Honorary Titles in Healthcare Leadership: why clarity matters

There is a funny obsession with titles amongst healthcare leaders. Nearly every CEO and Chair you spot leading a trust or a health board these days refers to themselves as a “professor” or a “doctor”. Even those with no academic qualifications will stick an (honorary) “Dr” before their name these days before sending emails to all staff to celebrate their latest round of deckchair-rearrangement.

I suppose their thinking is, what use is it to lead a profession of doctors and professors if you’re not a doctor or professor yourself?

This problem is not new. Dr Minh Alexander covered this a couple of years ago, in her article Professor: does the routine use of honorifics reduce confidence in public life?"¹ – well worth a read.

Clarification This is not the same as an honorary role. Colleges and universities recruit clinicians into honorary roles all the time (eg “Honorary Clinical Lecturer”), and there is clear guidance about how those roles are represented. Imperial, for example, publish a list of expectations of honorary association holders,² which state persons must ensure that “it is clear that the association with the College is on an honorary or visiting basis”. Other colleges do the same.

An honorary role is a function. An honorary title is a gesture of respect. The latter should not be treated as equivalent to a substantive qualification.

With that in mind, take a look at the following email³ I received from NHS Education for Scotland (NES; a health board in its own right, and the lead employer for hundreds of doctors across Scotland):

From: NHS Education for Scotland
Sent: 17 June 2025 16:09
To: All Resident Doctors in Training

NES welcomes Scottish Government announcement

Dear colleagues,

The Cabinet Secretary today (17 June) is announcing a strategy to drive improvement, innovation and cohesive delivery. This is aimed at transforming health and care services, supporting our health and social care workforce and delivering for the people of Scotland.

The strategy recognises that to meet the ambition of service renewal and address the health and care needs of our population, we urgently need to work differently… (yada yada yada)

[… cut …]

Yours sincerely,

Dr David Garbutt QPM, Chartered FCIPD
Chair
NHS Education for Scotland

Professor Karen Reid
Chief Executive
Education for Scotland

The letter is signed by Dr Garbutt and Professor Reid. Anyone skimming the email would assume: fine, both clinicians. In fact, neither is a medic nor an academic.

David Garbutt’s reappointment to the board of NES was announced by the Scottish Government in January 2022⁴, where his biography does not reference any medical training or any academic posts. The title comes from an honorary doctorate awarded by the University of Strathclyde in 2025, referenced among papers circulated to the Board of NES earlier this year.⁵

Karen Reid’s biography,⁶ similarly, refers only to honorary qualifications granted by the University of Dundee Business School, and the University of St Andrews. Again, no clinical education or formal academic background.

To that end, I pulled up the response to a request I had made across a number of institutions in Scotland, including the University of Dundee, the University of St Andrews and Strathclyde University. Below is a copy of the email I had sent just a month prior to the University of St Andrews:

From: ronald@rmacd.com
Sent: 21/05/2025 22:32
To: foi@st-andrews.ac.uk

FOI - Honorary Degrees

Good evening,

I write in relation to regulations surrounding the use of honorary titles and have had sight of your “Honorary Degree Guidelines”,⁷ last updated 18/02/2025. With that in mind, I would like to ask:

Does the University condone the day-to-day use of honorary titles such as “Doctor” or “Professor” outside of University business?

Yours sincerely,
R MacDonald.

Their response was clear:

Convention dictates that Honorary titles are used only in the context of the awarding institutions, and if used elsewhere should be clearly identified as being honorary [my emphasis]. The University would also not give an MD to anyone who did not have a medical degree.

With that in mind, the following request⁸ was made to NHS Education for Scotland, and CC’d to both Karen Reid and David Garbutt:

From: ron@docs.scot
Sent: 18/06/2025 14:48
To: nes.foi@nhs.scot
CC: Karen Reid; David Garbutt

Re: NES welcomes Scottish Government announcement

Good afternoon,

I make reference to the email below,³ and the attached response to a related FOI⁹ which was made to the University of St Andrews relating to the use of honorary titles.

The University of St Andrews makes quite clear their policy as to the use of honorary titles outside of official university business as follows:

“Convention dictates that Honorary titles are used only in the context of the awarding institutions, and if used elsewhere should be clearly identified as being honorary.”

To that end, I request the following information, under FOI if necessary:

1. Please advise as to the total number of emails that have been sent on behalf of Karen Reid or David Garbutt over the previous twelve months, where the use of their honorary titles has not been made clear within the context of the email.

Yours sincerely,
Dr R MacDonald (MBChB).

NES responded with the following:¹⁰

From: nes.foi@nhs.scot
Sent: 16/07/2025 16:55
To: ron@docs.scot

…

It is not possible to provide the information you have requested – this is because of the volume of emails which are received, issued, retained and deleted. Some are issued personally by the Chair or CEO and some on their behalf by their offices. Not all emails are required to be retained and therefore it is not possible to provide a precise number given the specifics of your request. As such, under Section 17(1) of the Freedom of Information (Scotland) Act 2002 (FOISA) the information you describe is not held by NES.

You should note that both the Chair and the CEO make clear on their NES official biographies and/or LinkedIn (all of which is in the public domain) that respective awards conveyed by respective universities are honorary – and this information would be confirmed on request. Both the Chair and CEO (respectively) act in accordance with guidance received from awarding institutions.

…

Here’s the thing though: it shouldn’t take me looking up the biographies of those sending me emails to find that their titles have been awarded on an honorary basis, and that when I get an email from my employer that the “Doctor” or “Professor” in question is not in fact a doctor or a professor at all. Precision matters: I make decisions based on who is telling me what. As does Government.

Which brings me neatly onto another point: where else are these titles being used?

This is not just about internal NHS emails. The same titles are turning up in official submissions to Parliament, to Government, to the press. If an email to all doctors in training can give the wrong impression, how much worse is it when written evidence is sent to Parliament signed by a “Professor” who is not a professor in any substantive sense? Policymakers will take that at face value. They assume expertise. That affects decisions.

For example:

February 2023: Evidence submitted by NHS Education for Scotland to the Scottish Parliament’s COVID-19 Recovery Committee.¹¹ Signed: Professor Reid. No reference to this being an honorary title.

November 2024: Letter submitted by NHS Education for Scotland to the Convenor of the Scottish Parliament’s Health, Social Care and Sport Committee, regarding training numbers in dentistry.¹² Again, signed by Professor Reid. No reference to this being an honorary title.

It’s not just NES. Take NHS Lothian. Five professors in the senior leadership team.¹³ Only three hold substantive or visiting posts. The others, including the CEO, hold honorary professorships. The biographies make this clear if you dig around, but the letterheads and public statements use the titles without saying they’re honorary. It is ambiguous by design.

This matters. Titles confer authority. They shape how information is received and trusted. When their status is unclear, it misleads. It blurs the line between expertise and status. This needs to change.

• Honorary titles should always be identified as honorary when used outside the awarding university.

• NHS boards and public bodies should follow the same rules that universities set.

• Parliamentary submissions and official statements must state clearly who is speaking and in what capacity.

The question is not whether people deserve recognition. It is whether those titles, when stripped of their honorary context, distort how their authority is perceived. Public boards and NHS leaders routinely use “Dr” or “Professor” on letterheads and parliamentary submissions without stating they are honorary. That is misleading.

The fix is straightforward: declare them as honorary, or don’t use them. Anything less is a failure of transparency.