Value based health and care action plan: measurement framework

The VBH&CAP Measurement Framework

The formulation of the Measurement Framework (and accompanying Technical report) has been led by government research analysts from the Whole System Intelligence Analysis Division (WSIA) within the Directorate for the Chief Operating Officer, NHS Scotland, Scottish Government. This work has been undertaken in collaboration with Action Leads, the Scottish Government Realistic Medicine Policy Unit and other stakeholders.

Each Action within the Value Based Health and Care Action Plan has a dedicated Lead or Leads. These Action leads, who report into the VBH&CAP Implementation Group, represent a range of organisations involved in delivering the Action Plan. These organisations include the Scottish Government, NHS Education for Scotland, Public Health Scotland, NHS 24, Healthcare Improvement Scotland and the Centre for Sustainable Delivery.

The Measurement Framework contains 14 substantive sections that correspond to the 13 Actions set out in the Action Plan, along with an additional section that reports on overall progress against the Plan’s commitments. Each of the 13 Action sections is divided into two components: “Progress to date and future priorities” and “Monitoring metrics.” Each component serves a separate and distinct purpose.

About the ‘progress to date and future priorities’ content

The ‘progress to date and future priorities’ content for each Action were provided by the corresponding Action Leads. It should be acknowledged that some elements of the ‘progress and future priorities’ sections are not easily captured by monitoring metrics. Therefore, these sections present narrative-based updates.

It should also be noted that some ongoing work streams related to certain Actions are not currently captured by specific monitoring metrics in the Measurement Framework. This is primarily because reliable evidence to assess their progress and impact is not yet available. However, Action Leads have aimed to reflect ongoing and planned activity within the ‘progress to date and future priorities’ section for each Action in the Framework.

Future iterations of the Framework will seek to include additional monitoring metrics that relate to work streams which are currently planned or in development.

Monitoring metrics: identification, methodology and reporting

To support readers’ understanding and interpretation, this Measurement Framework report provides an overview of the methodological background underpinning the development of the Framework, as well as the various data sources related to its monitoring metrics. A comprehensive methodological account of the analytical work undertaken to support the Measurement Framework is available in the accompanying Technical report which is published alongside this report.

A total of 90 monitoring metrics have been collated for inclusion in the Measurement Framework. The identification, triage and reporting of these monitoring metrics was led by government research analysts from the Whole System Intelligence Analysis Division (WSIA).

Each of the 13 Actions within the Value Based Health and Care Action Plan has a dedicated Lead or Leads. WSIA’s work to identify and triage monitoring metrics was supported by these Action leads, who report into the VBH&CAP Implementation Group and represent a range of organisations involved in delivering the Action Plan. These organisations include the Scottish Government, NHS Education for Scotland, Public Health Scotland, NHS 24, Healthcare Improvement Scotland and the Centre for Sustainable Delivery.

Given the cross-cutting and in some cases holistic or generalist nature of work undertaken to deliver the VBH&CAP, a decision was taken to include a small sub-set of monitoring metrics pertaining to the “overall progress and impact of the VBH&CAP”. Members of the Measurement Framework Governance Group acted as the “leads” for the development of these metrics. As a result, the Measurement Framework monitoring metrics are categorised into 14 sections: a section for each of the 13 Actions from the VBH&CAP, plus an additional section covering “overall progress and impact of the VBH&CAP”.

WSIA analysts’ work began with a scoping exercise to identify and assess all available and relevant data sources. This process built on a prior internal evaluability assessment undertaken by the Realistic Medicine Policy Unit, which delivered workshop sessions with relevant stakeholders from the Realistic Medicine network^[3] in summer 2024. One of the outputs from these sessions was an initial mapping of existing evidence sources.

WSIA analysts then led inception workshops with the Action leads for each Action, which were undertaken between October 2024 and March 2025. The basis for these workshops was the existing data sources identified by the evaluability assessment workshops and the “Measures of success” set out for each Action in the Action plan, which propose high level mechanisms for monitoring progress against the objectives set out in the corresponding Action. The purpose of the inception workshops with Action leads was to scrutinise the availability and reliability of previously identified sources, to explore previously unidentified sources, and to identify data gaps. Thereafter, meetings were held periodically with each of the Action leads (monthly or quarterly), to the track progress with development of emerging data sources and Action workstreams.

The initial scoping exercise, including the inception workshops, and subsequent engagement with Action leads led to the identification of 38 viable monitoring metrics, which were assessed as providing at least partial monitoring coverage across 8 of the 14 Actions from the VBH&CAP, plus the “overall progress and impact of the VBH&CAP” section. Data gaps were however also identified across all 14 sections. The existing data sources were identified from across a wide range published and previously unpublished activity, usage and survey data, which are explained fully later in this section and throughout this report.

In response to the identification of data gaps through the scoping exercise, WSIA analysts committed to planning and delivering primary research to address those gaps. In this context, data gaps were deemed to be the absence of good quality data or research which could be used to assess the progress or impact of work aligned to commitments set out in the VBH&CAP. The vast majority of gaps identified related to an absence of mechanisms for collecting the views and experiences of Health and Care staff in relation to their awareness and delivery of Realistic Medicine and Value Based Care. As a result, WSIA analysts subsequently designed and delivered three separate surveys with Health and Care professionals (The Realistic Medicine Survey, The Scottish Atlas of Variation Survey and The Value Based Health and Care Survey) as well as undertaking secondary analysis of qualitative data captured by the existing Health and Care Experience Survey (HACE) 2023/24, all specifically designed to address the identified Measurement Framework data gaps.

A total of 52 (of 90) metrics were derived from primary research delivered by WSIA analysts through the three surveys set out above. Of the metrics derived from primary research delivered by WSIA analysts, the majority (n=42) came from the Value Based Health and Care Survey, the findings from which are published for the first time in this Measurement Report and Technical report. A full outline of these metrics and the survey’s methodology is set out in Section 3.1 (The Value Based Health and Care Survey). A findings report for The Realistic Medicine Survey - which produced data for nine Measurement Framework Monitoring Metrics - was published on 13 May 2025. A findings report for The Scottish Atlas of Variation Survey - which produced data for one Measurement Framework Monitoring Metric - was published on 11 February 2026. The full background, methodology and findings presentation for this research can be found within their linked publications.

For ease of explanation, this report categorises the various data sources used in the measurement framework into four groups.

• Previously unpublished survey data
• Published survey data
• Previously unpublished activity and usage data
• Published activity and usage data

For ease of reading, metrics based on findings from surveys which sampled a wide range of health and care professionals are referred to as “health and care professionals surveyed” throughout this Measurement Framework report.

Existing data identified through the initial scoping exercise and subsequent engagement with Action leads are spread across all four of these groups, whilst data produced via WSIA analysts’ primary research and secondary analysis fall into the published and previously unpublished survey data groups. Each data point pertaining to each of the measurement framework monitoring metrics is grouped into one of these four categories. Full background and methodological information for previously unpublished survey, activity and usage data is provided in the corresponding sections of this report (Section 3 for previously unpublished survey data and Section 4 for previously unpublished activity and usage data). Each of the 90 monitoring metrics, and the publication of the data where previously unpublished, was approved by the corresponding Action lead(s), data controller(s) and by the Measurement Framework Governance Group.

As many actions comprise multiple strands of work, some of which overlap across actions, each monitoring metric reflects one or more aspects of each action rather than its full scope. The monitoring metrics are indicative, offering insight into the wider context and direction of travel. They are not intended to provide a comprehensive audit of all activity or progress associated with each action. For this first iteration of the Measurement Framework, the monitoring metrics should be understood as baseline measures against which progress will be assessed in future updates.