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Variations in healthcare – how can we begin to tackle them?

Posted by: , Posted on: - Categories: Chief Knowledge Officer, Public health data

We all know that provision of healthcare varies from one hospital to another, from one GP to another and from one part of the country to another, but what causes these variations to occur?

Healthcare can vary in a number of ways; quality, the amount of money spent, outcomes achieved, and the types of service available.

Not all variation is bad. Some is expected, and often linked to patient choice. But some cannot be explained by the same causes – and is “unwarranted”.

When variation is “unwarranted” it means patients may receive treatments or services they don’t need or be denied access to those which they do need. This can have negative impacts on the population as a whole, leading to costly errors and a decrease in quality of care for patients.

If these variations can be addressed on a local level and the more effective services and practices seen in some areas of the country were adopted by others,  then there is significant potential to save lives, diagnose ill health sooner and prevent emergency hospital admissions.

As part of our work to improve population healthcare, PHE, alongside NHS England and NHS Rightcare has today launched the third and biggest NHS Atlas of Variation in Healthcare to help commissioners, service providers and health professionals deliver the best healthcare.

This is the first Atlas since the creation of NHS England and PHE and is a joint enterprise demonstrating our shared ambition to improve the health of the population and individuals within it, reduce health inequalities, and increase the value from investment in healthcare.

When the approach in one town is major surgery and in another, it’s watchful waiting, you know there’s a problem. [taken from the Atlas]

PHE has a responsibility to produce data and intelligence to support the NHS and local authorities and help identify areas that require priority attention, and where shifts in investment will enhance local health and improve quality.

We produce a range of tools to help clinicians, commissioners and service providers understand when things are working well and when they are not, and to develop understanding of what can be done to ensure patients are receiving the best possible healthcare, wherever they live and whatever their background . An example includes The Spend and Outcomes Tool which gives an overview of spend and outcomes across key areas of business.

The Atlas of variation is another, more comprehensive, major tool that focuses on improving value for patients. By this we mean improving the benefit of something relative to the cost.

It is a powerful tool, providing clinicians, commissioners and services with huge opportunities to change the way healthcare looks in their area. It aims to support the NHS to identify variation so the over-use and under-use of services can be addressed.  It also offers patients the chance to get a better understating of what high quality care should look like so they can engage in the debate with clinicians.

This is the third and largest Atlas of Variation (3.0). In addition to highlighting variations in NHS services the Atlas highlights the importance of prevention and has indicators related to PHE’s seven priorities: obesity, smoking, harmful drinking, best start for children, dementia, antimicrobial resistance and tuberculosis. Commissioning for Value is reflected in a number of indicators which were used in the Commissioning for Value Packs.

How is this Atlas different to the others?  It has over 100 indicators, more than a third more than Atlas 2.0 – increased in response to requests from Atlas users. It covers the most issues and programme budget categories (PBC’s), and expands on a number of the topics including mental health, Cancer and The Care of Older People.

There are 19 indicators for cardiovascular-related conditions (equivalent to a specialist Atlas within the compendium), and 24 maternity and reproductive health and children and young people's indicators (equivalent to another specialist Atlas within the compendium). There is also are a greater number of case-studies for a compendium atlas.

PHE is proud to part of this collaboration, driving a focus on delivering best-value healthcare for England.

You can find out more about the complete series of Atlases at

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