For the first time, variations across the breadth of child health services provided by NHS England are presented together to allow clinicians, commissioners and service users to identify priority areas for improving outcome, quality and productivity. This presentation is by Dr Ronny Cheung, Atlas editor and Paediatric SpR St Thomas' Hospital, London

1. NHS Atlas of Variation in Healthcare
for Children and Young People
March 2012
Dr Ronny Cheung
Editor, Child Health Atlas
Copyright 2011 Right Care

2. Why variation matters
• For Children & Families
• Equity of access
• Quality of care
• Appropriateness of care
• Improved outcomes
• For the NHS
• Inefficiency
• Poor value from limited resources
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3. 3

4. Unwarranted variation
“Variation that cannot be explained by patient illness or
preference”
Prof J Wennberg,
Dartmouth Atlas of Variation
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5. 5

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7. Categories Indicator Maps
Resources 1. Expenditure on community child health
Health promotion & 2-4: Immunisation rates
Disease prevention 5: Breastfeeding
Neonatal care 6. Perinatal mortality
7. Retinopathy of prematurity testing
8. Admission rates of full term infant
9. Readmissions of newborns
Disorders of blood 10. Sickle Cell disease admissions
Endocrine, metabolic and nutritional 11-12. Diabetes: HbA1c<10% & DKA rates
Mental health 13. Inpatient admissions for mental health
Learning Disability 14. Rates of children with SEN
Neurological problems 15-16. Epilepsy: emergency admission & LOS
Hearing 17. Newborn screening
18. Grommet insertion rates
Respiratory 19. Asthma: emergency admissions
20-21. Bronchiolitis: admissions & LOS
22. Tonsillectomy rates
Gastrointestinal 23. Endoscopy rates
24. Inflammatory bowel disease: admissions
Genitourinary system 25. Orchidopexy performed by age 2yrs
Emergency care 26. A&E attendance rates under 4yrs
End-of-Life care 27. Deaths in hospital for children with life-limiting conditions
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8. Diabetes: Diabetic ketoacidosis rate
Percentage of children 0-15yrs with previously diagnosed diabetes admitted to hospital for DKA
2009-2010
Threefold variation
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9. Epilepsy: Emergency admission rate
for children with epilepsy per population aged 0-17yrs 2007/8-2009/10
Over fourfold variation
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10. Asthma: Emergency admission rate
for children with asthma per population aged 0-17yrs 2007/8-2009/10
Nearly fivefold variation
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11. Perinatal mortality rate
per all births 2007-9
Twofold variation
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12. Percentage of children with statement of special
educational needs
in primary school children in state-funded schools, by LA at Jan 2011
Sixfold variation
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13. Tackling variations
• Key questions
• Is the variation warranted or unwarranted?
• If unwarranted, what are the causes?
• What can we do to address the causes?
• Key steps
• Tackle high priority areas
• Commissioning for value
• System-based approach
• Clinical leadership
• Clinical networks
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14. About ChiMat
ChiMat provides information and intelligence which will help you examine and address
questions which the NHS Atlas of Variation in Healthcare for Children and Young People
may raise for your local area.
For example, ChiMat’s Disease Management Information Toolkit (DMIT) allows PCTs to
compare their emergency admission rates, bed-days and lengths of stay with a range of
different comparators for children with asthma, diabetes and epilepsy. It is designed to
highlight variations at PCT level and allow benchmarking to inform the commissioning
decision-making process for children’s services.
Other useful tools include:
ChiMat Data Atlas which brings together a range of data and statistics on child and
maternal health into one easily accessible hub.
Local Authority Child Health Profiles 2012 which provide a snapshot of child health and
well-being for each local authority in England using key health indicators, which enables
comparison locally, regionally and nationally
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15. Thank you
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