Diagnostics: The NHS Atlas of Variation in Diagnostic Services



  We are excited to introduce the NHS Atlas of Variation in Diagnostic Services, the latest publication in the series of impressive NHS Atlases, which have highlighted variation in the provision of healthcare services.Diagnostic services are of great importance in the NHS because, when used correctly, they support or rule out potential diagnoses, and underpin the effective and efficient management of patient pathways.

Unwarranted variation in the rates of diagnostic testing is of the utmost relevance to individual patients with the over-use, as well as under-use, of diagnostic tests being potentially serious issues. For example, effective capacity planning in imaging services should enable improved patient access balanced against the need to avoid over-use of interventions that have the potential to cause harm, such as ionising radiation.

Although the data presented in the Diagnostic Services Atlas may be open to more than one interpretation, the power of the Atlas series lies not in the answers they provide but in the questions they raise. There is an urgent need for work to improve our understanding of variation in the rates of many diagnostic services, and to understand whether the variation observed is random, warranted (i.e. true clinical variation), or caused by other factors such as poor access to services or need for education. Why do commissioners in one locality commission over four times the number of audiology assessments per head of population than commissioners in another (see Map 23, pages 102–103), and why is there 170-fold variation in the usage of rheumatoid factor testing (see Map 45, pages 146–147)?

Our work across the NHS through the auspices of NHS England will be focussed upon addressing the issues raised by and described in this Diagnostic Services Atlas, with the aim of ensuring that patients have timely, equitable access to the appropriate diagnostic tests and the reports generated.

The magnitude of variation for many of the indicators in the NHS Atlas of Variation in Diagnostic Services may surprise some people. In a context of evidence-based medicine and guidelines, how is it possible that the degree of variation in diagnostic testing is so great?Of critical importance in tackling the problems revealed by the Diagnostic Services Atlas is the contribution that healthcare scientists, radiologists, pathologists and the various sub-specialties can make.

We need to recognise the immense knowledge and skill, and to be given the opportunity to apply that skill for the benefit of the whole population and not just for those patients referred for test.

The launch event for the Diagnostic Atlas 27th November 2013:
Improving Value in Diagnostic ServicesPresentation by Professor Sue Hill OBE – Chief Scientific Officer for England

The complete set of presentations from the launch eventIntroduction – Sir Muir Gray – Right Care National Lead

Physiology Diagnostics & the Atlas of Variation
Professor Sue Hill OBE – Chief Scientific Officer for England

NHS Atlas of Variation in Diagnostic Services
Prof Erika Denton – NCD Diagnostics

Prof Jo Martin – NCD Pathology

The Royal College of Radiologists – Giles Maskell – President

Pathology: Tackling Unwarranted Variation
Dr Bernie Croal – RCPath Vice-President

Reducing variation: some ACB initiatives
Eric S.Kilpatrick – ACB President