Value based health and care action plan: measurement framework

Action 11

The Scottish Government, the Centre for Sustainable Delivery, NHS Boards and Healthcare Improvement Scotland will further promote and support the use of improvement tools and approaches that help to deliver VBH&C, including Active Clinical Referral Triage, Effective Quality Interventions Pathways (Opt-In Pathways), Discharge PIR (Patient Initiated Review), and digital approaches that help NHS Boards and Health and Social Care Partnerships to manage patients by reducing or stopping lower value interventions and care.

Progress to date and future priorities

The Centre for Sustainable Delivery (CfSD) have introduced Active Clinical Referral Triage (ACRT) across multiple specialties, Opt-In Pathways and Patient Initiated Review (PIR) models. In parallel the CfSD Innovation Team has introduced the Digital Dermatology Image Capture Referral Pathway, Pharmacogenomics, and Digital Diabetes solutions.

In addition, the National Green Healthcare Scotland Team has delivered the world-first removal of Desflurane, a potent greenhouse gas, from NHS Scotland’s supply chain, alongside the introduction of greener practices to reduce carbon emissions, waste, and energy use in operating theatres.

CfSD will continue to collaborate with the Scottish Government to share learning nationally, building capacity and capability for sustainable delivery, ensuring priorities remain aligned with the Service Renewal Framework, Population Health Framework, Programme for Government and Operational Improvement Plan.

Looking ahead, priorities include expanding digital triage and referral tools as well as Patient Focused Booking in outpatients supporting a more patient centred pathway that considers / reduces health inequalities; working with teams to support flow through perioperative pathways, strengthening data capture to evidence patient outcomes and experiences, and supporting clinical teams to confidently phase-out lower-value interventions. The National Green Scottish government Scotland Team will build on its achievements by extending sustainable practices across all Boards, expanding programmes into other high-impact clinical areas, and enhancing measurement of carbon savings to support Scotland’s net zero targets.

Monitoring metrics

The monitoring metrics for Action 11 draw on survey data from Consultants, Resident Doctors and other health and care professionals, as well as administrative data from national programmes and services. The survey‑based metrics describe levels of awareness and use of key approaches intended to reduce or stop lower‑value interventions. Administrative data capture procedure volumes, released appointments, reduced travel and associated cost savings.Together, these metrics outline how these tools and approaches are being used across the system and the scale of activity associated with efforts to reduce lower‑value care.

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.

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.

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.

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.

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.

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

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

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

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

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

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

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

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

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.