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.

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

2. Physiology Diagnostics
• 8 Clinical services
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Audiology
Cardiac Physiology
Gastrointestinal Physiology
Neurophysiology
Ophthalmic & Vision Science
Respiratory Physiology & Sleep Physiology
Urodynamics
Vascular Technology
• > 300 different tests
• > 15 million tests undertaken pa, demand
growing
• Key component of most clinical pathways

3. What does the Atlas tell us?
Test
Variation
After exclusions
Audiology assessments *
11x
5x
New born hearing tests o
4x
2.5x
Sleep studies *
79x
23x
COPD patients with FEV recorded #
1.3x
1.2x
Urodynamic tests *
144x
23x
Electrocardiography *
34x
4x
Diagnostic invasive
electrophysiology *
n/a
829x
Peripheral neurophysiology *
124x
37x
* national data collected monthly since 2008
# from GP database (QoF) data
O from National Screening Programme data

4. Challenging variation - Audiology
• Data shows a 11 fold difference
between highest and lowest areas
(still 5 fold after exclusions)
• Why is Norfolk so different to Suffolk?
Or Hillingdon and Hounslow?
- Can we account for this variation?
• Undiagnosed and untreated audiology
issues can profoundly affect an
individual’s ability to communicate
– and so the rest of their health

5. Interventions
to reduce unwarranted variation
• Providing a ‘feedback loop’ challenge to the commissioning
system – empowering clinicians in services and informing
contract management
• For patients: ensuring a fresh focus on the identification of
undiagnosed, and untreated conditions and the prevention of
disease progression
• Improving adoption of new technology & service redesign
• Quality assurance and peer review systems (such as IQIPS –
Improving Quality In Physiological Sciences)
• Tackling workforce shortages

6. Equipment
Management
&
Calibration
Performance
to SOPs &
guidelines
Knowledge
management
Diagnostic
services
MDT delivery
Advice and
expertise
Technical &
Clinical
interpretation
Quality
Systems &
Assurance
Diagnostic
services in
NHS –
getting it
right

7. Getting it right –
Mike Richards’s Vision
…we need to harness robust and timely
information from other sources to provide a more
rounded picture of a trust….
Accreditation and peer review already play an
important role in quality improvement …. I strongly
believe that such schemes have a key role to play in
the future of hospital inspection.
We need to use information from these schemes to
feed directly into CQC monitoring processes and
the development of trust-specific key lines of enquiry
for use at inspections.‘
Professor Sir
Mike Richards,
Chief Inspector
of Hospitals

8. Taking the Atlas forward in future
• The Atlas of Variation represents a subset of
diagnostic procedures – those that are monitored and
recorded nationally
• Some important diagnostics do not have sufficient data
to build a variation picture
– eg rate of EEG testing for epilepsy
• Need to focus on impact on patient experience and
outcomes when selecting additional indicators

9. Any questions?