Primary Care Trusts (PCTs) in England continue to vary significantly in the amount they spend on treating cancer, mental health problems and heart disease, even after the different needs of local communities are taken into account, a new report reveals.

Across the country, expenditure between the highest and lowest spending PCTs varies 2.9-fold on mental health, 2.5-fold on cancer and 2.2-fold on circulatory conditions such as heart disease, says the study, which is published by The King’s Fund health policy think tank.

For example, PCTs across England spend between 8.7% and 25% of their budgets on mental health, with Islington PCT spending £332 per head (after adjusting for need) compared with East Riding of Yorkshire PCT’s £114, it says.

In cancer, local PCT spending varies from 3.6% to more than 9% of budget, with Knowsley PCT spending £118 per head while Ealing PCT spends just £47, and for circulatory diseases the nationwide range is 5.7% to nearly 11%, with Middlesbrough PCT spending £167 per head compared to Southwark PCT’s £76.

During 2006-7, the government’s three clinical priorities of mental health, coronary heart disease and cancer continued to consume the largest shares of PCT spending, at 12%, 9% and just over 6% respectively. The largest share of spending was devoted to mental health services, at over £8.4 billion (12%), twice as much as was spent on cancer care, says the study.

However, Professor John Appleby, The King’s Fund chief economist, cautions that some of the variations are not solely due to deliberate choices by PCTs - other contributory factors include variations in clinicians’ decisions about who and when to treat and what treatment to provide, and hospitals’ different levels of efficiency. Nevertheless, he says, while “we must be careful in drawing firm conclusions from this data…it does raise questions about the consistency of the decisions PCTs make about how much they spend on different diseases.”

The Fund’s chief executive, Niall Dickson, also stresses that the report’s findings do not mean that any individual PCT's spending is necessarily wrong. However, he adds: “it does suggest that as well as unexplained variations in clinical practice, there are unexplained spending variations - some of these are almost certainly not justified. We need better information about what PCTs spend their money on and what gains in health they achieve as a result. Fortunately, over the next few years we should achieve that."

However, David Stout, director of the PCT Network, which represents all PCTs in England, said many of the variations shown in the report 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,” he said.

And a spokesman for the Department of Health pointed out that the local NHS is free to make decisions on spending priorities based on the character and needs of their local population, as long as they meet national standards and guidance. “It would be impractical as well as undesirable for every single spending decision by local health managers to be dictated by Whitehall,” he added.