Atlases of Variation in Health and Health Care

In the National Health Service (NHS), we are interested to know whether people in different parts of the country have equal access to the same quality of evidence based NHS services according to their need. We are also interested in the value of the NHS services provided, it is important to identify ineffective practice as well as this can lead to wasted resources and potential patient harm.

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 Where to Look and 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 (ie 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.

In developing and publishing this series, Public Health England 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.

For enquiries relating to the atlases please contact:

As the Atlases are large documents, we have provided individual topic sections as standalone PDFs for download as well.



2010 Compendium

Full Document


2011 Compendium

Full Document Data File


Alcohol Cancer Circulation Dental
EmergencyCare Endocrine Gastrointestinal Genitourinary
Hearing Learning Dis Mat & Neonates   Mental Health
MSK Neurological Non PBC Older People
Respiratory Vision


2015 Compendium

Full Document Data File Metadata


LA Opp Tool CCG Opp Tool


Alcohol Cancer Cardio Child & Maternal
Critical Care Dental Emergency End of Life
Gastro Infectious Disease Interv. Radiology Learning Dis
Mental Health MSK Neurological Older People
Respiratory Vision


Themed Atlases

2012 Child Health Full Document Data File Metadata
2012 Diabetes Full Document Data File Metadata
2012 Kidney Full Document Data File Metadata
2012 Respiratory Full Document Data File Metadata
2013 Diagnostics Full Document Data File Metadata
2013 Liver Disease Full Document Data File Metadata


2017 Diagnostics


Full Document


Data File



Sections Introduction Imaging Endoscopy
Physiological Screening Summary Table
Slidepack Webinar

We would be grateful if you would take a few minutes to complete our user survey to inform future developments of the Atlas of Variation programme: