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Header image for the current page Reducing clinical variation

Clinical Variation and Health Inequalities

With the NHS facing unprecedented demand for services, local health systems are under continual pressure to improve productivity and performance. One key approach to achieving this objective is reducing the causes of unwarranted clinical variation – the national disparity in health access, outcomes and expenditure.

Understanding the causes and effects of unwarranted variation offers the opportunity to ensure that:

  • Higher value healthcare is strengthened and replicated
  • Poorer value healthcare is identified and eliminated
  • Productivity and efficiency are increased
  • Services and care pathways are improved
  • Impactful change programmes can be implemented at pace
  • Financially challenged systems can make significant savings.

Turning opportunities into improvements

At Arden & GEM, we recognise the scale and scope of the challenges now faced in local health and care systems: transforming care delivery, creating new organisations, working together in new devolved ways. Set against this backdrop, we can enable health economies to realise the full potential that reducing unwarranted variation offers by identifying and understanding causes, prioritising areas of focus, and developing and implementing evidence based interventions. By drawing upon our expertise in business intelligence, programme management, service transformation, procurement and clinical engagement; we can translate opportunities into realistic implementation programmes. We are uniquely placed to partner you from clear and robust strategy development to fast and effective implementation.

NHS RightCare Lead Provider

We are experienced in interpreting NHS RightCare intelligence and working with the national NHS RightCare team, and their regional delivery partners, to support CCGs and STPs in implementing initiatives to reduce unwarranted clinical variation. We have received the NHS RightCare kite-mark award for demonstrating capabilities to support CCGs and systems to deliver the key processes within the NHS RightCare approach.

A proven approach to change management

We successfully blend existing insight, extensive experience, and an ability to interpret national challenges locally with our proven approach to designing, developing, testing and delivering cost-effective health services. Our tried and tested five stage change model provides an end-to-end solution or modular provision that tailors the support, tools, techniques and content to meet your exact needs.

1) Decide what to change
We help systems to identify where to prioritise their contractual, transformational and service improvement effort, based on potential impact using our advanced analytics, leading business intelligence systems and bespoke clinical variation explorer tool.

2) Build consensus
We can help you to identify and engage with stakeholders to establish a shared understanding of the problems and gain agreement on the best way forward, with expertise in clinical engagement, clinical analysis and interpretation, and workshop facilitation.

3) Evaluate the options
We recognise that you cannot change everything at once and are able to work with you to evaluate available options, quickly moving to a shortlist of business cases. We draw upon our library of successful change schemes, advanced modelling tools and decision support frameworks to provide rigour and best practice learning.

4) Make change happen
With a robust approach to programme management and experience of implementing redesigned services and new models of care, we can help you to implement sustainable initiatives to improve healthcare and maximise value. Whether you are looking for additional capability, capacity or expertise – our team of professionals can support you to transform your vision into reality.

5) Learn and improve
We can establish and support continuous improvement approaches, at an organisational and system level, ensuring that the measurement of outcomes, impact and replicability is built in from the beginning.

Our reducing clinical variation highlights

To find out more, please click here for our Reducing clinical variation brochure

We can enable health economies to realise the full potential that reducing unwarranted variation offers by identifying and understanding causes, prioritising areas of focus, and developing and implementing evidence based interventions.

We would love the opportunity to talk with you about working collaboratively to meet you clinical variation challenges.


Arden & GEM is successfully helping healthcare systems to highlight and redesign care to tackle unwarranted variation. Find out more by accessing the resources below.


If you’d like to contact us about reducing clinical variation, please fill in the form below:

The Five Year Forward View sets an ambitious target of achieving 50,000-100,000 Personal Health Budgets (PHBs) by 2020, with clinical commissioning groups (CCGs) expected to deliver PHBs for between 0.1% and 0.2% of their population.

The scale of the task is significant, and there are complexities to overcome if we are to deliver the tailored, personal care envisaged. Many CCGs are at an early stage of formulating their solutions, but examples of best practice are beginning to emerge, which can give commissioners the tools they need to develop effective and sustainable PHB plans.

In tandem with CCGs, Commissioning Support Units have been on a rapid learning curve. Thanks to our involvement in the early adopter sites and our work with CCGs across the country, we have developed specialist expertise in this area and a clear operating model to effectively support CCGs. As a result, we are not only seeing positive impacts for patients but evidence of cost savings through different ways of working.

In our experience, one of the first and most important steps is to understand and plan for the challenges which lie ahead. As well as the obvious impact of administrating the service, there are significant cultural challenges to overcome which require a different way of thinking about control and risk. There are also implications for contracting, where traditional block contracts may not deliver the person-centred, flexible solutions which are central to PHBs. This is why training is a vital part of delivering successful PHBs, as even generously resourced operations may not have all of the experience and knowledge required to ensure an effective service. A thorough review of a CCG’s readiness to meet national targets, including addressing key challenges, is a good place to start. This provides valuable feedback and ensures there is a clear plan of action to deliver within the timescales.

When it comes to implementation, we have developed a clinically-led, seven-step model to create and manage PHBs, drawing on both national guidance and learning from early adopter sites. From obtaining consent and understanding the health and wellbeing needs of patients; to creating individual plans, organising support and monitoring progress - adopting a clear, effective process helps CCGs stay on track.

As well as giving patients more control over the management of their health, there are positive signs that PHBs can deliver efficiencies. By analysing data across four of our CCG areas and comparing the annual cost of PHBs with the estimated cost of equivalent ‘traditional’ care packages, we are seeing savings of between £120,000 and £460,000 per CCG, over £1 million in total – which is a 16% cost avoidance.

As we move towards Integrated Personal Commissioning, which will expand personalisation further, it’s important to look beyond current PHB requirements and explore innovative solutions. We are working with some CCGs to look beyond continuing healthcare to areas such as mental health and equipment. We are also developing a cloud-based IT system which will transform the management of PHBs for commissioners, with a central recording system and the ability to easily analyse data and produce reports from anywhere. Patients will also be able to access their care plans and see progress on delivering their PHB.

While current targets are stretching, there is growing data, experience and innovation which will help CCGs to deliver PHBs and to explore the possible.

For more information about our PHB service please click here.