy - November 2025

Service renewal framework first 6 months (NHSEG/25/59)

Paper NHSEG/25/59 had been shared with attendees in advance of the meeting for noting. The paper provided a progress update covering the first 6 months of SRF. 

A full discussion on SRF would be scheduled at the December NHS Scotland Executive Group meeting. 

Action no action lead timescale

NHSEG25/73 - service renewal framework discussion - SG Secretariat - EG Meeting - 10 December 2025

Any other business

Caroline Lamb, DG Health and Social Care/Chief Executive NHS Scotland reminded colleagues the next meeting they have with the First Minister collectively is 4 November 2025. At this meeting colleagues should be prepared to discuss progress against the OIP and preparations for winter.

Date and time of next meeting

The next meeting will take place on Wednesday 10 December 2025, 13:00-16:00.