The NHS Atlas series is pivotal in the interrogation of routinely available data that relate investment, activity and outcome to the whole population in need and not just those who happen to make contact with a particular service.  Only by taking this population perspective can we trigger the search for unwarranted variation and assess the value of the healthcare provided both to populations and to individuals.

The NHS Atlas of Variation in Healthcare was first published in November 2010 as a compendium of indicators; this was widely welcomed by the NHS and other stakeholders. Since its inception, there have been a further two compendium atlases published, the most recent of which was in September 2015. Alongside the compendiums, a series of themed atlases focusing on specific conditions or populations have been published; topic areas include children and young people, diagnostic services, liver disease, diabetes and respiratory disease.

In many localities across England, the NHS Atlas of Variation in Healthcare series has been used as a stimulus to start a search for unwarranted variation, and as a springboard to releasing resources for re-investment in higher-value healthcare for local patients and populations.

The data and information presented in each of the atlases do not always explain the reason for the variation, however the strength and power of the atlas series is in the questions they raise about equity, effectiveness and value. The data on variation shown in the atlases can be triangulated with data from other sources such as PHE’s National Intelligence Networks, Health Profiles and Spend and Outcome Tools, alongside NHS RightCare’s Commissioning for Value packs.

Work must continue to deepen our insights into variation seen around the country in the activity and outcomes for patients and to understand whether the variation observed is random, warranted (i.e. true clinical variation based on geographical variation in need) or unwarranted and caused by under- or over- provision, failure to implement evidence guidelines or poor access for patients because of travelling times, socioeconomic factors or poor health literacy.

The Atlases are produced by Public Health England (PHE) and in developing and publishing this series, PHE consults with NHS RightCare, NHS National Clinical Directors (NCDs), various Department of Health teams and the Health Intelligence Networks to highlight unexpected levels of variation within their area of expertise.

If you have any queries or comments about the Atlas series, please contact