Managing the paradox between equality and diversity in healthcare: Unwarranted vs warranted variations

Abstract Unwarranted variations in healthcare services are variations that cannot be explained by public health needs or medical needs. The NHS has introduced several policy initiatives aimed at reducing unwarranted variations, but there are barriers to their effectiveness. In recent years, efforts to address unwarranted variations in England and Wales have led to the Department of Health setting standards via agencies such as the National Institute for Health and Clinical Excellence, with implementation and service development left to local health services. The implementation of centrally set standards has brought about greater transparency in the variations in healthcare provision across the UK. The key task for policymakers, managers and clinicians is to determine which of these variations are justifiable — or warranted — and which are unwarranted. This paper examines the extent of unwarranted variations as well as their implications for patient care and public confidence in the UK health system. It suggests that some local variation is warranted, provided minimum care standards are maintained.