Value based health and care action plan: measurement framework
This report is the first iteration of the Value Based Health and Care measurement framework. It presents updates and monitoring metrics which aim to provide an assessment of the progress with and impact of work aligned to each of the 13 actions from the value based health and care action plan.
Annex 2: Metric data sources first published in this Measurement Framework: Methodological Overview
The data (both quantitative and qualitative) for some of the metrics included in the Measurement Framework have been sourced or captured specifically for that purpose, and as such have not been publicly reported prior to their inclusion in the Measurement framework. The unpublished data sources include survey data, usage data from relevant services, tools and initiatives, qualitative evidence from case studies and secondary analysis of the HACE survey. Background and methodological overview of each of the previously unpublished sources are provided below.
Annex 2.1 Value Based Health and Care survey
This survey was designed to inform the content of metrics in the Measurement Framework and aimed at gathering the views and experiences of healthcare professionals regarding the delivery of the Value Based Health and Care Action Plan. The survey was developed by government research analysts from the Whole System Intelligence Analysis Division and the Realistic Medicine Policy Unit within the Scottish Government, in collaboration with stakeholders directly involved in delivering the actions. The survey was available online for anonymous participation between Sep 30 – Nov 9, 2025.
The survey consisted of 21 closed-ended questions. Some questions required respondents to select a single response option, while others allowed multiple selections. Four questions included an “other” option, which enabled respondents to provide an alternative written answer.
A snowball sampling approach was used to distribute the survey. An invitation email from the Deputy Chief Medical Officer, which included the survey information, the survey link and the privacy notice, was sent to members of the Realistic Medicine Network, who were asked to share it within their respective areas of work. Two reminder emails were circulated using the same approach. This method aimed to reach a cross section of healthcare professionals. Due to the sampling strategy, the total number of individuals who received the survey is unknown, and therefore a response rate cannot be calculated.
Survey responses were anonymous and no personal identifiable information was requested. A total of 425 responses were received. Respondents were asked questions in relation to their profession and area of work. Allied Health professionals accounted for 25% of respondents, followed by nurses (15%) and consultants (15%) (See Table 1). More than half of respondents (59%) worked in NHS Territorial Boards and almost a third (31%) worked in a Health and Social Care Partnership (see Table 2).
| Total | % | |
|---|---|---|
| Allied Health Professional | 105 | 25% |
| Consultant | 63 | 15% |
| GP | 47 | 11% |
| Manager | 46 | 11% |
| Nurse | 72 | 17% |
| Pharmacist | 40 | 9% |
| Other | 36 | 8% |
| Total | 425 | - |
| Total | % | |
|---|---|---|
| NHS Territorial Board (e.g. NHS Fife, NHS Highlands, etc) | 251 | 59% |
| Health and Social Care Partnership | 132 | 31% |
| Total | 425 | - |
Annex 2.2 Case studies
The case studies in the Measurement Framework provide supplementary evidence of how the principles of Realistic Medicine and the delivery of VBH&C are applied in practice across a range of healthcare settings. These case studies were not delivered by WSIA analysts; rather, they result from collaborative engagement with relevant Action Leads and stakeholders who are actively involved in implementing Realistic Medicine and delivering VBH&C within their organisations and local contexts.[23]
Each case study illustrates the impact of one of the 13 actions set out in the VBH&CAP. They highlight how national ambitions are being translated into tangible change in practice, education, service delivery or patient engagement. The list below sets out the case studies included in the first iteration of the Measurement Framework.
Action 1:
- Queen Margaret University
- Contributor: Alison Lyles, Lecturer and Programme Leader, MSc Dietetics
- Robert Gordon University
- Contributor: Vicki Falls, Course Leader, BSc/MSc Midwifery
- University of St Andrews
- Angela Flynn, ScotGEM Agents of Change Director
The case studies were collected during the 2024/2025 financial year. HEIs were identified through ongoing discussions and collaborative work with NES to embed RM and VBH&C within their curricula. Institutions already engaged in this work or demonstrating emerging practice were invited to contribute. A case study template was used for the semi‑structured interviews to ensure consistency across contributions. Content was drafted collaboratively by NES and the participating HEIs with each institution providing final approval and sign‑off.
Action 9:
- Enhancing Patient Communication through Community of Practice Collaboration. Contributor: Karen Howe, Realistic Medicine programme manager
- Organisation: NHS Lothian
- Advancing Shared Decision Making in NHS Fife through Community of Practice Engagement.
- Contributors: Linda McGourty, Carron Waterson and Emma O’Keefe
- Organisation: NHS Fife, Realistic Medicine clinical lead
The case studies were collected in October 2025. Members of the Community of Practice were invited to submit examples illustrating the impact of the CoP. Contributions were provided in written form using a response template.
Annex 2.3 Unpublished data, including usage data
Unpublished data, primarily usage data, form a key component of the measurement framework. They provide quantitative evidence of reach, adoption and engagement with programmes, services, pathways, initiatives and digital resources that support the delivery of Realistic Medicine and VBH&C.
Several metrics rely on usage data extracted for a 12-month period, based on either the calendar year or the financial year. While these metrics do not directly measure outcomes, they provide an important proxy for implementation and uptake. They also provide a baseline and benchmark against which progress and impact of specific VBH&CAP actions can be assessed over time.
The table below outlines the key characteristics of these data and the time periods they cover.
Table 3: Unpublished data included in the measurement framework
Metric 1.1 - Usage data
Total learner completions across four Value Based Health and Care
TURAS
e-modules
Metric 1.1 - Time period
Jan-Dec 2025
Metric 1.1 - Background
E-modules include:
- Finance and Value Based Health and Care Toolkit
- Introduction to Value Based Health and Care
- Managing Risk
- Shared Decision Making
Metric 1.2 - Usage data
Total number of times Sway resources were accessed
Metric 1.2 - Time period
Jan-Dec 2025
Metric 1.2 - Background
‘Sways’ are online learning resources. These include:
- VBH&C: Outcomes that matter to people
- VBH&C for Social care
- Shared Decision Making
- How to measure SDM
- Unwarranted variation
Metric 1.4 - Usage data
Total number of times animations were accessed
Metric 1.4 - Time period
Jan-Dec 2025
Metric 1.4 - Background
‘Animations’ are short information videos. These include:
- Value Based Health and Care
- Realistic Medicine
- Shared Decision Making
- Personalised approach to care
- Reduce harm and waste
- Unwarranted variation
- Managing risk better
- Become improvers and innovators
- Animations can be accessed here: Realistic Medicine | Turas | Learn
Metric 1.6 - Usage data
Total user visits to the
TURAS
Learning Pages
Metric 1.6 - Time period
Jan-Dec 2025
Metric 1.6 - Background
Pages available here:
Realistic Medicine | Turas | Learn
Metric 3.4 - Usage data
Number of individuals enrolled in Connect Me in 2025
Metric 3.4 - Time period
Jan-Dec 2025
Metric 3.4 - Background
Connect Me is an
NHS
Scotland remote health monitoring service enabling individuals to securely share health data from their own devices for safe self‑management.
Metric 7.1 - Usage data
Interaction (total page views) with Demand Optimisation webpage.
Metric 7.1 - Time period
30/9/25 to 27/1/26
Metric 7.1 - Background
The DO Atlas is a set of dashboards that visualise variation in diagnostic test to identify over‑, under‑ and unwarranted variation.
Metric 10.4 - Usage data
Percentage of Content Reviewed on
NHS
Inform
Metric 10.4 - Time period
Jan-Dec 2025
Metric 10.4 - Background
The content reviewed is checked by experts on a structured three-year cycle, with additional updates made when feedback or new evidence requires it.
Metric 10.5 - Usage data
Percentage of
NHS
Inform Clinical content governed by Subject Matter Experts
Metric 10.5 - Time period
Jan-Dec 2025
Metric 10.5 - Background
NHS
Inform clinical content verified by subject‑matter experts, showing how much information is confirmed as accurate and up to date.
Metric 10.6 - Usage data
Total user visits to
NHS
inform webpages
Metric 10.6 - Time period
Jan-Dec 2025
Metric 10.6 - Background
Frequency of users’ access to Scotland’s national health information service.
Metric 10.7 - Usage data
Total user visits to
RDS
webpages
Metric 10.7 - Time period
Jan-Dec 2025
Metric 10.7 - Background
The
RDS
is Scotland’s national digital decision‑support platform enabling consistent, safe, person‑centred care decisions.
Metric 10.8 - Usage data
Total user visits to Professional-facing
RM
website and mobile App
Metric 10.8 - Time period
Jan-Dec 2025
Metric 10.8 - Background
The toolkit provides health and care staff in Scotland with tools and guidance to support Realistic Medicine in practice.
Metric 10.9 - Usage data
Total user visits to Citizen-facing
RM
website and mobile App
Metric 10.9 - Time period
Jan-Dec 2025
Metric 10.9 - Background
The toolkit helps people and professionals make shared, person‑centred care decisions based on what matters to the individual.
Metric 11.6 - Usage data
Total number of procedures across five interventions identified as low or limited clinical value
Metric 11.6 - Time period
April 2024 to March 2025
Metric 11.6 - Background
These procedures fall under the
which contains a series of procedures where
suggests that there is less clinical benefit and as such, they must not be routinely offered by
NHS
Scotland.
Metric 12.11 - Usage data
Interaction with effective prescribing resources (total views)
Metric 12.11 - Time period
April 2024 to March 2025
Metric 12.11 - Background
These resources support safe, person‑centred and evidence‑based prescribing across Scotland through practical improvement guides and toolkits.
Annex 2.4 Health and Care Experience Survey 2023/24: Secondary Analysis
The Scottish Health and Care Experience Survey (HACE) is a national survey that gathers feedback on people’s experiences of GP services, out‑of‑hours care and social care. It is an online and postal survey sent to a random sample of people who were registered with a General Practice in Scotland, lived in Scotland, and were aged 17 and over on 25 September 2023. The survey has been run every two years since 2009. The 23/24 survey included closed and open‑ended questions and received 107,538 responses (equating to an overall response rate of 20%), including 43,803 free‑text comments about experiences of General Practice and out‑of‑hours care. Questionnaires were sent out in October and November 2023 asking about peoples’ experiences during the previous 12 months.
The free-text comments were collected through two open-ended questions in the HACE survey[24]: Question 18, which focused on people’s experiences of General Practice, and Question 26, which focused on out of hours healthcare. Secondary analysis of these free text comments in the Health and Care Experience Survey 2023/24 was carried out by government research analysts to inform the Value Based Health and Care Measurement Framework, specifically Metric 14.7. Responses to both open-ended questions were combined and analysed together. Appropriate ethical procedures were followed to access the free-text responses to both questions of the HACE survey. These procedures primarily involved submitting a formal access request, adhering to data protection standards, and ensuring all data was handled securely.
Due to the large volume of free-text responses, a list of keywords was developed and used to filter and identify relevant comments containing terms related to the Value Based Health and Care.[25] Responses containing at least two specified keywords were initially selected (n=3,161). Following this, a shorter list of primary keywords was identified and used to undertake a further round of screening, which resulted in 1,081 responses. A final manual review excluded comments that were unclear, lacked sufficient detail, or fell outside the scope of the analysis. This resulted in a total number of 426 responses included for the secondary analysis. These were examined using thematic analysis, independent of the closed‑ended survey questions.
The free-text responses were analysed independently from the closed-ended questions. Respondents’ comments generally reflected a balance between positive and negative experiences; however, some discrepancies were observed, with slightly more negative experiences reported. While the findings from the closed-ended questions highlighted mostly positive experiences of care, the slightly higher proportion of negative free-text comments may indicate that respondents with negative experiences were more inclined to share their views.
Contact
Email: realisticmedicine@gov.scot