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The NHS atlas
  1. Geoff Hughes
  1. Correspondence to Professor G Hughes, Emergency Department, Royal Adelaide Hospital, North Terrace, Adelaide 5000, Australia; cchdhb{at}

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In November last year the government, under the banner of the NHS's Quality, Innovation, Productivity and Prevention (QIPP) strategy, published something that may appeal to readers who like maps (cartophilicas? cartographophiliacs?). The NHS Atlas of Variation in Healthcare—Reducing unwanted variation to increase value and increase quality ( is 100 pages long, has 34 separate maps of England and aims to complement Equity and Excellence: Liberating the NHS, the government white paper published in the summer of 2010. The latter, among many things—some very controversial—commits to improving the value the taxpayer gets from the NHS budget.

The Atlas aims to ‘put variations in activity expenditure, quality, outcome, value and equity firmly on the health service agenda for the next decade, and to stimulate the NHS to search for unwarranted variation and, by extension, to tackle the causes and drivers of that variation’. The authors wisely state that “some variation is not only inevitable but also necessary in both clinical practice and healthcare commissioning. However, unwarranted variation is cause for concern”. The Atlas also aims to complement the individual Primary Care Trust (PCT) Health Investment Packs, available …

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