Value based health and care action plan: measurement framework

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.

Progress to date and future priorities

A Citizens Jury on shared decision making was held in autumn 2018. The Jury’s number one recommendation was to develop a programme to inform and educate the public of their right to ask questions of their health professional and the benefits of doing this in terms of what they want and the best outcome for them. In response, the Scottish Government worked with NHS Inform to develop the It’s OK to Ask Campaign. The campaign encourages people to ask their professionals the BRAN questions - the benefits, risks alternatives and what happened if they choose to do Nothing. The campaign has been running successfully for a number of years now.

In 2024 Healthcare Improvement Scotland published Citizen Panel 14, which indicates strong public support for better use of NHS resources to reduce waste and harm; and reinforced the desire for citizens to be actively involved in decisions about their care (shared decision making). To facilitate ongoing use of patient stories, the Scottish Government have collaborated with Care Opinion and a section on Realistic Medicine features in their annual review, further promoting the Citizen Panel 14 public viewpoint. We can see citizen-reported improvements in shared decision making through Health and Care Experience Survey results 2023/24 which demonstrates improvements in the proportion of people who felt they had involvement and influence in their care decisions.

The main future priorities are:

• Continue to learn from those with lived experience to improve services and seek an update on outcomes.
• Engage with Care opinion to explore how this platform can further support public engagement, provide agency and support people to make informed choices about their treatment and care
• Continue ongoing work to explore the role of public libraries in health and wellbeing and opportunities to incorporate Realistic Medicine principles and resources in the information they give to the public.

Monitoring metrics

The monitoring metrics for Action 13 draw on survey data from health and care professionals, findings from Citizen Panel research and the Health and Care Experience Survey. They outline awareness and use of shared decision‑making initiatives, perceived organisational support and patient‑reported involvement in treatment decisions. These metrics present engagement levels with shared decision‑making approaches across both professionals and the public.

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.

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.

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.

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.

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

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

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

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.

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.

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.

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.^[19]