Variations in local NHS spending highlighted by The King's Fund analysis

Stark variations in how much the NHS spends locally on different diseases are revealed in a new King's Fund briefing published today (9 August).

Local variations in NHS spending priorities analyses new Department of Health data* from 2003/4-2004/5 that shows how much money is being spent by primary care trusts** (PCTs) in England on different diseases.

The briefing reveals that some PCTs spend much more than others on particular diseases, such as cancer, mental health and coronary heart disease, even after differences in the health needs of local populations and other factors have been taken into account.

At the extremes, on mental health, Islington PCT is spending four times the amount spent in Bracknell Forest PCT after accounting for needs and other factors. Leaving aside the most extreme contrasts, there are still large variations with a two-fold difference in mental health spending per head across 90 per cent of PCTs.***

There are similar variations for other diseases. The proportion spent on cancer care ranges from three per cent to over 10 per cent of PCTs' budgets. For example, Daventry and South Northamptonshire PCT is spending four times more than Heart of Birmingham Teaching PCT after accounting for needs and other factors.

The King's Fund Chief Economist Professor John Appleby said:

'This new data is very revealing, and raises serious questions about the consistency of decisions PCTs make about how much they spend on different diseases.

'However, a proportion of the variation in PCT spending will not be a result of deliberate choices by PCTs. Variations in clinical decisions about who and when to treat, and what treatment to provide, and differences in the efficiency of hospitals, contribute to the variations in PCT spending.

'The Department of Health's National Programme Budget Project is an extremely important initiative which should start to help answer vital questions about where the money goes, what we get for our investment in the NHS and how the NHS can improve value for money.'

The briefing also shows in which areas the extra money allocated for the NHS in 2004/5 has been spent. The largest share of spending (over £7 billion – 11 per cent) was devoted to mental health services – twice as much as spent on cancer care.

The new figures show that spending is reaching the government's three clinical priorities of mental health, coronary heart disease and cancer. They received the highest share of the total increase in PCT spending between 2003/4 and 2004/5.

Notes to editors: 

*The National Programme Budget Project started in 2002, with PCTs reporting their spending on 21 different disease areas, such as mental health problems, cancers and tumours and respiratory diseases, for the first time in 2003/4. This data is available on the Department of Health website.

**PCTs are in charge of spending around 80 per cent (nearly £60 billion) of the NHS budget in England. The amount of money allocated by the Department of Health to each PCT is calculated taking into account population size, age and need for health care, as well as the cost of providing services particular to each area. 

*** 90 per cent of PCTs spend between 9 and 18 per cent of their budgets on mental health.

  1. For further information or interviews, please contact the King’s Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  2. For advance copies of the briefing including tables illustrating variations, contact the media and public relations office. Local variations in NHS spending priorities will be available to download from the King's Fund website from Wednesday 9 August.
  3. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.