Value based health and care: action plan

Sets out the actions to support health and care colleagues practise Realistic Medicine and deliver value based health and care, by focusing on outcomes that matter to people, optimising use of health and care resources, and contributing to a more sustainable health and care system.


My Annual Report for 2022/23: Doing The Right Thing, sets out four great population health challenges faced in Scotland. We know that threats from infectious diseases remain; life expectancy is stalling and health inequalities are widening; demand for and utilisation of our health and social care services continues to increase in an unsustainable way; and the climate emergency requires adaptation and is already affecting Scotland’s health and wellbeing. There is a pressing need to do things differently if we are to address these interconnected challenges and improve the lives of the people we care for.

There remains unwarranted and potentially harmful variation and waste within the services that we provide. The Organisation for Economic Co-operation and Development estimates that 20% of healthcare spend does not actually result in improvement in health. This consumption of resource without benefit is more likely to prevent those who are disadvantaged from receiving the care that they need, worsening health inequalities. It is also a drain on our natural resources and increases harmful emissions – wasteful care is poor care for our patients and our environment and increases the potential for harm to them both.

In Delivering Value Based Health & Care: A Vision for Scotland, I set out my thoughts on the way we should deliver care in Scotland. We know the challenges we continue to face. We know too that we need to deliver care differently if we are to meet these challenges. The Vision is for everyone regardless of your role or where you work. No matter your role, whether you are a clinician, Allied Health Professional, carer, finance manager, chief officer or porter, you can help build a more equitable and sustainable health and care system.

As I said in my annual report, care is human. It is about personal interaction, uncertainty, co-creation and compassion in managing risk, anxiety and hope. It is about the power of the relationship and being able to jointly identify issues that affect us, our preferences and our goals. It is as much about alleviating as it is about fixing, but always with honesty, kindness and consideration of others life experience. Care is not just biomedical, it is biographical too. The desire is to provide careful and kind care, that people really value.

I believe that by practising Realistic Medicine we can find ways to deliver the outcomes that matter most to the people we care for. It is about making evidence-based choices about how we use the resources we have at our disposal. It is about listening to and supporting the people we care for to make informed choices about the care that is right for them.

There remain concerns about finding the time to have meaningful conversations with the people we care for. Teams across Scotland are however, already leading the way, finding opportunities to practise differently. Working collaboratively across traditional health and social care boundaries, utilising the skills and expertise of multidisciplinary professional groups will help us to deliver Value Based Health and Care (VBH&C) centred on what matters to the people in our care. There are examples of this in Scotland already, such as for people living in care homes, who benefit from regular multiagency discussions, where there is a shared understanding of people’s preferences and goals and a proactive, anticipatory approach to care. This type of working reduces duplication and omissions in care and provides better value care.

We all share the responsibility to limit the impact of the way we practice on our planet and deliver more sustainable care to help address the climate emergency. Practising Realistic Medicine can help to reduce waste and help us optimise the use of resources. It can support people to live more years in good health and enable recovery and renewal of services across Scotland.

This action plan sets out the actions we will take to support you to deliver VBH&C. We will continue to work with our partners to deliver them. Meantime, I would ask everyone, no matter your role, to do what you can to deliver better value care and help secure the sustainable health and care system for Scotland that we all wish to see.

Professor Sir Gregor Smith

Chief Medical Officer for Scotland



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