The health board published a lengthy statement on Friday, addressing what it described as “misinformation” around the case.

NHS Fife insisted it had acted transparently and accused the campaign group Sex Matters, which is supporting Ms Peggie, of attempting to “steer public opinion”.

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It claimed reports suggesting it had been compelled to release cost information by the Scottish Information Commissioner were “inaccurate.”

The statement said: “The information commissioner stated in his decision cited above that: ‘the withheld information the Authority provided to the Commissioner was obtained from CLO after the date it received the Applicants’ requests. This means the Commissioner cannot make a finding on, or require disclosure of, this information in his decision notice.’ 

“NHS Fife subsequently made the decision to publish the figures on its website up until 31 May 2025 in the interests of transparency, and on the basis that similar information was being actively sought.”

However, Decision 133/2025 — issued by the Commissioner earlier this month — was highly critical of NHS Fife’s refusal to answer requests from The Herald and others about how much [[pub]]lic money had been spent defending the case.

At the time of the ruling, Mr Hamilton found NHS Fife had not undertaken any searches for the information and had repeatedly argued it was exempt from disclosure. He dismissed those claims and ordered the board to carry out “adequate, proportionate searches” and respond to applicants by Sunday July 14.

Following the ruling, NHS Fife quietly published figures on its website confirming it had spent £220,465.93 on the case as of May 31.

That figure has since risen to £258,831.31, though the board insists its direct liability is capped at £25,000 under the national CNORIS indemnity scheme.

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In a strongly worded statement, Mr Hamilton said: “The petulant tone of NHS Fife’s latest statement is quite remarkable, but it is the contents that concern me most.

“They have now cast doubt upon the assurances they gave me regarding compliance with my Decision Notice. I will investigate further and, if the Authority has not indeed fully complied with my Decision, then I may report the matter to the Court of Session as a contempt of court.”

Scottish Conservative MSP for Mid Scotland and Fife Murdo Fraser said: “This is a scathing and deserved rebuke from the information commissioner towards NHS Fife.

“It is almost unprecedented for him to intervene against a public body in this way, but he has been left with no option following the extraordinarily ill-judged statement by the health board.

“How on earth can John Swinney and Neil Gray continue defending the indefensible when it comes to the behaviour of those at NHS Fife?

“Their reputation lies in tatters and that could fall even further if their behaviour results in them ending up in court.”

Taking to X, Labour’s deputy leader, Dame Jackie Baillie said: “Unprecedented intervention by the Information Commissioner and shows serious concern about NHS Fife.

“The statement from NHS Fife victimises counsel, witness and Sandie Peggie. It must be withdrawn and an apology given. The SNP need to get a grip – this is their health board.”

A spokesperson for the health board told the Courier: “We are surprised and disappointed by the information commissioner’s remarks in this case.

“As we have said previously, we remain committed to complying fully with the decision notices issued in this matter, and indeed our wider compliance with all statutory obligations under the Freedom of Information (Scotland) Act 2002.”

NHS Fife has already been forced to amend its statement after Ms Peggie’s legal team accused it of linking threats of sexual violence to the nurse’s supporters.

During Friday’s hearing, the claimant’s barrister, Charlotte Elves, said it was “a matter of some concern” that the health board appeared to be associating the actions of anonymous individuals online with Sex Matters, which is supporting Ms Peggie.

She pointed to paragraph three of the NHS Fife statement, which referenced the organisation’s CEO, Maya Forstater, who has already given evidence, and the group’s chair, barrister Naomi Cunningham KC, who is leading Ms Peggie’s case.

The next paragraph states that while the case had attracted “significant and very polarised debate” on social media, “what began as debate has evolved into much more worrying behaviour, including a threat of physical harm and sexual violence, which has required the involvement of Police Scotland”.

Ms Elves told the tribunal: “Paragraph four of the statement seems to conclude that [Sex Matters’ involvement] has resulted in more worrying behaviour that has involved Police Scotland. It is a matter of some concern that a party to proceedings seems to link a witness in these proceedings with the conduct of members of the public, including threats of physical violence.”

She added: “This is quite unusual conduct of a party in proceedings, and we are concerned that it is irresponsible and unsafe in the context of what we already know.”

NHS Fife’s senior counsel, Jane Russell KC, said she had only just seen the statement and asked for more time to consider it.

However, she rejected the suggestion that it contained anything defamatory or untrue.

“It is a bit of a stretch to say that paragraph three is leading to paragraph four,” she said. “There is no way NHS Fife’s statement could be seen to directly link the threats to those involved with Sex Matters.”

She argued that the context for the statement was important, stating: “Because this has taken place in public, Fife’s witnesses have been exposed to a very unsafe environment. I have received threats, as have witnesses.”

Nevertheless, NHS Fife later tweaked the release, adding: “To be clear, NHS Fife is not seeking to suggest that anyone involved with Sex Matters have contributed to the behaviour or issues mentioned above.”

The Peggie tribunal resumed this week after a five-month adjournment. Ms Peggie, an A&E nurse at Victoria Hospital in Kirkcaldy, is suing the board and her colleague, Dr Beth Upton, after she was suspended for raising objections to the trans doctor’s use of a female changing room on Christmas Eve 2023.