Cancer patients in the metropolitan borough of Knowsley, near Liverpool, can count themselves fortunate in one respect. Unlucky though they are to have the disease, they live in the area with the highest spending on cancer treatment in the country.
At £118 per head of population, Knowsley is spending two-and-a-half times as much battling the illness as Ealing in west London, which comes bottom of the league and spends just £47 a head. Similar discrepancies in spending are revealed for heart and circulatory diseases: heart patients in Middlesbrough benefit from spending of £167 per head of local population, more than twice that in Southwark, south London, which spends £76 a head.
The biggest gap is in mental health, with a 3.4-folddifference between high- spending Islington, north London, (£332 a head) and West Kent (£98).
The differences have been revealed in an analysis of spending patterns across the country. They show how unequal the National Health Service, which was set up to provide care according to need, has become in reality. Wide variations in the amounts spent on various diseases from primary care trusts' £69bn budget, which accounts for three quarters of the total NHS budget, suggest a "postcode lottery" operates similar to that for expensive drugs.
"This is much bigger and affects many more people and involves millions if not billions of pounds," said John Appleby, chief economist at The King's Fund, the health policy think-tank.
Instead of simply determining whether you have access to costly drugs, your postcode may dictate every aspect of your health care, including whether you get surgery, how soon you get it, how long you stay in hospital, your treatment plan and ultimately how long you survive.
However, Knowsley's high spending may not necessarily translate into a lower death rate. Figures published by Cancer Research UK in June showed that the north of England had overall a 20 per cent higher death rate from cancer than the south.
Professor Appleby, whose analysis of Department of Health spending data, "Local Variations in NHS Spending Priorities", is published today, said the huge variations in spending had not improved since the last such study three years ago. They remained even after differences in local needs were taken into account. "We don't know what the reasons for the differences are, but I think they will come down to differences in decisions by clinicians," he said.
The Liberal Democrats' health spokesman, Norman Lamb, said: "This analysis points to an unacceptable postcode lottery of care, with PCTs totally unaccountable to the communities they serve for these funding decisions." It raised questions as to how the variations affect patient care, he said.
Cancer spend (per head)