Delivering value based health and care: a vision for Scotland

1. Foreword

By publishing this vision, I'm asking all of my health and care colleagues, regardless of your role or where you work, to think about how we build a more equitable and sustainable health and social care system.

We know our system in Scotland is facing significant challenges. Health inequalities are widening. Demand for services is increasing. The COVID-19 pandemic and cost of living crisis have led to additional pressures on services, and our budgets.

The Organisation for Economic Co-operation and Development (OECD) estimate that up to 20% of all healthcare is of no value to the people receiving it. To put it another way, up to one fifth of our healthcare resource could be being wasted. We cannot continue to deliver care the way we always have. As I discussed in my most recent annual report, health and care systems across the world are thinking about how they can deliver Value Based Health & Care (VBH&C), which focusses on achieving outcomes that matter to people, while using their resources wisely.

The last few years have been hard for many of us too, both personally and professionally and I recognise that sometimes it's been difficult to think positively about the future. However, the challenges we face present us with an incredible opportunity to do things differently – to make optimal use of the resources we have and create a health and care system that both we and the people we care for can be proud of.

I am convinced that by practising Realistic Medicine we will deliver VBH&C and ultimately, a fairer more sustainable system. Through shared decision making we can deliver person centred care. By identifying and tackling unwarranted variation in health, treatment and outcomes we can reduce waste and ensure equity of access for those who need our help the most.

I am not asking you to deliver more. Nor am I asking you to focus on saving money. I'm asking you to focus on achieving the outcomes that matter to people, use evidence to target our interventions on what really makes a difference, and practise in a sustainable way. This is the essence of VBH&C.

This vision signals the start of our journey towards delivering VBH&C across Scotland. In 2023, we will continue to work together to agree the actions required to deliver this vision.

The future of our health and care system very much depends on the decisions we make as professionals. By sharing this vision with you, I am setting out my thoughts on the way we should deliver care in Scotland. I hope that you recognise the need for a new culture of stewardship and will help me to foster it. In doing so, we can relieve some of the workload pressures we are experiencing, make better use of the resources we have at our disposal, increase job satisfaction and provide care that the people we care for, and those closest to them, really value.

Professor Sir Gregor Smith

Chief Medical Officer for Scotland