Diagnostic services atlas key headlines nov 2013 -v1

Copyright 2011 Right Care

The NHS Atlas of Variation in Diagnostic Services

November 2013

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.

There is an urgent need for work to improve our understanding of variation in the rates of many diagnostic services, and to understand whether the variation observed is random, warranted or caused by other factors.

Why do commissioners in one locality commission over four times the number of audiology assessments than commissioners in another, and why is there 170-fold variation in the usage of rheumatoid factor testing ?

“ Our work across the NHS through the auspices of NHS England will be focussed upon addressing the issues raised by and

described in this Diagnostic Services Atlas, with the aim of ensuring that patients have timely, equitable access to the appropriate

diagnostic tests and the reports generated.”

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The magnitude of variation for many of the indicators in the NHS Atlas of

Variation in Diagnostic Services may surprise some people. In a context of

evidence-based medicine and guidelines, how is it possible that the

degree of variation in diagnostic testing is so great?

In this Atlas, the focus is on people with symptoms who are in need of a diagnosis. For people with a diagnosis, although there are variations in treatment, there is some consistency regarding what happens to them. This is in direct contrast to people in need of a diagnosis, who face a more disorderly health service.

There are several reasons why such variation in the use of diagnostic services exists…

First, the evidence base is much weaker for diagnosis than for treatment, a problem being addressed by the National Institute for Health Research (NIHR).

Second, there is the practice of what is sometimes referred to as “defensive medicine”, the practice of testing “just in case”, a particular challenge in the context of biochemical and other laboratory tests, which is why a relatively large number of such indicators are presented in the Pathology Services section.

Third, younger doctors, who perhaps were trained in a shorter period of time, have become more reliant on technology.

Of critical importance in tackling the problems revealed by the Diagnostic Services Atlas is the contribution that healthcare scientists, radiologists, pathologists and the various sub-specialties can make.

Healthcare scientists, pathologists and radiologists need to be recognised as professionals with immense knowledge and skill, and to be given the opportunity to apply that skill for the benefit of the whole population and not just for those patients referred for tests.

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www.rightcare.nhs.uk/atlas

In printYou can order free printed copies using the online form on out website

OnlineHigh and Low resolution PDFs are available for download

InteractiveA fully interactive InstantAtlastm is available online

The Atlas of Variation in Diagnostics Services covers five areas of diagnostic services: imaging, endoscopy, physiological diagnostics, pathology, and genetics. We attach a copy of the Preface and Contents, to show the coverage of the indicators, of which there are 69 in total. We regard this Atlas as being very important because it highlights a phenomenon that we have observed in our work for Right Care that, although there is concern about variation in the management of diseases, the management of symptoms and the use of diagnostic services shows even greater variation, some of which is likely to be unwarranted.

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