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.

Annex A: Information about partner bodies

Health and Social Care

The Realistic Medicine programme has been working with NHS Boards since 2015. The aim is to now incorporate a value based approach to health & care in Scotland with support from NHS Boards, our Realistic Medicine network, managed clinical networks, GP clusters, and health and social care partnerships (HSCPs).

Pivotal to this work are the health and social care teams, which include our network of Realistic Medicine clinical leads, programme managers, chief executives, medical, nursing, midwifery, Allied Health Professionals and finance directors who will support health and care colleagues to deliver VBH&C.

Centre for Sustainable Delivery (CfSD)

The Centre has a vital role in supporting our national efforts to remobilise, recover and redesign towards a better health care system and build on the significant progress and developments, which have already been achieved through redesign and transformation. This includes the rapid rollout of new techniques, technology and clinically safer, faster and more efficient pathways for our patients.

The CfSD's strategy supports Realistic Medicine, and we will work collaboratively to ensure VBH&C is embedded throughout their work.

Scottish Government Care & Wellbeing Portfolio

Improving population health requires a whole system response. The Care and Wellbeing Portfolio is working to deliver a coherent series of integrated reform programmes aimed at improving population health and reducing health inequality. Through the work of the Care and Wellbeing Portfolio, we are looking to create the best environment to stimulate national and local action to tackle these issues and take a systematic approach to planning and delivering care and wellbeing. The Portfolio is being designed to promote innovation and new ways of working; redesign the system around the person; and ultimately prioritise prevention, improve population health and reduce inequality. We are clear that we need to take a person centred approach and work across government, with our local government partners, and wider public sector on critical aspects of recovery to address the systematic inequalities made worse by Covid to reduce inequalities and improve the health for those who suffer poor health disproportionately.

NHS Scotland Climate Emergency Strategy

The NHS Scotland Climate Emergency Strategy outlines NHS Scotland's aim to become a net-zero health service by 2040, as well as a more environmentally and socially sustainable organisation, which is resilient to climate change. Whilst climate change is the greatest threat to global health this century, action to reduce emissions, adapt to climate change and reduce environmental harm can have co-benefits for the health of the population. Delivering services in an environmentally sustainable way provides greater value and can contribute to financial sustainability.

Public Health Scotland (PHS)

Our health and care system will continue to work with PHS to develop The Scottish Atlas of Healthcare Variation and provide supporting narrative to all NHS Boards. The Atlas is an important tool to contribute to eliminating unwarranted variation, realising Realistic Medicine and supporting reducing harm and waste within the health service.

Understanding variation (random, warranted or unwarranted), through the engagement of clinicians, users and service providers, is key to providing VBH&C within NHS Scotland.

This work will also involve the development of mechanisms to support, monitor progress and evaluate use of refreshed maps. This work supports the NHS Recovery Plan.

Healthcare Improvement Scotland (HIS)

Healthcare Improvement Scotland (HIS), Scotland's national improvement organisation, supports the transformation of health and social care through the redesign of clinical and care services and the development of cultures of continuous improvement. The ihub, part of HIS, enables health and care systems to apply improvement methodologies to the design implementation of changes that deliver sustainable transformation.

NHS Education for Scotland (NES)

NHS Education for Scotland (NES) is responsible for developing and delivering healthcare education, training and resources for the NHS, health and social care sector and other public bodies. They have a Scotland-wide role in undergraduate, postgraduate and continuing professional development.

We will continue to work in collaboration with NES to explore further areas for development. This is key to support delivery of the VBH&C vision.

Demand and Optimisation Team

The National Demand Optimisation Group (NDOG) has developed an Atlas of Variation to help tackle unwarranted variation in Primary Care.

There is considerable variation in the use of laboratory diagnostic tests across primary care. Some of this variation can be attributed to clinical and demographic differences. However, some variation can be attributable to differences in practice processes and pathways or individual requester preferences.

The Atlas of Variation contains monthly data on NHS board primary care requesting totals for a specific suite of blood science tests from cancer, cardiac, diabetes and other general pathways. The Atlas consists of three separate dashboards that allow GP practices to compare their request rates with their cluster, health board, peer group and national rates. We will continue to work with the NDOG to support utilisation of the atlas of variation.

NHS Partners

We will continue to network and collaborate with colleagues across the world including NHS Wales' Value Based Healthcare team. This will enable further support of our vision's aims by continuing to build effective and efficient partnerships. This also creates opportunities for continued shared learning and future collaborative work.

Health and Care Colleagues

We want to hear views from colleagues from across our health and care system and we will engage with Royal Colleges and the Allied Health Professions Federation, given their interest in the wellbeing of their membership and in their education and accreditation, as well as being influential in setting standards and some clinical guidelines.


VBH&C requires public involvement to ensure that our health and care system is sensitive to the needs and preferences of patients. The benefits of better engagement include improved outcomes and experiences for patients; safer services; better decision making; and a greater sense of public 'ownership' of services that ultimately the public pay for and support.

Third Sector Organisations

The third sector focus on the delivery of essential health and care services, as well as helping people to access them, which can help improve people's wellbeing and contribute to economic growth. Our health and care system must continue to link and work with third sector organisations to support a VBH&C approach, which will align with our shared aim of improving outcomes for people in Scotland.


We aim to collaborate with universities as part of the evaluation of our work and as partners in research (supporting the Community of Practice) to further support delivery of VBH&C.


Research helps create the conditions for a modern health and social care service that is focused on providing the evidence we need to deliver VBH&C. Work continues to enable further trials of the most advanced healthcare treatments, diagnostics and medical technologies and bring them to people faster. Research is also being used to help understand what doesn't work (lower value care), so we can improve best practise and focus our precious resources on providing healthcare that people really value and will benefit from.



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