Page last updated at 23:42 GMT, Sunday, 7 September 2008 00:42 UK

NHS 'spending lottery persists'

Breast tumour
Cancer is one of the areas where disparities in spending are seen

Entrenched differences remain in the amount local health bodies spend on major diseases, a think-tank says.

The King's Fund says variations in spending on mental health, cancer and heart disease across England was virtually unchanged from 2004 to 2007.

The report warns the differences have a more wide-ranging effect than so-called "postcode lotteries" for cancer drugs.

A Department of Health spokesman said it was for primary care trusts to decide their own spending priorities.

The King's Fund analysis looked at spending on cancer, mental health and circulatory diseases, such as heart disease from 2004 to 2007.

Figures for 2006-7 show 12% of PCT spending went to mental health, 9% to coronary heart disease care and just over 6% to cancer care.

Local NHS organisations are answerable to their local populations for the decisions they make
Department of Health spokesman

The think-tank used the department's own formula for assessing need, which takes into account factors such as the number of elderly people living in an area and levels of deprivation.

The report found that, between the highest and lowest spending PCTs, there was more than a three-fold variation on mental health care, a 2.5-fold difference on cancer and a 2.2-fold difference on circulatory diseases.

The spending gaps are virtually the same as those seen in its 2006 report.

The report highlights examples including Knowsley PCT spending 118 per head on cancer care, compared with Ealing PCT, which spends 47.

Middlesbrough PCT spends 167 per head on circulatory diseases, compared with 76 by Southwark PCT.

And Islington PCT spends 322 per head on mental health care, compared with East Riding PCT which spends 114.

'Widespread effects'

The King's Fund said the Department of Health data was not perfect but warned the variations in spending were too big to be ignored.

Professor John Appleby, the King's Fund's chief economist, who compiled the report, said: "Even when local need and other legitimate reasons for variations in spending are taken into account, PCTs continue to spend varying amounts on cancer, coronary heart disease, mental health and a range of other diseases."

And he said these disparities had wider effects than the high-profile issues over a "postcode lottery" access to rare cancer drugs.

"That issue is not trivial but this affects more people and involves much more money."

Doctors' decisions about treatment and hospital efficiency could be factors influencing spending on diseases, he added.

A Department of Health spokesman said: "As long as they meet national standards and guidance, the local NHS is free to make decisions on spending priorities based on the character and needs of their local population.

"It would be impractical as well as undesirable for every single spending decision by local health managers to be dictated by Whitehall.

David Stout, director of the PCT Network which represents the majority of primary care trusts, said: "Many of these variations are expected as different areas have different patterns of illness which require an appropriate local response.

"This is why we need local decision-making within a national health service to make sure local needs are met rather than a one size fits all approach with decisions made from the centre."

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