However, the case is complex and NHS Fife do not actually pay the full costs.
The taxpayers most likely will.
Shared legal team
Crucially, NHS Fife is sharing a legal team with Dr Upton, the transgender medic at the forefront of the case.
This may sound odd but it is actually standard in NHS legal cases.
It is argued that the staff member may only have become exposed to any risk of liability after being sued while doing their job.
However, NHS Fife must weigh up the risks in sharing a legal team, including whether there could be any “conflicts of interest”.
Ms Peggie is suing her employer and Dr Upton after she objected to the trans medic’s use of the female changing room on Christmas Eve in 2023 at Victoria Hospital in Kirkcaldy.
She also made reference to the situation being similar to men being housed in the female prison estate.
The nurse was placed on special leave in December 2023 and suspended in January 2024.
She was cleared of all misconduct allegations on July 15 2025, including two patient safety complaints.
NHS Fife legal team
It is important to note that health boards in Scotland do not directly employ their own solicitors.
Solicitors in the Central Legal Office (CLO) act exclusively for the NHS.
However, the CLO then appointed Jane Russell KC, from the Essex Court of Chambers in London, to represent the case in court.
Silks – or King’s Counsel (KC) barristers – typically charge between £500 and £1,500 per hour.
Given Ms Russell had been at Dundee Tribunal Hearing Centre over 10 days from July 16, with court sitting approximately between 10am and 4pm each day, the recent sessions could have cost the health board at least £30,000.
However, NHS Fife is a member of the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS).
This is a pooling arrangement between Scottish health boards and means NHS Fife will only be required to meet the first £25,000 of the cost.
The remaining bill is covered by the scheme, which is paid for through the Scottish Government‘s Health and Social Care Directorate that underwrites the scheme.
Costs so far
As of June 30, NHS Fife have accrued £258,831.31 in legal costs associated with the Sandie Peggie case.
But the costs are undoubtably set to rise.
Research by Murray Blackburn Mackenzie policy collective states: “The decisions which have driven the cost of this case rest formally with NHS Fife, but in practice the CLO also appears to be a relevant decision-maker of some sort, but to what extent and with what oversight from its own senior management, is very difficult to say.
“Perhaps the only place it will ever be possible to unpick the full story of who decided what, when and how, will be in front of a parliamentary committee, with the questions asked direct of senior staff and board members for NHS Fife, National Services Scotland and the Scottish Government itself.”
In a statement published on July 18, NHS Fife said: “As of 30 June 2025, £258,831.31 in legal costs have been recorded as expenditure related to the legal services associated with this case.
“NHS Fife is liable for the first £25,000 of costs associated with defending the case.”
Earlier this year, NHS Fife did not reveal the legal costs, stating that the health board “believed that it did not hold the figures requested as the legal fees were managed through the Central Legal Office (CLO) and National Services Scotland (NSS) who administered the CNORIS Indemnity scheme”.
Following criticism from the Scottish Information Commissioner, NHS Fife revealed the costs amounted to £220,465.93 up to May 2025.