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

2. Monitoring metrics: background, data and source

This section of the report contains sub-sections focused on each of the 13 Actions from the VBH&CAP, plus the “overall progress and impact of the VBH&CAP”. Each of these sub-sections includes the specific Action text, the intended outcome of the Action (“Action results in”) and the proposed measures of success: this information is taken directly from the previously published VBH&CAP. The sub-sections also include the specific monitoring metrics identified through the aforementioned exercise, their findings, and their respective data source.

Through the workshops and subsequent engagement with Action leads, it became clear that the scope, scale and maturity of the work to support each Action was varied, and that the focus or prioritisation of some areas was still evolving. This was reflected in the process of formulating the monitoring metrics and may explain any perceived divergences between the specific focus of “action results in”, “measures of success” and monitoring metrics.

The VBH&CAP set a 2030 time horizon, the stated vision being that: “by 2030 all health and care professionals will be supported to deliver Value Based Health and Care. This will achieve the outcomes that matter to people and a more sustainable system”. It should also be noted therefore that some existing, ongoing or planned work streams related to certain Actions are not currently captured by specific monitoring metrics in the Measurement Framework as they have yet to progress. Future iterations of the Framework will seek to include additional monitoring metrics that relate to work streams which are currently planned or in development.

Action 1

The Scottish Government and NHS Education for Scotland (NES) will engage with NHS Boards, education providers and wider partners to inform the education, training, and tools to support kind and careful care, and the day to day practise of Realistic Medicine.

Action results in:

• Health and care professionals more confident in their knowledge and ability to deliver VBH&C.
• People are supported to practise Realistic Medicine and VBH&C by peers and leaders across the system.

Proposed measures of success:

• Health and care workforce surveys
• Training feedback
• Patient feedback using tools such as Care Opinion

Monitoring metrics:^[5]

Metric 1.1: Across four Value Based Health and Care TURAS training e-modules there were 2,146 learner completions in 2025.

Source: Management information provided by NHS NES. Activity and usage data first published in this Measurement Framework: see Section 4.

Metric 1.2: The 5 Realistic Medicine Sway learning resources were accessed 15,774 times in 2025.

Source: Management information provided by NHS NES. Activity and usage data first published in this Measurement Framework: see Section 4.

Metric 1.3: 9% of health and care professionals surveyed reported using the Realistic Medicine Sway learning resources to support the care they provide.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 1.4: The 8 Realistic Medicine training Animations^[6] were accessed 2,655 times in 2025.

Source: Management information provided by NHS NES. Activity and usage data first published in this Measurement Framework: see Section 4.

Metric 1.5: 10% of health and care professionals surveyed reported using the Realistic Medicine animations to support the care they provide.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 1.6: The Realistic Medicine TURAS learning pages were viewed 23,858 times in 2025.

Source: Management information provided by NHS NES. Activity and usage data first published in this Measurement Framework: see Section 4.

Metric 1.7: 26% of health and care professionals surveyed reported using the TURAS Realistic Medicine learning pages to support the care they provide.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 1.8: 13% of health and care professionals surveyed had completed some Realistic Medicine and/or Value-Based Health & Care training.

Source: Practising Realistic Medicine Survey. Scottish Government. (2025). Published at: Realistic Medicine: Survey Highlights.

Metric 1.9: Of those health and care professionals surveyed who had completed training, 63% had completed the NES Shared Decision Making e-learning module and 44% completed the Introduction to Value Based Health and Care e-learning module. 54% had watched the realistic medicine animation.

Source: Practising Realistic Medicine Survey. Scottish Government. (2025). Published at: Realistic Medicine: Survey Highlights.

Metric 1.10: Of those health and care professionals surveyed who had completed training, the majority reported feeling significantly (24%) or somewhat (53%) more confident in their knowledge and ability to practise Realistic Medicine because of completing training.

Source: Practising Realistic Medicine Survey. Scottish Government. (2025). Published at: Realistic Medicine: Survey Highlights.

Action 2

The Scottish Government, professional bodies, NHS Boards and Health and Social Care Partnerships (HSCPs) will work together to increase professional awareness of Realistic Medicine and enable delivery of Value Based Health and Care.

Action results in:

• Increasing awareness and knowledge of Realistic Medicine and VBH&C across the health and social care sector in Scotland.
• A strengthening community of practice across Scotland of professionals who foster a culture of stewardship, promote Realistic Medicine and deliver VBH&C for the people of Scotland.

Proposed measures of success:

• Health and care workforce surveys and feedback.

Monitoring metrics:

Metric 2.1: A majority of health and care professionals surveyed reported feeling very (24%) or fairly (51%) confident in their understanding of the principles of Realistic Medicine.

Source: Practising Realistic Medicine Survey. Scottish Government. (2025). Published at: Realistic Medicine: Survey Highlights.

Metric 2.2: A majority of health and care professionals surveyed reported that Realistic Medicine has had a strong (29%) or slight (41%) positive influence on their practice of healthcare in the previous year.

Source: Practising Realistic Medicine Survey. Scottish Government. (2025). Published at: Realistic Medicine: Survey Highlights.

Metric 2.3: 66% of health and care professional surveyed described their understanding of the following statement as clear: ‘By practising Realistic Medicine we can deliver Value Based Health and Care’.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 2.4: Qualitative Evidence from the Realistic Medicine Survey relating to awareness of Realistic Medicine and delivery of Value Based Health and Care.

Source: Practising Realistic Medicine Survey. Scottish Government. (2025). Published at: Realistic Medicine: Survey Highlights.

Action 3

Through national digital health and care data strategies, the Scottish Government will work with delivery partners to support development of digital technology and provide data that enables professionals to practise Realistic Medicine and deliver VBH&C.

Action results in:

• Systems and services are designed, digitally enabled, and delivered around the needs of the people we care for, facilitating better value care and helping to reduce health inequalities.

Proposed measures of success:

• Increased uptake and use of tools such as Near Me, Connect Me, and digital tools to support future care planning, and applications available through the Right Decision Service.

Monitoring metrics:

Metric 3.1: Approximately 316,000 consultations with Near Me were carried out in 2025.

Source: Near Me: Review of Usage. Jan – Dec 25. Digital Health and Care Scotland. Published at: Near Me – Digital Services and Innovation (Accessed: 12/2/26).

Metric 3.2: 23.01 million patient travel miles were avoided in 2025 through Near Me consultations.

Source: Near Me: Review of Usage. Jan – Dec 25. Digital Health and Care Scotland. Published at: Near Me – Digital Services and Innovation (Accessed: 12/2/26).

Metric 3.3: 41% of health and care professionals surveyed reported using Near Me to support the care they provide.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 3.4: 27,643 individuals were enrolled for Connect Me in 2025.

Source: Management information provided by the National Virtual Consultation Service. See Section 4.

Metric 3.5: The proportion of health and care professionals surveyed who had faced the following barriers when using digital technology to support the delivery of VBH&C:

• lack of awareness of available digital technologies (62%),
• insufficient time to learn or integrate new technologies into practice (52%),
• insufficient training, confidence or knowledge on using these tools (44%).

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Action 4

The Scottish Government will support development of a national Person Reported Experience Measure (PREM) to improve delivery of person-centred care.

Action results in:

• The people we care for are listened to and fully involved in decisions about their care.
• Experience data and evidence is used routinely by health and care professionals to drive improvement

Proposed measures of success:

• Development of national PREMs.
• Widespread use of national PREMs, shared decision making measures such as CollaboRATE and patient experience surveys.

Monitoring metrics:

Metric 4.1: Around a quarter of health and care professionals surveyed reported using feedback from PREMs to inform their delivery of person-centred care very often (4%), often (9%) or occasionally (11%).

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 4.2: Around one-in-ten health and care professionals surveyed report using feedback from shared decision-making measurement tools such as CollaboRATE or SURE^[7] to inform their delivery of person-centred care very often (1%), often (3%) or occasionally (6%).

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 4.3: Around six-in-ten health and care professionals surveyed report using feedback from patient experience surveys to inform their delivery of person-centred care very often (8%), often (20%) or occasionally (34%).

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 4.4: Around four-in-ten health and care professionals surveyed report using feedback from Care Opinion to inform their delivery of person-centred care very often (7%), often (14%) or occasionally (22%).

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 4.5: Around one-in-ten health and care professionals surveyed report using feedback from the Near Me end of consultation survey to inform their delivery of person-centred care often (2%) or occasionally (7%).

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Action 5

The Scottish Government and delivery partners will explore digital capture and use of Patient Reported Outcome Measures (PROMs) and specific outcome measures to drive improvement and better value care

Action results in:

• PROMs and outcome measures can be captured digitally, helping us measure the outcomes that matter to the people we care for and drive improvement.

Proposed measures of success:

• Increased use of PROMs and outcome measures to capture outcomes that matter.

Monitoring metric:

Metric 5.1: Around a quarter of health and care professionals surveyed reported using feedback from PROMs to inform their delivery of person-centred care very often (6%), often (8%) or occasionally (11%).

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Action 6

The Scottish Government and our delivery partners will continue to develop and promote the Scottish Atlas of Healthcare Variation.

Action results in:

• Health and care professionals understand variation in treatment, diagnostic testing and service provision. They can identify areas and population groups where variation is unwarranted, and work with colleagues to reduce it.
• Resources are in place to equip health and care professionals to understand the factors contributing to inequity of access and experience.
• Resource and capacity can be released to concentrate on delivering care that matters to people.

Proposed measures of success:

• Reduction in unwarranted variation identified through use of Atlas data.
• Reduction in lower value testing, treatments, care, and interventions

Monitoring metrics:

Metric 6.1: 8% of health and care professionals surveyed have used the Scottish Atlas of Healthcare Variation to help them look for unwarranted variation in access to healthcare, treatment and outcomes often or occasionally.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 6.2: Health and care professionals surveyed identified the most common barriers to using the Scottish Atlas of Healthcare Variation as:

• ‘lack of awareness about the Atlas’ (72%),
• ‘insufficient training or knowledge on how to use the Atlas’ (23%),
• ‘insufficient time to learn or integrate the Atlas into practice’ (20%).

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 6.3: 66% of Orthopaedics, Ophthalmology, and Dentistry health and care professionals surveyed had not used the recently updated paediatric dental extraction and hip, knee and cataract surgery Atlas maps, whilst the remainder had occasionally (19%) or a very small number of times (15%).

Source: Scottish Atlas of Variation Surgical Procedures Dashboard: Survey Insights on the latest Atlas maps. Scottish Government (2026).

Available at: Scottish Atlas of Variation Surgical Procedures dashboard: survey report.

Metric 6.4: Qualitative Evidence from the Value Based Health and Care survey relating to health and care professionals’ views of the Atlas: Many noted low awareness of the SAoV maps and viewed the Atlas data as outdated and incomplete, reducing its usefulness.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Action 7

The Scottish Government will support National Services Scotland (NSS), NHS Boards, HSCPs and the Realistic Medicine Network to further develop and roll out the Demand Optimisation (DO) Atlas.

Action results in:

• More people receive tests that they will benefit from, and fewer people are subjected to inappropriate testing, resulting in the more appropriate use of diagnostic resources.
• Staff are trained to understand inequalities and strive to reduce these in their area.

Proposed measures of success:

• Reduction in inappropriate testing.
• Increase in appropriate tests that are currently underused

Monitoring metric:

Metric 7.1: The Demand Optimisation Atlas was accessed 808 times during the 4-month period between its launch on 30/09/25 and 27/1/26.

Source: Management information provided by Public Health Scotland: see Section 4.

Action 8

The Scottish Government will support people and communities to access preventative and proactive approaches to improve healthy life expectancy and reduce health inequalities.

Action results in:

• An increased focus on health promotion, illness prevention and proactive care improves healthy life expectancy, helping to reduce health inequalities, and reducing pressure on the wider health and social care system.
• There is a system-wide commitment to anti-racism and action to reduce racialised inequalities in health and care. This means people from minority ethnic communities receive culturally sensitive, person-centred care

Proposed measures of success:

• Improved access, experience and health and care outcomes in areas and population groups where the need is greatest, with explicit early focus on minority ethnic communities.
• Improved staff understanding of the necessity of prevention

Monitoring metrics:

Metric 8.1: 51% of health and care professionals surveyed agreed that their organisation promotes a culture of prevention in health and care.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 8.2: 43% of health and care professionals surveyed agreed that their organisation actively works to address racialised inequalities in health and care.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 8.3: When asked to think about the last healthcare professional they saw within NHS Scotland, 63% of Citizen’s Panel respondents agreed that they were involved in discussing what they can do to promote good health and prevent ill health in the future.

Source: Healthcare Improvement Scotland (2024) Fourteenth Citizens’ Panel Report: Realistic Medicine, Value Based Health and Care, and NHS Reform. Available at: Fourteenth Citizens' Panel report.

Metric 8.4: When asked to think about the last healthcare professional they saw within NHS Scotland, 63% of Citizen’s Panel respondents agreed that they were involved in discussing what they can do to promote good health and prevent ill health in the future.

Source: National Records of Scotland (2024) Life Expectancy in Scotland 2022–2024. (Accessed: 12^th February 2026).

Action 9

The Scottish Government and our delivery partners, including NES, Professional Bodies, NHS Boards and HSCPs, will continue to develop a multi-professional community of practice to foster a culture of stewardship.

Action results in:

• A stronger community of educated and empowered multidisciplinary health and care professionals.
• Better outcomes and experiences for the people we care for and a more sustainable health and care system, by providing leadership, learning, support, expertise, and strategic direction to embed VBH&C

Proposed measures of success:

• Realistic Medicine action plans will provide evidence of delivery of VBH&C at a local level
• Development of research trials, widespread shared learning from projects and pilots
• Professional surveys

Monitoring metrics:

Metric 9.1: Nearly one-in-five health and care professionals surveyed had engaged with the Community of Practice very often (3%), often (5%) or occasionally (10%). Around half (53%) were not aware of the Community of Practice.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 9.2: Around a third of health and care professionals surveyed had engaged with the Realistic Medicine Network very often (6%), often (10%) or occasionally (17%). Around three-in-ten (31%) were not aware of the Realistic Medicine Network.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 9.3: Nearly four-in-ten health and care professionals surveyed had engaged with their local Realistic Medicine Team very often (7%), often (14%) or occasionally (16%). Around three-in-ten (30%) were not aware of their Realistic Medicine Team.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 9.4: Nearly four-in-ten health and care professionals surveyed had engaged with local or national events related to Realistic Medicine very often (5%), often (11%) or occasionally (22%). A quarter (25%) were not aware of such events.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Action 10

NHS 24, NES, Healthcare Improvement Scotland (HIS), Centre for Sustainable Delivery (CfSD) and Public Health Scotland (PHS) will continue to ensure access to high quality evidence-based knowledge and information that supports delivery of the Realistic Medicine goals of safe, person-centred care; reducing unwarranted variation and inequality; reducing waste and harm; and empowering people to make informed choices about their care through shared decisions.

Action results in:

People and professionals are able to make evidence-based decisions, using easily accessible, high-quality guidance, enabling safer care, reducing unwarranted variation in practice, and promoting shared decision making.

Proposed measures of success:

• Feedback from health and care professionals on SIGN guidelines.^[8]
• Public and professional evaluation of the impact of Right Decision Service tools and Realistic Medicine apps.
• NHS Boards’ implementation of action plans for development of knowledge services

Monitoring metrics:

Metric 10.1: 65% of health and care professionals surveyed had used SIGN resources to support the care they provide.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 10.2: 62% of health and care professionals surveyed had used NHS Inform to support the care they provide.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 10.3: 41% of health and care professionals surveyed had used Right Decision Service tools for professionals to support the care they provide.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 10.4: 38% of content reviewed on NHS inform in 2025, against target of 33%.

Source: Management information provided by NHS Inform: see Section 4.

Metric 10.5: 87% of NHS Inform clinical content was governed by subject matter experts in 2025 (remainder governed internally by NHS 24).

Source: Management information provided by NHS Inform: see Section 4.

Metric 10.6: NHS Inform webpages were viewed 29,849,995 times in 2025 resulting in 39,429,563 page views.

Source: Management information provided by NHS Inform: NHS inform (2026) NHS inform annual status update report [Google Analytics dataset]. Extracted from: Google Analytics (Accessed: 9th January 2026). See Section 4.

Metric 10.7: Right Decision Service webpages have been viewed 11,325,817 times in 2025.

Source: Management information provided by Healthcare Improvement Scotland: see Section 4.

Metric 10.8: Professional-facing Realistic Medicine website^[9] and mobile App^[10] have been viewed 15,395 times in 2025.

Source: Management information provided by Healthcare Improvement Scotland: see Section 4.

Metric 10.9: Citizen-facing Realistic Medicine (‘Being a partner in my care’) website and mobile App have been viewed 8,497 times in 2025.

Source: Management information provided by Healthcare Improvement Scotland: see Section 4.

Action 11

The Scottish Government, CfSD, NHS Boards and HIS will further promote and support the use of improvement tools and approaches that help to deliver VBH&C, including Active Clinical Referral Triage (ACRT), Effective Quality Interventions Pathways (Opt-In Pathways), Discharge PIR (Patient Initiated Review), and digital approaches that help NHS Boards and HSCPs to manage patients by reducing or stopping lower value interventions and care.

Action results in:

• Widespread use of improvement tools and approaches enable and empower professionals to deliver higher value, more sustainable care.
• New strategies and ways of working ensure sustainability is a priority.

Proposed measures of success:

• CfSD Heat Maps, reductions in waiting lists and more people are directed to more appropriate care.
• Guideline development informed by evidence on sustainability.
• Low value interventions are stopped or reduced.

Monitoring metrics:

Metric 11.1: Of Consultants and Resident Doctors who completed the Value Based Health and Care Survey (n=70), nearly one-in-three reported that Active Clinical Referral Triage (ACRT) had provided them with significant (6%), some (16%) or limited (10%) support to reduce or stop lower-value interventions and care. 24% said that they had not used ACRT, whilst 43% reported being unaware of ACRT.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 11.2: Of Consultants and Resident Doctors who completed the Value Based Health and Care Survey (n=70), around one-in-five reported that Opt-In Pathways had provided them with significant (3%), some (9%) or limited (7%) support to reduce or stop lower-value interventions and care. 31% said that they had not used Opt-In Pathways, whilst 47% reported being unaware of Opt-In Pathways.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 11.3: Of Consultants and Resident Doctors who completed the Value Based Health and Care Survey (n=70), around two-in-five health and care professionals surveyed reported that Discharge PIR (Patient Initiated Review) had provided them with significant (11%), some (24%) or limited (4%) support to reduce or stop lower-value interventions and care. 29% said that they had not used Discharge PIR, whilst 30% reported being unaware of Discharge PIR.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 11.4: Around one-in-five health and care professionals surveyed reported that CfSD Clinical Pathways had provided them with significant (2%), some (6%) or limited (7%) support to reduce or stop lower-value interventions and care. 25% said that they had not used CfSD Clinical Pathways, whilst 59% reported being unaware of CfSD Clinical Pathways.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 11.5: Nearly one-in-five health and care professionals surveyed reported that NHS Scotland Discovery data had provided them with some (8%) or limited (9%) support to reduce or stop lower-value interventions and care. 19% said that they had not used NHS Scotland Discovery data, whilst 60% reported being unaware of NHS Scotland Discovery data related to reducing or stopping lower-value interventions and care.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 11.6: The NHS Scotland National Referral Protocol contains a series of procedures where evidence suggests that there is less clinical benefit and as such, they must not be routinely offered by NHS Scotland. The number of procedures carried out during 2024/25 for the following National Referral Protocol procedures:

• Benign skin lesions – 5,239
• Breast surgery – 1,128
• Ganglion – 508
• Rhinoplasty – 123
• Varicose veins – 1,107

Source: Data source: Public Health Scotland Database - Scottish Morbidity Records - SMR01 dataset (inpatients and day cases) Date of Analysis: 14/01/2026 (SMR01). And: Data source: Public Health Scotland Database - Scottish Morbidity Records - SMR00 dataset (outpatients). Date of Analysis: 07/01/2026 (SMR00). See section 4.

Metric 11.7: 148,542 appointments were released in 2024/25 through ACRT.

Source: NHS Centre for Sustainable Delivery Annual Report 2024–25. Published at: Centre for Sustainable Delivery Annual Report.

Metric 11.8: 2.4 million of patient travel miles were avoided in 2024/25 through ACRT.

Source: NHS Centre for Sustainable Delivery Annual Report 2024–25. Published at: Centre for Sustainable Delivery Annual Report.

Metric 11.9: £31 million in cost avoidance to NHS Scotland in 24/25 as a result of ACRT.

Source: NHS Centre for Sustainable Delivery Annual Report 2024–25. Published at: Centre for Sustainable Delivery Annual Report.

Metric 11.10: 82,507 appointments were released in 24/25 through Discharge PIR.

Source: NHS Centre for Sustainable Delivery Annual Report 2024–25. Published at: Centre for Sustainable Delivery Annual Report.

Metric 11.11: 1.5 million patient travel miles were avoided in 24/25 through Discharge PIR.

Source: NHS Centre for Sustainable Delivery Annual Report 2024–25. Published at: Centre for Sustainable Delivery Annual Report.

Metric 11.12: £13 million in cost avoidance to NHS Scotland was achieved in 2024/25 as a result of PIR.

Source: NHS Centre for Sustainable Delivery Annual Report 2024–25. Published at: Centre for Sustainable Delivery Annual Report.

Metric 11.13: Approximately 20,000 appointments were avoided as a result of the National Elective Coordination Unit since its launch in July 2022.

Source: NHS Centre for Sustainable Delivery Annual Report 2024–25. Published at: Centre for Sustainable Delivery Annual Report.

Metric 11.14: £9.4 million in cost avoidance to NHS Scotland as a result of the National Elective Coordination Unit since its launch in July 2022.

Source: NHS Centre for Sustainable Delivery Annual Report 2024–25. Published at: Centre for Sustainable Delivery Annual Report.

Action 12

The Scottish Government will work with NHS Boards and HSCPs to continue to develop and support effective prescribing practices.

Action results in:

• Reduction in over- and under-prescribing, identified through national therapeutic indicators.
• Avoidable medication related admissions are decreased.

Proposed measures of success:

• Quality prescribing guides, which focus on high value prescribing in Scotland, and national indicator data.

Monitoring metrics:

Metric 12.1: 7-step person-centred reviews:

• Supported surveyed health and care professionals to achieve significant (9%) or some reduction (32%) in their use of medicines of low and limited clinical value.
• Had significant (10%) or some (25%) positive impact on health and care professionals’ ability to deliver safer, more effective, and person-centred care.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 12.2: National Therapeutic Indicators:

• Supported surveyed health and care professionals to achieve significant (7%) or some reduction (25%) in their use of medicines of low and limited clinical value.
• Had significant (4%) or some (19%) positive impact on health and care professionals’ ability to deliver safer, more effective, and person-centred care.
• Had significant (9%) or some (17%) positive impact on health and care professionals’ ability to look for unwarranted variation in prescribing practices.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 12.3: Polypharmacy prescribing guidance and implementation toolkits:

• Supported surveyed health and care professionals to achieve significant (11%) or some reduction (32%) in their use of medicines of low and limited clinical value.
• Had significant (10%) or some (24%) positive impact on health and care professionals’ ability to deliver safer, more effective, and person-centred care.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 12.4: High risk prescribing toolkit for Vision and EMIS (Electronic Medicines Information System):

• Supported surveyed health and care professionals to achieve significant (5%) or some reduction (18%) in their use of medicines of low and limited clinical value.
• Had significant (4%) or some (13%) positive impact on health and care professionals’ ability to deliver safer, more effective, and person-centred care.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 12.5: Scottish Therapeutics Utility:

• Supported surveyed health and care professionals to achieve significant (6%) or some reduction (19%) in their use of medicines of low and limited clinical value.
• Had significant (6%) or some (14%) positive impact on health and care professionals’ ability to deliver safer, more effective, and person-centred care.
• Had significant (8%) or some (17%) positive impact on health and care professionals’ ability to look for unwarranted variation in prescribing practices.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 12.6: Scottish Government Quality Prescribing Resources had significant (4%) or some (14%) positive impact on surveyed health and care professionals’ ability to deliver safer, more effective, and person-centred care.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 12.7: Approximately 43 per 1,000 people in Scotland were prescribed 10 or more medicines, including at least one high-risk medication in July-September 2025.

Source: Public Health Scotland (2025). National therapeutic indicators data visualisation: Data to September 2025. Available at: National therapeutic indicators data visualisation (Accessed: 2^nd March 2026).

Metric 12.8: Approximately 12 per 1,000 people in Scotland were prescribed three or more of the following medicine classes: benzodiazepines/Z‑drugs, opioids (including tramadol), gabapentinoids, antidepressants, and antipsychotics (excluding depots), ‘triple whammy’, in July-September 2025.

Source: Public Health Scotland (2025). National therapeutic indicators data visualisation: Data to September 2025. Available at: National therapeutic indicators data visualisation (Accessed: 2^nd March 2026).

Metric 12.9: Approximately 1 per 1,000 people in Scotland were prescribed an ACE inhibitor or angiotensin receptor blocker, a diuretic and a Nonsteroidal Anti-Inflammatory Drug, increasing the risk of acute kidney injury; in July-September 2025.

Source: Public Health Scotland (2025). National therapeutic indicators data visualisation: Data to September 2025. Available at: National therapeutic indicators data visualisation (Accessed: 2^nd March 2026).

Metric 12.10: Approximately 50 per 1’000 people in Scotland were prescribed 3 or more short-acting beta-agonist inhalers (SABA) per annum in July-September 2025.

Source: Public Health Scotland (2025). National therapeutic indicators data visualisation: Data to September 2025. Available at: National therapeutic indicators data visualisation (Accessed: 2^nd March 2026).

Metric 12.11: Approximately 50 per 1’000 people in Scotland were prescribed 3 or more short-acting beta-agonist inhalers (SABA) per annum in July-September 2025.

Source: Public Health Scotland (2025). National therapeutic indicators data visualisation: Data to September 2025. Available at: National therapeutic indicators data visualisation (Accessed: 2^nd March 2026).

Metric 12.12: Interaction with effective prescribing resources (total views between Apr 24 to Mar 25):

• Diabetes Quality Prescribing Guide - 2,351
• Respiratory Quality Prescribing Guide - 2,904
• Antidepressant Quality Prescribing Guide - 1,863
• Benzodiazepine and Z-drug Quality Prescribing Guide - 1,127
• Achieving Value and Sustainability in Prescribing Guidance – 1,022
• Right Decision Service Diabetes toolkit - 9,905
• Right Decision Service Respiratory toolkit - 14,685
• Right Decision Service Polypharmacy toolkit - 89,601
• Right Decision Service ‘Manage My Meds’ toolkit - 10,644

Source: Management information provided by the Scottish Government. Extracted from: Google Analytics (Accessed: June/July, 2025). See section 4.

Action 13

The Scottish Government will work with HIS Community Engagement, NHS Boards & HSCPs and the public to understand awareness of VBH&C and Realistic Medicine to support shared decision making, health literacy, agency, and advocacy.

Action results in:

• Increased public knowledge, awareness and participation in shared decision making and understanding of Realistic Medicine.

Proposed measures of success:

• Healthcare experience survey, PREMs, PROMs, and shared decision making evaluation tools like CollaboRATE.
• Increased citizen and community engagement.

Monitoring metrics:

Metric 13.1: Nearly half of health and care professionals surveyed reported significant (9%), moderate (19%) or limited (19%) promotion for the “It’s OK to ask” campaign within their organisation. 46% reported being unaware of this campaign.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 13.2: Around half of health and care professionals surveyed with a patient facing role reported using BRAN questions very often (19%), often (20%) or occasionally (13%). 34% said that they were not familiar with the BRAN questions.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 13.3: Around four-in-five health and care professionals surveyed, with a patient facing role who were aware of BRAN questions, agreed (53%) or strongly agreed (28%) that BRAN questions are effective in helping people make an informed choice about their treatment and care.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 13.4: Around half of health and care professionals surveyed, with a patient facing role who were aware of BRAN questions, agreed (34%) or strongly agreed (17%) that their organisation supports them in promoting and using BRAN questions.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 13.5: 42% of Citizen Panel 14 respondents reported prior awareness of the need for improved outcomes and effective use of healthcare resources.

Source: Healthcare Improvement Scotland (2024) Fourteenth Citizens’ Panel Report: Realistic Medicine, Value Based Health and Care, and NHS Reform. Available at: Fourteenth Citizens' Panel report.

Metric 13.6: 19% of Citizen Panel 14 respondents had heard of Realistic Medicine before receiving the survey, whilst 76% had not.

Source: Healthcare Improvement Scotland (2024) Fourteenth Citizens’ Panel Report: Realistic Medicine, Value Based Health and Care, and NHS Reform. Available at: Fourteenth Citizens' Panel report.

Metric 13.7: 12% of Citizen Panel 14 respondents reported they had heard of BRAN questions before receiving the survey, whilst 86% had not.

Source: Healthcare Improvement Scotland (2024) Fourteenth Citizens’ Panel Report: Realistic Medicine, Value Based Health and Care, and NHS Reform. Available at: Fourteenth Citizens' Panel report.

Metric 13.8: 21% of Citizen Panel 14 respondents had heard of the NHS “It’s OK to Ask” campaign before receiving the survey, whilst 70% had not.

Source: Healthcare Improvement Scotland (2024) Fourteenth Citizens’ Panel Report: Realistic Medicine, Value Based Health and Care, and NHS Reform. Available at: Fourteenth Citizens' Panel report.

Metric 13.9: 66% of Health and Care Experience Survey 2023/24 respondents agreed that they ‘had a chance to ask about the benefits and risks of the treatment’ the last time they received treatment or advice at their General Practice.

Source: Scottish Government, Health and Care Experience Survey 2023/24. Available at: Health and Care Experience Survey 2023/24: National Results.

Metric 13.10: 71% of Health and Care Experience Survey 2023/24 respondents agreed that they were ‘involved in decisions about [their] treatment and care’ the last time they received treatment or advice at their General Practice.

Source: Scottish Government, Health and Care Experience Survey 2023/24. Available at: Health and Care Experience Survey 2023/24: National Results.

Metric 13.11: 70% of Health and Care Experience Survey 2023/24 respondents agreed that ‘staff helped [them] to feel in control of [their] treatment and care’ the last time they received treatment or advice from Out of Hours Healthcare. ^[11]

Source: Scottish Government, Health and Care Experience Survey 2023/24. Available at: Health and Care Experience Survey 2023/24: National Results.

Overall progress and impact of the VBH&CAP

Monitoring metrics:

Metric 14.1: Around six-in-ten health and care professionals surveyed reported that their organisation strongly (15%) or somewhat (46%) promotes Realistic Medicine and Value-Based Health & Care.

Source: Practising Realistic Medicine Survey. Scottish Government. (2025). Published at: Realistic Medicine: Survey Highlights.

Metric 14.2: A little more than four-in-ten health and care professionals surveyed reported that their professional body strongly (12%) or somewhat (32%) promotes Realistic Medicine and Value-Based Health & Care.

Source: Practising Realistic Medicine Survey. Scottish Government. (2025). Published at: Realistic Medicine: Survey Highlights.

Metric 14.3: Around half of health and care professionals surveyed reported that they had been very well supported (11%) or had received some support (40%) from peers and leaders across the Health and Care system to practice Realistic Medicine and Value-Based Health & Care.

Source: Practising Realistic Medicine Survey. Scottish Government. (2025). Published at: Realistic Medicine: Survey Highlights.

Metric 14.4: Around seven-in-ten health and care professionals surveyed agreed (49%) or strongly agreed (20%) that they are ‘able to take the time to get to know the people [they] care for and what is important to them’.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 14.5: Most health and care professionals surveyed agreed (58%) or strongly agreed (28%) that they are ‘able to involve the people [they] care for in decisions about their care’.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 14.6: A majority of health and care professionals surveyed agreed (58%) or strongly agreed (29%) that they are ‘able to listen to the people [they] care for and understand the outcomes that matter to them’.

Source: Value Based Health and Care Survey. Scottish Government. (2025). Survey first published in this Measurement Framework: see Section 3.1.

Metric 14.7: Qualitative Evidence from the Health and Care Experience Survey 2023/24 survey relating to respondents’ experiences of person-centred care and shared decision making in General Practice and Out of Hours Healthcare:^[12]

Respondents described mixed experiences of person‑ centred care, with some feeling respected and supported through attentive, coordinated treatment, while others encountered dismissive interactions and poor communication that left them feeling unheard and poorly supported.

Source: Secondary analysis – published here for the first time - of data captured as part of Scottish Government, Health and Care Experience Survey 2023/24. See Section 3.2.