The postcode lottery of treatment in the NHS has been exposed by the largest government analysis of healthcare in England, which reveals wide regional disparities in patient treatment.
The NHS Atlas of Variation, a copy of which has been obtained by the Guardian, lays bare the tension between the health secretary's vision of a "localised" health service and the need to impose basic minimum standards of acceptable care.
While ministers accept that "some variation is warranted because different populations have different levels of need", the differences in cost, quality and patients outcome mean that "unwarranted" inequalities need to be ironed out.
The most stark contrast shows up in the rate of prescribing anti-dementia drugs, with patients in some parts of the country – such as North Lancashire – prescribed 25 times as many treatments and tablets to help "temporarily improve or stabilise symptoms" than in Kent.
One possible reason for such disparities, according to the report, is the lack of awareness some local GPs have in spotting Alzheimer's early.
Charities have long warned about the barriers put in place by clinicians. "Our own research shows that there is an unwillingness of GPs or consultants to prescribe the drugs. The most commonly cited reason people were denied treatment and support was a lack of awareness among GPs regarding symptoms, services and treatments for people with Alzheimer's disease," said a spokesperson for the Alzheimer's Society.
"The drugs can make an enormous difference to quality of life – making it easier to recognise loved ones or remain independent."
There is also concern that some women suffering with breast cancer are staying too long in hospital in certain parts of the country. In parts of south Wales, patients can stay for days whereas in Hertfordshire the same surgery warrants an overnight stay.
The report states that most patients undergoing breast cancer surgery can be "safely managed as day cases or with a single overnight stay" but it adds: "At present, over 20 primary care trusts (PCTSs) have (average) lengths of stay in excess of three days".
Covering 71 key indicators – including hospital admission rates, what treatments health trusts choose to fund and how children are managed in NHS – the atlas attempts to map the "utilisation of healthcare services that cannot be explained by variation in patient illness or patient preferences".
Access to care homes, paid for by the NHS for the very frail, also varied considerably. The health service funds places if the patient is receiving end-of-life care or has an acute medical condition requiring intensive, out-of-hours care.
However in Devon and Cornwall, noted for their large elderly populations, the admission rate for those aged over 74 to care homes funded by the NHS was just under three per 100,000 of the population. In Northumberland, the equivalent figure is 190 people in every 100,000. Lifestyle choices do play a part in the differences. Some primary care trusts funded weight loss or bariatric surgery – such as gastric band operations – for 25 in every 100,000 patients in their local area. Such operations were carried out most frequently in the East Midlands and least often in East Anglia.
The atlas also shows a three-fold variation in the number of angiopasty operations booked in different parts of the country (three times as likely in Peterborough than County Durham) – troubling at a time, says the report, when such procedures are carried out at low rates compared to other developed nations.
It also highlights for the first time variation in spending between primary care trusts – both overall and on types of disease. There is more than three-fold variation in the amount PCTs spend on learning disabilities, a two-fold variation in spending on mental health and nearly two-fold variation on cancer.
Others spent six times as much on neonatal care as others. With infectious diseases, some care trusts spent in one year £145 per head of their population when the average was just £26.
John Appleby of the King's Fund said that those commissioning healthcare should be "named and asked to explain" the disparities. "It is very difficult to know what causes this. A lot of illness is down to age basically. But also patients may not want treatments. Once you explain how unpleasant say even a cataract operation is people may not want it.".
The government is aware that its plans are being tarred as increasing health inequalities and last week Andrew Lansley, the health secretary, told GPs that "the degree of variation is considerable, and unexplained by simple differences in population".
He said clinicians and commissioners should use NHS data to "identify variations in prevalence, spend, outcomes and service use".
His ministerial colleague Lord Howe, who is currently piloting the bill through the Lords, gave a statement to the Guardian.
"The Atlas of Variation lets us look at how the local NHS is meeting the clinical needs of their local population. This will help commissioners to identify unjustified variations and drive up standards so patients are receiving consistently high quality care throughout the NHS.
"We are committed to improving results for patients and our new NHS Outcomes Framework will hold the NHS to account for this. Commissioners will be able to apply contractual penalties if any organisation is failing to deliver improvements for patients."
