As services begin to recover from the impact of COVID-19, on the 6 December 2022 we have refreshed 6 procedure maps and equivalent same day surgery maps to facilitate clinical discussions and local quality improvement work in these areas.

The Scottish Atlas of Healthcare Variation aims to highlight geographical variation in the provision of health services and associated health outcomes. It is designed to facilitate discussion and raise questions about why differences exist and promote quality improvement through the conversation.

Variation occurs for a number of reasons.

There will always be some variation because health systems are complex and the population has differing needs.

However, some variation cannot be explained by the characteristics of the people being treated, or their geographical setting. This is called unwarranted variation.

The Scottish Atlas of Healthcare Variation is an important tool to contribute to eliminating unwarranted variation, realising realistic medicine and support reducing harm and waste within the health service. The tool is designed to highlight variation and no judgement on the performance or inferences on quality of care of one geographical area against another should be concluded.

Professor Mahmood Adil, Medical Director, National Services Scotland, gives a brief overview of the Scottish Atlas of Variation and the contribution it can make to supporting realistic medicine within Scotland.

What questions might the Atlas stimulate?

• Does the variation matter?
• Do some patients receive a poorer service than others?
• Are we doing things the same way as in other parts of the country?
• Do we need to change what we are doing?
• Can we learn from successful innovations or best practice guidelines elsewhere, or can we share our expertise with others?

Why is it important to understand variation?

Understanding variation (random, warranted or unwarranted), through the engagement of clinicians, users and service providers, is key to providing value based healthcare within NHS Scotland.

Recognising unwarranted variation is of vital importance because it allows the identification of:

• underuse of higher value interventions – i.e. under-treatment
• overuse of lower value interventions
• overuse of interventions which may result in increasing harm

It will also inform discussion on how to shift resources to areas which provide the greatest value.

How do we select maps for the Atlas?

Maps are selected by the Scottish Atlas of Healthcare Variation Governance Group (SAoHVGG). The group is made up of representatives from key professional groups (Medical Directors, Directors of Public Health, Nursing, AHP, Finance, Pharmacy and Healthcare Sciences) and is chaired by Professor Paul Knight OBE.

The group is responsible for helping to ensure that:

• There is a robust, consistent and transparent process around the selection of maps to be published.
• The maps selected are impartial, evidence based and as comprehensive as possible. This ensures PHS adheres to the UK Statistics Authority Code of Practice (external website).

The SAoHVGG will report to the Deputy Chief Medical Officer (DCMO) until the Realistic Medicine Value Group (RMVG) has been reconvened. Read more about the map selection process in our Scottish Atlas of Healthcare Variation Governance resource.