The new NHS Atlas of Variation has revealed a 25-fold variation in anti-dementia drug prescribing rates across England, and also that patients with type 2 diabetes are twice as likely to receive the highest standard of care in some areas of England compared to others.

There is also an eight-fold variation across the country in the range of patients receiving angioplasty treatment for a severe heart attack, according to the Atlas, which has been published by the Department of Health (DH).

This second Atlas of Variation, which has been published through the DH's national Quality, Innovation, Productivity and Prevention (QIPP) programme, highlights the amount each Primary Care Trust (PCT) spends on clinical services and links this with the health outcomes which patients see. It provides 71 maps - compared with 34 in the first Atlas, which was published in November 2010 - to help commissioners learn from one another, consider the appropriateness of a service and investigate when clinical health outcomes are not reflecting the financial investment that has been made, says the DH.

The new Atlas also has 15 programme budget categories, compared to 11 in the first version, and contains a new section on the steps which local commissioners and providers can take to reduce unwarranted variation in their locality, and which tools to use.

There two main aims for the new Atlas, says the DH. The first is to offer clinicians and commissioners a fresh opportunity to identify variation and take action to reduce this where it is unwarranted, which it defines as "variation in the utilisation of health care services that cannot be explained by variation in patient illness or patient preferences." 

The second is to highlight the work being done by the NHS Right Care programme to support anyone - whether commissioner or provider, clinician or manager - wanting to reduce unwarranted variation, not only in activity and cost but also in quality, safety and outcome, within their locality or between their locality and other areas of the country.

Commenting on the new Atlas, Health Minister Lord Howe said that the government's modernisation plans for the NHS will result in a more patient-centred service "that achieves health outcomes that are amongst the best in the world and gives people a greater say about their healthcare."

"The Atlas of Variation lets us look at how the local NHS is meeting the clinical needs of their local population. This will help commissioners to identify unjustified variations and drive up standards so patients are receiving consistently high-quality care throughout the NHS," said the Minister, adding: "we are committed to improving results for patients and our new NHS Outcomes Framework will hold the NHS to account for this. Commissioners will be able to apply contractual penalties if any organisation is failing to deliver improvements for patients."

- The NHS Right Care programme is focused on increasing value for patients and and commissioners, and is targeted at clinicians, commissioners and patients. It has five workstreams: - population planning and programme budgeting; - clinical networks and systems of care; - better-value clinical practice; - shared decision-making; and - population medicine.

Next year, the programme will publish a series of themed atlases in collaborations, focused on a specific condition or population, and investigate variation in more depth. The first of these will be completed by March/April and include diabetes, child health, organ donation and transplantation and kidney care, to be followed by diagnostics, liver disease and respiratory disease, and then, potentially. cancer and mental health.