Failings in the commissioning and provision of end of life care services are costing the NHS more than £100m every year.

A damning National Audit Office report has found massive service variations, with a difference of more than £1,500 per death between the highest and lowest spending primary care trusts.

NAO director of health studies Karen Taylor said the NHS faced a "real challenge" to achieve the recommendations of the Department of Health's end of life care strategy, published in July.

Most PCTs were unable to provide complete spending figures for end of life care. They lacked data on what services they had and on local needs, which, Ms Taylor said, were "reasonably easy to predict".

Researchers found one PCT had spent only£154 per death on end of life care in 2006-07, while another was paying£1,684.

Low profile

The low profile of end of life care has been cited as a reason why the arguments over patients wishing to "top up" their treatment to extend their life by a short time assumed such media and political importance.

In some areas, no palliative care beds were being commissioned in independent hospices.

The size of hospital based and community palliative care teams also varied considerably. Hospices' strategic planning was hampered because seven in 10 PCTs were commissioning only annual contracts and negotiations often dragged on well into the year.

Hospice funding

The report also lays bare the extent to which the hospice movement subsidises the NHS, with only 26 per cent of hospice funding on average coming from PCTs.

Ninety-seven per cent of hospices said PCT funding did not fully cover the cost of the NHS services they provided.

The NAO predicts that£104m a year could be saved and reinvested in community provision - preferred by most patients - if emergency hospital admissions were cut by 10 per cent and average lengths of stay of terminally ill patients were cut by three days.

The report calls on public health directors to monitor service provision and demands that PCTs look into commissioning more services from hospices to support patients with conditions other than cancer.