It is the highest level of intervention currently available and addressed “serious, significant and persistent” concerns around the use of freedom of information (FOI) legislation.
At least six significant issues were identified by the watchdog, including the health boards “interpretation” of requests and the handling of “high profile issues”.
It comes after NHS Fife has been rebuked by the watchdog on a number of occasions, including how it has handled FOI requests from The Herald in relation to costs and transparency in the Sandie Peggie employment tribunal.
Mr Hamilton said there were also concerns around NHS Fife’s “co-operation with the Commissioner’s staff during the investigatory process”.
The intervention will look to address the issues and support improvements in the culture and practice from the health board.
Mr Hamilton said: “Level 4 interventions are extremely rare, but the serious and systemic nature of the concerns that have come to light mean that this is the only route through which these issues can be appropriately addressed and resolved. While the board is undoubtedly facing challenges, the failure to get its FOI response right has only served to compound those challenges – and is eroding trust between it and the public it serves.
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“These issues need to be urgently addressed if NHS Fife is to meet its legal duties, and I will work constructively with the board to help get its FOI function back on track, for the benefit of all.”
The Information Commissioner has asked the health board to designate a member of staff to take the improvement work forward by January 16.
This intervention is only the second to have been undertaken at level four, with the first launched in 2021 in response to the inappropriate sharing of personal information about an FOI requester by Aberdeenshire Council.
In a letter to the health board, Mr Hamilton said the health board had “failed to fulfil its statutory obligations”.
He said: “As you may be aware, level four interventions are extremely rare; however, I consider that – given the range of issues identified – a level four intervention is most appropriate in this case.”
The letter was also sent to Patricia Kilpatrick, chair of Fife Health Board and Health Secretary Neil Gray.
Mr Hamilton warned the health board in July it could face contempt of court proceedings in the Court of Session after it appeared to suggest it had not fully complied with a decision made by the watchdog.
The health board published a lengthy statement which said claims that it had been compelled to release cost information by the Scottish Information Commissioner were “inaccurate”.
A fresh investigation was formally launched into NHS Fife in relation to how it handled requests in the Sandie Peggie employment tribunal.
The Commissioner was critical of the health board’s refusal to answer requests from The Herald and other media outlets about how much public money had been spent on the case.
NHS Fife received three separate requests in March 2025 for the cost to date of the legal action involving nurse Sandie Peggie, which was brought by Ms Peggie after her complaint about sharing a changing room with transgender medic Dr Beth Upton led to her being suspended.
NHS Fife rejected all three FOI requests, stating that the information requested was exempt under the FOI Act’s exemption – which protects personal information.
However, an investigation by the SIC revealed that when responding to the FOI requests, the health board did not actually have the information on which it based its reply.
It is now known the case has cost the public purse more than £400,000.
A spokesperson from NHS Fife said: “NHS Fife can confirm that we have received a level four intervention notice from the SIC in relation to our handling of freedom of information requests.
“This follows constructive engagement with the commissioner earlier this year, alongside our own internal audit, which identified the need for improvement in our FOI processes.
“The findings and requirements set out in the notice will now form part of our ongoing organisational improvement plan.
“We take our statutory responsibilities seriously and recognise that this level of intervention reflects the scale of change required.
“We will work closely and constructively with the SIC to provide assurance, deliver the necessary improvements, and ensure full compliance with the notice.”