• Cataract Surgery
• Cholecystectomy
• Elective Primary Hip Replacement
• Elective Primary Knee Replacement
• Hernia
• Colonoscopy

In response to our 'call for maps' in autumn 2019, we received almost fifty suggestions from groups and individuals, covering a variety of topics.

Thank you to all who took the time to send us your ideas.

Proposals have now been reviewed and prioritised and the Scottish Atlas of Healthcare Variation Governance Group (SAoHVGG) has signed off a schedule for releases in 2020/21.

We will publish approximately fifty maps during the year. More information about the releases will be added to the web pages in advance of each quarter.

Q1 (Apr to Jun):

• HCC liver cancer
• Dental
• Obesity

Q2 (Jul to Sep):

• Liver transplants
• A Neurological - Condition
• Blood Transfusion
  

Q3 (Oct to Dec)

• Older people / frailty
• Pre Hospital care

Q4 (Jan to Mar):

• Diabetes - Type 2 pathways

Maps for Respiratory were updated to present the following additional data for NHS Boards and Local Authorities in Scotland:

• Asthma (<16 years/16+ years) - emergency admissions
• Asthma (<16 years/16+ years) - length of stay
• Asthma (<16 years/16+ years) - emergency readmissions
• Inhaled corticosteroids (% high strength)
• Mucolytics (long term)
• Influenza vaccine uptake (chronic respiratory disease risk group)

If you are interested to find out more, please visit respiratory section.

New deprivation views for some of these maps have been developed and we welcome any feedback.

The Scottish Atlas of Healthcare Variation Governance Group (AoHVGG) met for the first time in October 2019.  The group is chaired by Professor Paul Knight OBE and includes representatives for key professional groups (Medical Directors, Directors of Public Health, Nursing, AHP, Finance, Pharmacy and Healthcare Sciences).

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, thereby supporting ISD to adhere to the UK Statistics Authority Code of Practice.

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.

Maps for respiratory present the following data for NHS Boards and Local Authorities in Scotland:

• COPD 1-3 emergency admissions
• COPD 3+ emergency admissions
• COPD Length of stay
• COPD Emergency readmissions (28 days)
• COPD Mortality rates
• Smoking cessation – 4 week quit rate
• Smoking prevalence 16+

If you are interested to find out more, please visit respiratory section.

New deprivation views for some of these maps have been developed and we welcome any feedback.

The team continue to work towards adding asthma-related maps to this theme in January 2020.

We are now inviting proposals for new maps. Proposals must be submitted by 15 November 2019.  T

hey will be collated and scored by ISD during November and December, using an agreed prioritisation process. The Scottish Atlas of Healthcare Variation Governance Group will consider ISD’s prioritised list and agree which maps should be produced in January 2020. This will produce a release schedule for 2020/21.

If you would like to submit a proposal, please contact the ISD team (nss.scottishatlasofvariation@nhs.net) to request a copy of the proposal template.

The fifth iteration of the Scottish Atlas of Healthcare Variation was published on 24 September 2019 and presents the following data for health boards of residence and local authorities in Scotland:

• ADHD prescribing
• Antidepressant prescribing
• Antipsychotic prescribing
• Dementia prescribing
• Length of stay – General Psychiatry specialty
• Length of stay – Psychiatry of Old Age

This publication was revised on 16 October 2019.

Following the release of the NHS Highland case study, we have now published a second case study which investigates variation in the rate of adult tonsillectomy in NHS Grampian.

The case study details how NHS Grampian has successfully introduced a range of new measures which have resulted in an overall reduction in the number of adult tonsillectomies.

After identifying the initial variation, NHS Grampian reviewed guidance and introduced a new range of measures including a more robust vetting process, new referral guidance and a ‘patient decision aid’ tool to be used as part of a shared decision making process.

The NHS Grampian case study is a great example of a board using the principles of Realistic Medicine to address variation. The new measures introduced by NHS Grampian have helped to reduce harm and waste, as well as reduce unwarranted variation. The introduction of a new ‘patient decision aid’ tool is also an example of shared decision making between clinician and patient.

Following the publication of the Scottish Atlas of Healthcare Variation tonsillectomy data in January 2019, NHS Grampian now have one of the lowest rates for adult tonsillectomy in Scotland. This reduction is a direct result of the initial investigation and successful new measures implemented by NHS Grampian.

View the NHS Grampian case study for further details about the process and conclusions.

During the first three months of 2019 we have continued to expand the Scottish Atlas of Healthcare Variation and have added fifteen new maps in addition to the three original maps published in September 2018.

The September 2018 publication of the Scottish Atlas of Healthcare Variation presented activity data for three surgical procedures (elective primary hip replacement, elective primary knee replacement, cataract surgery for 65 years and over).

In January 2019 we published seven new maps which presented activity data for three additional surgical procedures (tonsillectomy, cholecystectomy and hernia procedures) and four British Association of Same Day Surgery (BADS) procedures (adult tonsillectomy, paediatric tonsillectomy, laparoscopic cholecystectomy and repair of inguinal hernia).

This was closely followed by the February 2019 publication which included a new ‘prescribing and associated outcomes’ section which presented prescribing data for statin and ‘triple whammy’ prescribing, as well as hospital activity data for Heart Failure and Stroke.

In March 2019, we published an additional four maps under a new ‘colorectal cancer’ section which presents data for colorectal cancer incidence, colorectal cancer mortality, colonoscopy and bowel cancer screening.

Following the addition of three new sections between January and March 2019 the Scottish Atlas of Healthcare Variation now includes a total of eighteen maps split into four overarching categories.

Following the release of the Scottish Atlas of Healthcare Variation we hope that the Atlas has sparked new conversations about variation in healthcare across Scotland.  One example where a board has proactively engaged with ISD to begin examining potential reasons for variation is the recent case study from NHS highland.

Following the first publication of the Scottish Atlas of Healthcare Variation in September 2018, NHS Highland wished to investigate the reasons behind what appear to be higher rates of elective hip replacements, elective knee replacement and cataract procedures for patients aged over 65.  In particular, they were keen to explore how activity related to the management of waiting lists influenced procedure rates.

NHS highland requested bespoke analysis from the Discovery Wraparound Service to help understand the possible reasons for variation.  In response, the Discovery Wraparound Service collated a large amount of data from a variety of sources to provide a detailed analysis to NHS Highland.

View the NHS Highland case study for further details about the process and conclusions.

We will be demonstrating the potential of the Scottish Atlas of Healthcare Variation to utilise social care data in the future and raise awareness of the tool at the following workshop:

"Source data supporting better care: the future is nearly here - Including Atlas of Variation."

The intelligence available locally about health and social care is about to grow markedly due to the decision to improve national collection of data. By this autumn, progress on the establishment of the single source of data on social care in Scotland will have reached an advanced stage and we can soon anticipate the new analyses that have not been possible before. These will bring new insights to support better decisions and provide the intelligence for joint commissioning. This session will examine how this has been achieved, what we can realistically expect in the short term and what opportunities all of this offers for the longer term future.

On 4 and 5 September we will be demonstrating our developments on the Scottish Atlas of Healthcare Variation to Health and Social Care professionals as part of training delivered by Sir Muir Gray and his team from Better Value Healthcare.

Gregor Smith (Deputy Chief Medical Officer), Helen Mackie (Realistic Medicine Clinical Advisor) and Simon Edgar (Director of Medical Education – NHS Lothian) will lead a conversation on variation in healthcare, addressing unwarranted variation and how the Scottish Atlas of Healthcare Variation can support clinicians locally to drive improvement discussions.