Variation - the good, the bad and the downright ugly

The NHS Atlas of variation and the interactive online maps demonstrate the postcode lottery of kidney care provided across the country. Some of this will represent strong local ownership and integration of care. The population of Bradford and East Kent are very different – they are highly unlikely to want precisely the same pattern of care. They are both fortunate to have local kidney care teams using IT to integrate and improve services.

Variation based on the needs and priorities of the local people is to be applauded. Unwarranted variation – due to resource constraints, clinical bias in primary and secondary care or failure to integrate service provision across the whole pathway of health and health care - is ‘the bad’. That said the fact other teams can do so much better at timely referral to kidney services, early transplantation and supporting home dialysis options should become the focus for local quality improvement – variation shows what can be achieved! The ‘downright ugly’ is the poor quality coding that makes a mess of the data captured – coding needs to be seen as an integral part of clinical care. We can only improve when we can define and measure what we do in both the individual case and the community we are part of .

Exploring the questions that the Kidney Care Atlas raises should prompt improvements in the local organisation of care delivery. Building on the best examples that currently exist. Promote a shift to establishing shared decision-making systems between patients and healthcare professionals as the norm for preference-sensitive care such as choice of modality of renal replacement therapy or whether to opt for conservative care. In addition, strengthen the science of healthcare delivery to foster innovation and put effective care delivery on a solid scientific foundation.

The Kidney Care Atlas is a landmark in the study of variation in kidney care in England. Data from the UKRR and QOF, as well as other datasets, have been used to illustrate how aspects of healthcare specific to kidney disease vary. The maps highlight only 18 of potentially numerous indicators relating to kidney care. They represent a sample of the variation in value and quality in renal services across England.  Identifying, mapping and attempting to address unwarranted variation should not be regarded as independent pursuits, but instead be perceived as intertwined with the quality improvement agenda for renal services. Have a look, share it, ask questions about your place on the map, discuss the issues with patients and set some local goals.