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 interested in the value of the NHS services provided as it is equally important to identify ineffective practice as this can lead to wasted resources and potential patient harm.

In many localities across England, the Atlas of Variation 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 Focus 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, PHE consults with NHS Rightcare, NHS National Clinical Directors (NCDs), Health Intelligence Networks and clinical specialists 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 Interactive Atlas


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



Interactive Atlas

2017 Liver Disease

Full Document

Data File


Sections Introduction Summary Table Chronic Liver Disease
Risk Factors Influenza Overdose

Liver Cancer

Transplants & EoLC

Interactive Atlas

2018 Palliative and end of life care

Full Document


Summary Table

Sections 1: Need 2: Hospitals 3: Community


Map References

Data File


Resources Slide Pack Interactive Atlas

Additional products

National Clinical Procedures Benchmarking Tool 

This provides CCGs with the rates of occurrence for 27 different clinical procedures for their local area. The tool allows CCGs to compare themselves with their RightCare similar 10 peer group as well as to the England value. The purpose is to highlight areas where there is significant variation, in order to stimulate conversation about best practice and whether the variation observed is warranted or unwarranted.

Benchmarking Tool

Supplementary Spine Charts


For any enquiries relating to the Atlas series or to provide us with feedback please contact us on:

Recent updates

June 2019

The Palliative and end of life care care interactive atlas has been updated. 17 of the indicators describing number of deaths, hospital activity, cause of death, place of death and the number of patients in need of palliative care as recorded on GP disease registers have been updated. They now include data up to 2017. 

December 2018

New Palliative and end of life care interactive atlas launched. This interactive version enables organisations to interrogate the data at a local level. Organisations can use the tool to see where they sit within the national landscape or within their peer group.

November 2018

Atlas of variation for palliative and end of life care in England has been released.