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Spending by primary care trusts across England on mental health and other services varies sharply, new research by health think-tank the King's Fund revealed last week.

What services are primary care trusts spending money on?
In 2004/05 the government’s three main priority areas for the NHS - mental health, cancer and heart disease - consumed the largest shares of spending by primary care trusts. Mental health services received the biggest spend at just over £7 billion - eleven per cent of PCT spending. (PCTs are in charge of spending 80 per cent of the NHS budget in England, around £58 billion).

 
Does spending vary between different PCTs?
Yes, there is considerable variation in the amount spent by primary care trusts on different diseases. Spending per head on mental health varies seven-fold.

Of course PCT spending is not wholly determined by PCTs themselves; it will in large part be a reflection of the individual decisions taken everyday by healthcare professionals.

Does spending vary due to differences in the local population's health and varying costs?
A significant degree of the variation in PCT spending patterns can be explained by differences in local health needs, the age of the population and varying costs of providing services in different parts of the country.

Areas judged to have high health needs and high costs will receive relatively more money than an area with lower needs and costs from the government. Because of this, we would expect to see primary care trusts spending different amounts of money on care.

But even once the needs, age and costs particular to an area are taken into account -a considerable degree of unexplained variation remains.

In the case of mental health, adjusting for these factors reduces a seven-fold gap in spending between the highest and lowest spending PCT to a four-fold gap.

As the latest report from the chief medical officer illustrated, there are large variations in the decisions made by clinicians about whether and how to treat particular conditions. These are likely to be at least part of the explanation for why PCT spending varies so widely.
 
Where is the extra money allocated to the NHS going? 
Overall, the services which got the three largest shares of the extra money in 2004/05 were the government’s priority areas of mental health, heart disease and cancer, accounting for 9.3%, 9.2% and 7.7% respectively.
 
Does higher spending lead to healthier patients?
In short, we don’t know. The Department of Health is currently looking into how variations in PCT spending on different diseases are reflected in population health outcomes, which should make it possible to examine the nature of the link between financial inputs to the NHS and health outcomes.

This will be timely given the government’s recent emphasis on effective commissioning and the role PCTs should play in securing maximum value for money.