Monday, 29 November 2010

NHS Atlas of Variation

The NHS Atlas of Variation in healthcare was published last Thursday to co-incide with the NHS Medical Directors’ Conference. It contains a series of maps of variation of activity, expenditure, quality, outcome, value and equity to stimulate the NHS to tackle the causes and drivers of that variation.

“If all variation were bad, solutions would be easy. The difficulty is in reducing the bad variation, which reflects the limits of professional knowledge and failures in its application, whilst preserving a good variation that makes care patient centred. When we fail, we provide service to patients who don’t need or wouldn’t choose them while we withhold the same services from people who do or would, generally making far more costly errors of overuse than of under use”.
Mulley, AJ. Improving productivity in the NHS. BMJ 2010. 341:c3965
doi: 10.1136/bmj.c3965 (Published 27 July 2010)
However unwarranted variation is cause for concern and the Atlas brings together a range of topics including chronic kidney disease (see map 24 on page 72/3 ) where it is clear that the variation cannot be explained by differences in the population served. The Atlas also provides links to several web-based analysis tools and resources for analysing health investment that can provide a good understanding of relative expenditure, health outcomes and drivers of spend at a fairly detailed level for local populations.