Delivering value based health and care: a vision for Scotland

Sets out the challenges our system is facing and how practising Realistic Medicine can deliver a more sustainable system. It includes six commitments on what we’ll do to support health and care professionals deliver care that people value.

8. Conclusion

Value Based Health & Care encourages us to focus on delivering the outcomes that matter to people and helps manage expectations throughout their care or treatment. Involving them in decisions about their care and maintaining a relentless focus on Realistic Medicine, will help us provide care they really value, reduce harm and waste and eliminate unwarranted variation in the care we provide. VBH&C also encourages us to become more creative and challenges us to think carefully about how we optimise the use of the resources we have for maximum benefit.

Now, more than ever, there needs to be a focus on ensuring our health and care services are used equitably and sustainably in order to meet the needs of the people of Scotland, as well as those of our future generations.

By providing leadership, support, expertise, and the strategic direction to embed VBH&C across Scotland, we will drive better outcomes and experiences for the people we care for and deliver a more sustainable health and care system.

Next Steps

We will consult widely in 2023 to develop an action plan that will describe how our health and care system in Scotland will deliver the vision for VBH&C. We will take a three horizons approach and ensure that the VBH&C action plan will support delivery of Care and Wellbeing portfolio aims:

  • Horizon 1 – right now, current trends and issues

This horizon focuses on operational actions to recover stable and reliable systems e.g. short-term actions for cost recovery, clearing backlogs etc. There is a recognition that reliance on business as usual needs to decrease over time to allow new ways of working to take over – approaches that deliver better value for people and for the system e.g. roll out of ACRT, PIR, CfSD best practice pathways, EQUIP and the Right Decision Service and knowledge services will help reduce waiting lists. Better use of MDTs in Primary Care and better use of technology like Near Me for group consultations will help deliver more personal value (better peer support, better use of MDT rather than GP time, less travel for patients) and societal value (better for the environment).

  • Horizon 2 – the pattern of actions taken over the medium-term (e.g. three to five years) to innovate and try out new methods of working in response to emerging challenges, changing demographics etc.

Some actions may work to support and improve traditional business-as-usual systems (sustaining innovation) while others will act as building blocks for future Horizon 3 systems (transformative innovation). Examples include providing health and care colleagues with the education, training and tools they need to practise Realistic Medicine and deliver better value care. This includes shared decision making training, developing and implementing tools which help tackle unwarranted variation, for example the Scottish Atlas of Healthcare Variation and the Demand Optimisation Atlas, and supporting development of a nationally coordinated approach to Patient Reported Outcome Measures (PROMS) and Patient Reported Experience Measures (PREMS).

  • Horizon 3 – the end or long-term goal, a vision for the future

This typically grows from small tests of change using improvement methodologies which are better aligned to emerging service challenges than traditional approaches. Over time new norms are established. Embedding a culture of stewardship where health and care colleagues use resources wisely is the norm. Evidence Based Medicine sits at the heart of all clinical decision making. PROMS and PREMS are gathered across the system and used routinely to drive quantifiable improvements in personal value as well as reductions in harm and waste.

By working in partnership with teams from across Scotland, our partners and the public, we will deliver the outcomes that matter to people with the resources available to us. Through collaboration, a focus on personalising care and being mindful of the resources we use, we can meet the needs of both our population and our planet.



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