NHS Atlas of Variation in Healthcare

The NHS Atlas of Variation in Healthcare identifies unwarranted variation in services, highlighting opportunities for commissioners and clinicians to improve health outcomes and minimise inequalities. The latest report published by Public Health England and NHS England in September 2015 is available on the NHS Right Care website, NHS Atlas of variation in healthcare: reducing unwarranted variation to increase value and improve quality. The report covers around 100 indicators of healthcare across a number of programmes, with 24 relating to the care of mothers, babies, and children and young people.

Atlas of variation in healthcare for children and young people

We have pulled together the relevant indicators included in the full report and more, building on those featured in the Annual report of the Chief Medical Officer 2012. Our children deserve better: prevention pays (published October 2013). The collection of over 60 indicators presented below illustrates the current state of child health in England by highlighting existing variation in healthcare and health outcomes for children and young people.

Determinants of child health
Poverty and homelessness
Child poverty: Percentage of children aged under 16 years living in families in receipt of out-of-work benefits or tax credits where their reported income is less than 60% of the median income by local authority
by CCG
Family homelessness: Rate of households accepted as unintentionally homeless and eligible for assistance per 1,000 households by local authority
Vulnerable Children
Children in the child protection system: Rate of children aged 0-17 years who were the subject of a child protection plan, per 10,000 children aged 0-17 years by local authority
Healthcare (medical) for looked-after children: Percentage of looked-after children (in care for at least 12 months) who had their annual health assessment by local authority
Healthcare (dental) for looked-after children: Percentage of looked-after children (in care for at least 12 months) who had their teeth checked by a dentist by local authority
Education
School readiness: Percentage of children at the end of foundation stage (at age 5) who are assessed as having achieved a 'good level of development' by local authority
Special educational needs (SEN): Percentage of children in state-funded schools with a statement of SEN by local authority
Crime & Youth Justice
Crime & youth justice: Rate of young people aged 10-17 years receiving their first reprimand, warning or conviction, per 100,000 population aged 10-17 years old by local authority

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Health promotion
Mortality
Stillbirths and neonatal deaths: Rate of stillbirths and neonatal deaths (under 28 days) per 1,000 live births and stillbirths by local authority
Perinatal mortality: Perinatal mortality rate per 1,000 births by local authority
by CCG
Infant mortality: Infant mortality rate per 1,000 live births by local authority
by CCG
Childhood mortality: Directly standardised mortality rate for children aged 1-17 years per 100,000 children aged 1-17 years by local authority
by CCG
Life limiting conditions: Percentage of all deaths which occur in hospital for children aged 0-17 years with life-limiting conditions by area team
Injury
Hospital admissions due to injury: Rate of hospital admissions caused by unintentional and deliberate injuries in children aged 0-14 years per 10,000 resident population by local authority
by CCG
Hospital admissions due to injury: Rate of hospital admissions caused by unintentional and deliberate injuries in young people aged 15-24 per 10,000 resident population by local authority
by CCG
Injuries from road traffic accidents: Rate of children aged 0-15 years killed or seriously injured in road traffic accidents, per 100,000 children aged 0-15 years by local authority
by CCG
Mortality from accidental injury: Directly standardised rate of death in children and young people aged 0-24 years due to all accidental injury, per 100,000 children and young people aged 0-24 years by local authority
Mortality from non-accidental injury: Directly standardised rate of death in children and young people aged 0-24 years due to all non-accidental injury, per 100,000 children and young people aged 0-24 years by local authority
Weight
Weight in 4-5-year-old children: Percentage of pupils in Reception class classified as overweight or obese by local authority
Weight in 4-5-year-old children: Percentage of pupils in Reception class classified as being a healthy weight by local authority
Weight in 10-11-year-old children: Percentage of pupils in Year 6 classified as overweight or obese by local authority
Weight in 10-11-year-old children: Percentage of pupils in Year 6 classified as being a healthy weight by local authority
Alcohol, smoking and substance misuse
Alcohol-related hospital admissions: Hospital admission rate for people aged 0-17 years due to alcohol-specific conditions, per 100,000 people aged 0-17 years by local authority
Dental health
Dental health: Hospital admission rate for dental caries in children aged 1-4 years, per 100,000 children aged 1-4 years by local authority
by CCG
Dental health: Children aged 5 years with one or more decayed, missing or filled teeth by local authority
Immunisations
Diphtheria, tetanus, polio, pertussis and Haemophilus influenzae type b (DTaP/IPV/Hib) vaccine coverage at 2 years: Percentage of immunisation completion for routine vaccinations against DTaP/IPV/Hib at 2 years by local authority
by CCG
Pneumococcal conjugate vaccine (PCV) coverage at 2 years: Percentage of immunisation completion for routine vaccinations against pneumococcal disease at 2 years by local authority
by CCG
Measles, mumps and rubella (MMR) vaccine coverage at 2 years: Percentage of immunisation coverage for routine vaccinations against MMR at 2 years by local authority
by CCG
Measles, mumps and rubella (MMR) vaccine coverage at 5 years: Percentage of immunisation coverage for routine vaccinations against MMR at 5 years by local authority
by CCG
Human papillomavirus (HPV) coverage at 13 years: Percentage of immunisation coverage for routine vaccinations against HPV for girls aged 12-13 years by local authority
Sexually Transmitted Infection
Chlamydia: Rate of diagnoses of genital Chlamydia trachomatis in young people aged 15-24 years per 100,000 people aged 15-24 years by local authority

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Child health in the perinatal period
Teenage pregnancy
Teenage conceptions: Conceptions in females aged <18 years, per 1,000 females aged 15-17 years by local authority
Teenage births: Percentage of delivery episodes where the mother is aged <18 years by local authority
by CCG
Antenatal health
Smoking in pregnancy: Percentage of women who currently smoke at the time of delivery by local authority
by CCG
Preterm birth
Neonatal mortality: Percentage of infants born at <30 weeks' gestation and admitted to neonatal units, who died <=28 days by neonatal network
Breastfeeding at discharge: Percentage of infants born at <33 weeks gestation and admitted to neonatal units who received any mother's milk at discharge from neonatal care by neonatal network
Survival free of any impairment at age 2 years: Percentage of infants born at <30 weeks' gestation and admitted to neonatal units who survived to 2 years of age free of any impairment (mild, moderate or severe) by neonatal network
Birth
Low birth weight: Percentage of live and stillborn infants who have a birth weight <2,500g by local authority
by CCG
Percentage of babies admitted to specialist neonatal care that were full-term (>= 37 weeks gestational age at birth) by neonatal network
Percentage of normally formed full-term (>-37 weeks gestational age at birth) infants admitted to neonatal intensive care that received therapeutic hypothermia by neonatal network
Score rating womens' experience of 'labour and birth' in the Care Quality Commission (CQC) Maternity Service Survey by NHS Hospital Trust
Postnatal Health
Breastfeeding initiation: Percentage of infants who are given breastmilk within 48 hours of delivery by local authority
by CCG
Breastfeeding at 6-8 weeks: Percentage of infants who are totally or partially breastfeeding at 6-8 weeks by local authority
by CCG
Postnatal health: Rate of emergency admissions to hospital of babies within 14 days of being born per 1,000 deliveries by local authority
by CCG
Re-admissions: Percentage of re-admissions to hospital following an elective Caesarean section within 28 days of discharge by CCG
Mean time from referral to assessment for hearing tests in newborns by PCT

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Healthcare for children and young people
Accident & Emergency Attendances
Emergency attendance: Rate of attendance to Accident and Emergency departments in persons aged 0-4 years per 1,000 population aged 0-4 years by local authority
by CCG
Emergency attendance: Rate of attendance to Accident and Emergency departments in persons aged 0-19 years per 1,000 population aged 0-19 years by CCG
Unplanned Hospital Admissions
Duration of non-elective hospital admissions: Mean length of stay (days) for non-elective admissions in children aged 0-17 years To be added
Zero-day admissions: Percentage of hospital admissions in children aged 0-17 years where the duration of stay was shorter than 24 hours local authority
by CCG
Emergency readmissions: Percentage of emergency admissions in children aged 0-15 years occurring within 28 days of the last, previous discharge from hospital after admission by local authority
Surgical procedures
Hospital admission rate: Directly standardised rate of elective admissions for orchidopexy in children aged 0-4 years, per 100,000 children aged 0-4 years by local authority
by CCG
Hospital admission rate: Directly standardised rate of admissions for paediatric endoscopy in children aged 0-17 years, per 100,000 children aged 0-17 years by local authority
by CCG

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Healthcare for acutely ill children
Bronchiolitis
Hospital admission rate: Directly standardised rate of emergency admissions with bronchiolitis in children aged under 2 years, per 100,000 children aged under 2 years by local authority
by CCG
Duration of hospital stay: Mean length of stay (days) for bronchiolitis in children aged under 2 years by local authority
by CCG
Lower Respiratory Tract Infections (LRTIs)
Hospital admission rate: Directly standardised rate of emergency admissions with LRTIs in children aged 0-4 years, per 100,000 children aged 0-4 years by local authority
by CCG
Duration of hospital stay: Mean length of stay (days) for LRTIs in children aged 0-4 years by local authority
by CCG
Ear, Nose and Throat Surgery
Tonsillectomy: Directly standardised rate of elective tonsillectomy in children aged 0-17 years per 100,000 children aged 0-17 years by local authority
by CCG
Aural ventilation tube insertion: Directly standardised rate of aural ventilation tube (grommet) insertion in children aged 0-17 years, per 100,000 children aged 0-17 years by local authority
by CCG
Urinary tract infections
Hospital admission rate: Rate of emergency admissions for urinary tract infections in children aged 0-4 years, per 100,000 children aged 0-4 years by local authority
by CCG
Duration of hospital stay: Mean length of emergency inpatient stay (days) for children with urinary tract infections aged 0-4 years by local authority
by CCG
Hospital admission rate: Rate of emergency admissions for urinary tract infections in children aged 5-14 years, per 100,000 children aged 5-14 years by local authority
by CCG
Hospital admission rate: Rate of emergency admissions for urinary tract infections in children aged 15-24 years, per 100,000 children aged 15-24 years by local authority
by CCG

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Children with long term conditions
Asthma
Hospital admission rate: Rate of emergency admissions for children with asthma, per 100,000 population aged 0-18 years by local authority
by CCG
Duration of hospital stay: Mean length of emergency inpatient stay (days) for children with asthma aged 0-18 years by CCG
Epilepsy
Hospital admission rate: Rate of emergency admissions for children with epilepsy, per 100,000 population aged 0-18 years by local authority
by CCG
Duration of hospital stay: Mean length of emergency inpatient stay (days) for children with epilepsy aged 0-18 years by CCG
Diabetes
Diabetes: Percentage of children and young people aged 0-24 years with diabetes cared for in a paediatric diabetes unit (PDU) whose most recent HbA1c measurement was less than 58 mmol/mol (7.5%) To be added
Sickle cell disease
Sickle cell disease: Number of emergency hospital admissions per individual patient admitted for sickle cell disease To be added
Inflammatory bowel disease (IBD)
Hospital admission rate: Directly standardised rate of emergency admissions for IBD in children aged 0-17 years, per 100,000 children aged 0-17 years by local authority
by CCG
Constipation
Hospital admission rate: Rate of emergency admissions for constipation in children aged 0-4 years, per 100,000 children aged 0-4 years by local authority
by CCG
Duration of hospital stay: Mean length of emergency inpatient stay (days) for children with constipation aged 0-4 years by local authority
by CCG
Hospital admission rate: Rate of emergency admissions for constipation in children aged 5-14 years, per 100,000 children aged 5-14 years by local authority
by CCG
Hospital admission rate: Rate of emergency admissions for constipation in children aged 15-24 years, per 100,000 children aged 15-24 years by local authority
by CCG

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Mental health
Hospital admission rate: Directly standardised rate of admissions for mental health conditions in children aged 0-17 years who had a hospital length of stay over 3 days in duration, per 100,000 children aged 0-17 years To be added
Regular attendances: Rate of children aged 0-18 years with three or more admissions to hospital per year for mental health problems, per 100,000 population by CCG
Hospital admission rate: Directly standardised rate per 100,000 (age 10-24 years) for hospital admissions for self-harm by local authority
by CCG

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