The Right Decision Service comprises a suite of digital systems and services, which deliver evidence for decision-making in different ways to different audiences. The key  systems are listed below.

Once for Scotland web and mobile app platform

This is the longest established and most widely used RDS system. It hosts decision-ready clinical and care guidance, clinical pathways, shared decision aids and clinical risk scoring tools from local and national organisations and programmes. All resources are quality assured through a governance framework provided by the Healthcare Improvement Scotland RDS team.

In 2024, the RDS team brought together multiple independent RDS web and mobile apps into the single Once for Scotland web and mobile platform. This platform now provides:

• health and social care staff across Scotland with one go-to place to access and deliver decision support solutions. 
• decision support tools to empower patients and the public to become active partners in shared decision-making and in supported self-care. The RDS works closely with NHS inform to complement its services and provide seamless support to people across Scotland and will integrate these apps with the MyCare.scot platform in future.
• 'no-code' decision support builder tools which enable trained RDS editors to build web and mobile apps to support local and national health and care needs.

Since creation of the single RDS web and mobile platform in 2024, this service has grown from strength to strength. At the end of 2025, the Right Decision Service provided access to 283 decision support 'toolkits' - packages of resources and tools delivered as individual websites and downloadable mobile apps within the RDS platform.

Other RDS systems and services are key examples of a Once for Scotland approach to digital innovation

Patient-specific decision support alerts embedded in electronic health record systems

This RDS system responds to triggers such as opening a patient record by checking the data in the patient record against evidence-based algorithms and issuing alerts and prompts to the clinician if any risks or concerns are detected.

The Scottish Government Effective Prescribing and Therapeutics Division has played a key role in developing this system, initially to support high risk polypharmacy prescribing. There is the potential for wider application, extending patient-specific decision support to other prescribing contexts and clinical interventions.

Currently the polypharmacy decision support alerting system is rolled out to all practices across NHS Tayside and NHS Lothian and in pilot practices across a number of NHS Boards. An external evaluation of impact in NHS Tayside and NHS Lothian is planned for delivery in 2026.

 

National platform for capture and use of Patient Reported Outcomes and Experience Measures (PROMs and PREMs)

This platform delivers directly on the national policy ambition to reshape the health and care system to deliver the outcomes that matter to people, and to empower people to be more in charge of the care they receive. Delivery of a Once for Scotland PROMs and PREMs platform to support shared decision-making, patient empowerment and person-centred service planning is a core commitment within the Service Renewal Framework and Value Based Health and Care Action Plan.

Development of this platform is currently funded through the UK-wide Voluntary Branded Medicines Pricing, Access and Growth (VPAG) scheme sponsored in Scotland by the Chief Pharmacist’s Office.

At end of 2025, an initial version of the platform has been developed and successfully tested. The system is designed to support future integration with the MyCare.scot service as part of the national Digital Front Door programme. 

• Creation of a standards-based national library of validated PROMs and PREMs
• Issuing of PROMs and PREMs questionnaires by text, email and manual printing with consent, verification of personal details and a privacy statement all in place. Patients can save the report of their PROMs and PREMs responses and these are submitted directly back to the platform.
• Embedding of PROMs and PREMs questionnaires in Right Decision Service web and mobile apps so that patients can access self-management and support material. 
• Management  of access and administration permissions at organisational and patient levels.
• Allocation of PROMs and PREMs to clinical and care pathways.
• Scheduling of issuing PROMs and PREMs and manual sending where required.
• Tracking and monitoring of receipt of PROMs and PREMs responses.

Work in progress includes integration of PROMs and PREMs responses into patient record systems and creation of population-level and individual patient-level dashboards.

Patient-specific pharmacogenomics decision support, integrated with electronic patient record systems.

This Right Decision system for personalised medicine is being developed as an extension of the existing decision support embedded in primary care electronic health record systems. Initially to be implemented and evaluated in NHS Tayside, it involves using existing guidelines to define decision support algorithms that combine the results of pharmacogenomic testing with the medicines in the patient record to issue recommendations and options for prescribing in the context of the patient record.

Multidisciplinary team decision support for discharge planning

This Right Decision Service system is being developed and piloted in NHS Lanarkshire with a view to wider roll-out across NHS Boards.

It supports healthcare professionals in assessing and managing the essential requirements for a safe and timely discharge, ensuring that all necessary medical, therapy, and social care needs, patient and carer involvement are addressed.  It incorporates a structured approach to planned date of discharge (PDD) determination, and improves transparency around decisions about discharge planning enhancing services'ability to audit and analyse PDD data.

The Right Decision Service development programme delivers the policy commitment to reshaping the health and care system to deliver the outcomes that matter to people, and to empower people to be more in charge of the care they receive.

RDS translates key goals of the Service Renewal Framework, Population Health Framework and Operational Improvement Plan into a wealth of practical tools for day to day use in frontline care. It plays a central role in delivering effective, person-centred within available resource as set out in the Value-Based Health and Care Action Plan, the Digital and Data Strategies, It directly supports the following principles and goals which are common to all the policy drivers:

1. Digital innovation to improve delivery of care, as a successful digital platform which enables the clinical and care workforce and citizens to make safe, person-centred decisions about treatment and support.
2. Putting people at the centre of care, through its national suite of shared decision-making tools and its partnership with NHS inform:
   • Innovate UK funding for RDS/NHS Inform to develop a shared decision aid for weight management
   • Once for Scotland Patient Reported Outcome and Experience Measures platform which delivers the Service Renewal Framework goal of ‘a nationally coordinated approach to the capture and use of patient reported outcomes and experiences.’ Plans are in hand to integrate patient access to this platform into MyCare.scot as part of the Digital Front Door programme.
   • Deploying  knowledge-based AI to deliver personalised medicine through development of pharmacogenomic decision support with Scottish Government and NHS Tayside.
3. Prevention and healthy living, through tools such as the national Waiting Well toolkit, the SIGN diabetes type 2 prevention and remission guideline, the Cardiovascular Risk Prevention pathway toolkit, highlighted in the SRF, and local Ageing Well
4. Improving access to care and shifting the balance of care to the community, through many tools for primary and community care and integrated health and social care - including:
   • national and local referral management pathways to improve timely access to treatment in the community
   • delivery of polypharmacy prescribing decision support and the BTS/NICE/SIGN asthma pathway to reduce emergency admissions
   • decision support for Flow Navigation Centres
   • Planned Date of Discharge decision support system for NHS Lanarkshire.
   • Other examples include the Optimal Cancer Diagnostic Pathway, a childhood epilepsy risk assessment tool for CAMHS services, the national Ageing and Frailty Standards and self-assessment tools.
5. Equitable delivery of health and care by:
   • delivering national guidance through a single Once for Scotland gateway
   • enabling collaboration and sharing of national and local guidance to improve consistency in care
   • inclusion of deprivation index in the ASSIGN 2.0 scoring tool
   • resources to support ethnic minority group needs and access to benefits.

 

Increasing usage levels indicate the value and utility that health and care professionals and citizens place on the RDS.

• 3 million unique users (as defined by Google Analytics)^[1] in Jan-Jun 2025, a 26% increase on the same period in 2024.
• 2.08 million unique users in 2024, a 22% increase since 2023
• delivers decision support content and tools provided by all 14 territorial boards, 6 national Boards, 10 SG programmes, 3 national social care bodies and 10 Health and Social Care Partnerships.
• sole access point for vital UK CA marked clinical tools, eg the national antimicrobial calculators, the national IV fluids calculator, the ASSIGN 2.0 cardiovascular risk tool
• sole access point for 13 SIGN guidelines in decision-ready format; national palliative care guidelines; national Scottish Cancer Network pathways; national referral guidelines from Centre for Sustainable Delivery, including new cancer referral guidelines.

[1]  ‘Unique users’ in Google analytics counts individual users to a website. Every time a user visits the website, their IP address assigns a unique identifier which is used to track the number of times they visit the site.

Examples of outcomes and benefits delivered by the RDS

Improving safety, reducing unwarranted variation

• 93% of respondents in a 2024 survey reported that RDS had improved evidence-informed practice; 91% that it had strengthened consistency in practice.
• 85% reported that it had improved patient safety and addressed clinical risks

Economic benefits - optimising efficiency, performance and sustainability

Examples of RDS saving time and money include the following (workings provided in paper for Corporate Finance Network):

• an estimated annual saving of £7.769 million from clinician time saved searching for essential guidance if even just 50% of the 5,800 training grade doctors in Scotland use RDS regularly
• economies of scale of up to £3.38 million annually compared with NHS Boards investing independently in decision support solutions.
• cash-releasing savings
  • Up to £2.18 million p.a. from consistent use of musculoskeletal pathways to reduce radiology tests.
  • Up to £1.8 million p.a. combined savings through reduced prescribing (est. 46% of savings) and reduced costs of hospital admissions related to adverse drug events (est. 54% of savings) resulting from safer use of medicines due to RDS tools.

Improving patient outcomes, putting shared decision-making at the centre of care

For example, in the  i-SIMPATHY study, the Manage My Meds app for patients and carers

• increased patient understanding of the side-effects of their medicines by 80% (from 13% to 93%)
• enabled 68% of patients to highlight concerns about potential side-effects of medicines in advance of medicines review. This contributed to a 30% reduction in side-effects post-review.

Timely and appropriate referral management to reduce waiting times

• A May 2024 survey of clinicians using the Dumfries and Galloway RefHelp app found that 97% of respondents said that it had changed their decisions about referral management for individual patients across a range of clinical presentations, including osteoporosis, asthma, dermatology, migraine and stroke.

Reducing avoidable admissions to urgent and unscheduled care

• 82% of clinicians using the RDS prescribing decision support tool embedded in patient record systems sad that it had alerted them to significant clinical risk to patients. It has reduced medicines-related harm (responsible for up to 1 in 6 emergency hospital admissions).

Reducing inpatient stay

Embedded use of eczema guidance via the RDS app in the paediatrics ward and emergency department in one NHS Board was associated with:

• reduction in inpatient stay from 3 days to 2 days
• reduction in dermatology referrals from both ED and the ward by 10.3% despite an overall increase in ED attendances