Value Based Health and Care action plan - measurement framework: technical report

1. Background and purpose

Realistic Medicine (RM) is an approach which is intended to promote personalised, shared decision‑making and aims to reduce harm, waste and unwarranted variation.^[1] Value Based Health and Care (VBH&C) is an associated approach which is designed to focus on achieving outcomes that matter to people and using resources efficiently. VBH&C aims to use available resources in an equitable, sustainable and transparent way to achieve improved outcomes and experiences for every person.^[2]

The Value Based Health and Care Action Plan (VBH&CAP) was published by the Scottish Government in October 2023. It outlines 13 actions to support health and care professionals in practising Realistic Medicine and delivering value based health and care as set out in the Vision for Scotland. The VBH&CAP contains a commitment to assess impact and improvement on an iterative basis, through the development of a measurement framework. It states: “We will use the measures of success indicated throughout this plan to inform a measurement framework".

The Measurement Framework aims to provide a system‑wide assessment of the delivery of Value Based Health and Care as set out in the Action Plan. The Framework will be updated every two years. The first iteration of the Framework establishes baseline monitoring metrics to benchmark and assess the progress and impact of the 13 actions. The framework is intended for health and care professionals, as well as the wider public, who wish to understand how the Action Plan is being assessed and how progress against objectives set out for each Action is being measured.

The Measurement Framework Technical Report supplements the first iteration of the Value Based Health and Care Action Plan: Measurement Framework which sets out the broader policy context, delivery update and key information on the monitoring metrics.

In addition to the information included in the Measurement Framework report, the Technical Report provides further technical information on the development of the framework as well as methodological and background information for each of the data sources presented in the framework’s monitoring metrics. The purpose of the Technical Report is to allow readers the opportunity to scrutinise figures and to provide comprehensive background information in relation to the development of the measurement framework in a manner which maximises transparency. The Technical Report seeks to adhere to the principles of Intelligent Transparency^[3], which involves proactively taking an open, clear, and accessible approach to the release and use of data and statistics.

1.1 Measurement Framework methodology

A total of 90 monitoring metrics have been collated for inclusion in the Measurement Framework. The identification, triage and reporting of these monitoring metrics was led by government research analysts from the Whole System Intelligence Analysis Division (WSIA).

Each of the 13 Actions within the Value Based Health and Care Action Plan has a dedicated Lead or Leads. WSIA’s work to identify and triage monitoring metrics was supported by these Action leads, who report into the VBH&CAP Implementation Group and represent a range of organisations involved in delivering the Action Plan. These organisations include the Scottish Government, NHS Education for Scotland, Public Health Scotland, NHS 24, Healthcare Improvement Scotland and the Centre for Sustainable Delivery.

Given the cross-cutting and in some cases holistic or generalist nature of work undertaken to deliver the VBH&CAP, a decision was taken to include a small sub-set of monitoring metrics pertaining to the “overall progress and impact of the VBH&CAP”. Members of the Measurement Framework Governance Group acted as the “leads” for the development of these metrics. As a result, the Measurement Framework monitoring metrics are categorised into 14 sections: a section for each of the 13 Actions from the VBH&CAP, plus an additional section covering “overall progress and impact of the VBH&CAP”.

WSIA analysts’ work began with a scoping exercise to identify and assess all available and relevant data sources. This process built on a prior internal evaluability assessment undertaken by the Realistic Medicine Policy Unit, which delivered workshop sessions with relevant stakeholders from the Realistic Medicine network^[4] in summer 2024. One of the outputs from these sessions was an initial mapping of existing evidence sources.

WSIA analysts then led inception workshops with the Action leads for each Action, which were undertaken between October 2024 and March 2025. The basis for these workshops was the existing data sources identified by the evaluability assessment workshops and the “Measures of success” set out for each Action in the Action plan, which propose high level mechanisms for monitoring progress against the objectives set out in the corresponding Action. The purpose of the inception workshops with Action leads was to scrutinise the availability and reliability of previously identified sources, to explore previously unidentified sources, and to identify data gaps. Thereafter, meetings were held periodically with each of the Action leads (monthly or quarterly), to the track progress with development of emerging data sources and Action workstreams.

The initial scoping exercise, including the inception workshops, and subsequent engagement with Action leads led to the identification of 38 viable monitoring metrics, which were assessed as providing at least partial monitoring coverage across 8 of the 14 Actions from the VBH&CAP, plus the “overall progress and impact of the VBH&CAP” section. Data gaps were however also identified across all 14 sections. The existing data sources were identified from across a wide range published and previously unpublished activity, usage and survey data, which are explained fully later in this section and throughout this report.

In response to the identification of data gaps through the scoping exercise, WSIA analysts committed to planning and delivering primary research to address those gaps. In this context, data gaps were deemed to be the absence of good quality data or research which could be used to assess the progress or impact of work aligned to commitments set out in the VBH&CAP. The vast majority of gaps identified related to an absence of mechanisms for collecting the views and experiences of Health and Care staff in relation to their awareness and delivery of Realistic Medicine and Value Based Care. As a result, WSIA analysts subsequently designed and delivered three separate surveys with Health and Care professionals (The Realistic Medicine Survey, The Scottish Atlas of Variation Survey and The Value Based Health and Care Survey) as well as undertaking secondary analysis of qualitative data captured by the existing Health and Care Experience Survey (HACE) 2023/24, all specifically designed to address the identified Measurement Framework data gaps.

A total of 52 (of 90) metrics were derived from primary research delivered by WSIA analysts through the three surveys set out above. Of the metrics derived from primary research delivered by WSIA analysts, the majority (n=42) came from the Value Based Health and Care Survey, the findings from which are published for the first time in this Measurement Report and Technical report. A full outline of these metrics and the survey’s methodology is set out in Section 3.1 (The Value Based Health and Care Survey). A findings report for The Realistic Medicine Survey - which produced data for nine Measurement Framework Monitoring Metrics - was published on 13 May 2025. A findings report for The Scottish Atlas of Variation Survey - which produced data for one Measurement Framework Monitoring Metric - was published on 11 February 2026. The full background, methodology and findings presentation for this research can be found within their linked publications.

For ease of explanation, this report categorises the various data sources used in the measurement framework into four groups.

• Previously unpublished survey data
• Published survey data
• Previously unpublished activity and usage data
• Published activity and usage data

For ease of reading, metrics based on findings from surveys which sampled a wide range of health and care professionals are referred to as “health and care professionals surveyed” throughout this Measurement Framework report.

Existing data identified through the initial scoping exercise and subsequent engagement with Action leads are spread across all four of these groups, whilst data produced via WSIA analysts’ primary research and secondary analysis fall into the published and previously unpublished survey data groups. Each data point pertaining to each of the measurement framework monitoring metrics is grouped into one of these four categories. Full background and methodological information for previously unpublished survey, activity and usage data is provided in the corresponding sections of this report (Section 3 for previously unpublished survey data and Section 4 for previously unpublished activity and usage data). Each of the 90 monitoring metrics, and the publication of the data where previously unpublished, was approved by the corresponding Action lead(s), data controller(s) and by the Measurement Framework Governance Group.

As many actions comprise multiple strands of work, some of which overlap across actions, each monitoring metric reflects one or more aspects of each action rather than its full scope. The monitoring metrics are indicative, offering insight into the wider context and direction of travel. They are not intended to provide a comprehensive audit of all activity or progress associated with each action. For this first iteration of the Measurement Framework, the monitoring metrics should be understood as baseline measures against which progress will be assessed in future updates.