1. Physiology Diagnostics & the Atlas of Variation Professor Sue Hill OBE Chief Scientific Officer for England

2. Physiology Diagnostics 8 Clinical services –Audiology –Cardiac Physiology –Gastrointestinal Physiology –Neurophysiology –Ophthalmic & Vision Science –Respiratory Physiology & Sleep Physiology –Urodynamics –Vascular Technology > 300 different tests > 15 million tests undertaken pa, demand growing Key component of most clinical pathways

3. What does the Atlas tell us? TestVariationAfter exclusions Audiology assessments *11x5x New born hearing tests o 4x2.5x Sleep studies *79x23x COPD patients with FEV recorded # 1.3x1.2x Urodynamic tests *144x23x Electrocardiography *34x4x Diagnostic invasive electrophysiology * n/a829x Peripheral neurophysiology *124x37x * national data collected monthly since 2008 # from GP database (QoF) data O from National Screening Programme data

4. Challenging variation - Audiology Data shows a 11 fold difference between highest and lowest areas (still 5 fold after exclusions) Why is Norfolk so different to Suffolk? Or Hillingdon and Hounslow? - Can we account for this variation? Undiagnosed and untreated audiology issues can profoundly affect an individual’s ability to communicate – and so the rest of their health

5. Interventions to reduce unwarranted variation Providing a ‘feedback loop’ challenge to the commissioning system – empowering clinicians in services and informing contract management For patients: ensuring a fresh focus on the identification of undiagnosed, and untreated conditions and the prevention of disease progression Improving adoption of new technology & service redesign Quality assurance and peer review systems (such as IQIPS – Improving Quality In Physiological Sciences) Tackling workforce shortages

6. Diagnostic services Equipment Management & Calibration Performance to SOPs & guidelines Quality Systems & Assurance Technical & Clinical interpretation Advice and expertise MDT delivery Knowledge management Diagnostic services in NHS – getting it right

7. Getting it right – Mike Richards’s Vision …we need to harness robust and timely information from other sources to provide a more rounded picture of a trust…. Accreditation and peer review already play an important role in quality improvement …. I strongly believe that such schemes have a key role to play in the future of hospital inspection. We need to use information from these schemes to feed directly into CQC monitoring processes and the development of trust-specific key lines of enquiry for use at inspections.‘ Professor Sir Mike Richards, Chief Inspector of Hospitals

8. Taking the Atlas forward in future The Atlas of Variation represents a subset of diagnostic procedures – those that are monitored and recorded nationally Some important diagnostics do not have sufficient data to build a variation picture – eg rate of EEG testing for epilepsy Need to focus on impact on patient experience and outcomes when selecting additional indicators

9. Any questions?