NHS Atlas of Variation in Healthcare – 2015

Introducing the 2015 Atlas

This is the ninth edition in the series of Atlases of Variation. This compendium Atlas is the largest yet, with 102 maps detailing widespread variation in the quality, cost, activity and health outcome of healthcare in the English NHS. Almost 25% of the indictors focus on children and young people services.

The Atlas is a collaboration with NHS England, Public Health England and NHS Right Care.

In devising Atlas 3.0, we have worked closely with the National Clinical Directors (NCDs) at NHS England or clinical leads, who are responsible for some of the programme budget categories (PBCs), certain groups of patients, or certain types of services, and with the various Intelligence Teams at Public Health England (PHE).

We have also worked with colleagues from some of the Royal Colleges, some of the national audits, and some academic units. For Atlas 3.0, indicators have been constructed using populations from CCGs, NHS Trusts, NHS Area Teams, neonatal networks, paediatric diabetes units, strategic health authorities, upper-tier local authorities (UTLAs) and lower-tier local authorities (LTLAs).

This Atlas is available as a PDF download and as an online InstantAtlas interactive version. Unlike previous atlases, we regret that printed copies are not available, in line with cross government policy.

For the first time, we will be producing a companion tool to the Atlas – the Opportunity Selector. This tool analyses and groups the maps by locality and includes extended interpretation to highlight where local commissioners may wish to focus their pathway improvement efforts. The Opportunity selector will be available at the end of September.

The Atlas tools should be used in combination with the Commissioning for Value insights packs for CCGs and the Spend and Outcome tool for CCGs.

Download the PDFs Online InstantAtlas version








Note, new filter functionality has now been added to the IA tool to enable drilldown by Region (13/10/2015)


You can now also dowload individual sections of the 2015 Atlas. Go the downloads page here >>

The 2015 Atlas Opportunity Locator.

For the first time, we are publishing a companion tool to the NHS Atlas of Variation 2015. The “Opportunity Locator” uses the same maps and data but allows local authorities and local CCGs to see how they are grouped according to their local boundary and demographic peers. There is some further indication of the “value opportunity” to the local health economy in focusing on their variance reletave to demographic peers.

Two tools are available for download: one for CCGs and one for Local Authorities. In addition their a some screencasts and guidance in how to ue and interpret the tools.

The Opprortunity Locator is a collaboration between NHS England, NHS Right Care and Public Health England.

If you have any queries about the locator and yout local position please send them to rightcare@nhs.net and we will field your queries accordingly.


The NHS Atlas of Variation series illuminates a distinct English vista of variation caused by population differences, varying professional opinions, and disparate organisational performance.

It is the latter two factors – the idiosyncratic practices of clinicians and of healthcare organisations – that represent unwarranted variation.

David C. Goodman, The dartmouth Atlas of Healthcare, Wennberg Collaborative

A reader of this volume should be attuned to three specific themes. The first is the evaluation of under and over-use. The variation, for example, in the percentage of patients with diabetes receiving evidence based processes of care shows the potential for CCGs to provide care that is likely to improve patients’ health and well- being. The metric helps to identify where existing resources should be directed, and the specific interventions are straightforward and within the current capacity of the NHS.

At the same time, high rates of antibiotic prescribing in primary and secondary care are hard to explain by population differences in bacterial infection incidence. Over-use is a more likely explanation, although it could be called a costly mis-use, given the absence of benefit and a greater likelihood of antibiotic resistance and allergies.

The second topic that should draw the reader’s attention is preference-sensitive care. This phenomenon is exemplified by surgery rates such as tonsillectomies (Map 88), and joint replacement (Map 59), the percentage of deaths occurring in hospital (Maps 66 and 89), and the rate of emergency admissions in patients over the age of 65 years with dementia (Map 55). The right rate for these decisions is not obvious, and clinicians themselves will often recommend different options to treat the underlying illness. Shared decision-making with the use of decision aids is now well recognised as providing scientifically sound information to patients, while helping to clarify their goals and values. Do the NHS Atlas maps reflect care decisions that incorporate the preferences of informed patients? The answer is likely to be yes, but only partly so, and only in a few localities.

The third area is better value (quality and outcomes per person-cost) and links under- and over-use, and preference-sensitive care, to spending. In aggregate, the NHS represents a remarkable value for the nation but is likely to differ across the sites of care. Although costs are complicated to identify in the NHS, higher and lower values in healthcare are obvious in the NHS Atlas series. Improving value across the NHS landscape is the central aim of providing the information in Atlas 3.0. As in maps of health, these maps of healthcare show us where to focus efforts to improve health and healthcare while holding the line on costs.