Research by HSJ has revealed the huge inequalities between healthcare need and NHS spending throughout England.
An HSJ analysis of the latest data on coronary heart disease premature death rates and primary care trust heart disease spending shows that some of the PCTs with the greatest health need spend the least.
The data, published by the Department of Health's Information Centre, shows that the premature death rate for coronary heart disease - defined as deaths between the ages of one and 75 - ranges from 2.1 premature deaths per 10,000 population in Kensington and Chelsea to 8.5 premature deaths in Hartlepool.
HSJ compared these death rates with DH figures on PCT spending on heart disease in 2006-07 and found that spending per heart disease death ranged from£166,151 at Wakefield PCT to just£17,241 at Calderdale PCT. This is despite the fact that Wakefield's premature death rate from heart disease is 14 per cent higher than Calderdale's.
The DH has made heart disease one of its priority areas for tackling health inequalities. Together with cancer and respiratory disease it accounts for two thirds of the life expectancy gap between PCTs in the poorest areas and the rest of England. The DH has set the NHS a target of a 10 per cent reduction in those life expectancy gaps by 2011, but the latest data shows that some PCTs could struggle to do that without radical changes to their programmes and spending.
NHS Alliance chief officer Michael Sobanja said: "PCTs will have to take great notice of data such as this and turn their attention to it. They must do something.
"Many health service contracts have been based on rolling forward what was spent in previous years and that is not necessarily related to the prevalence of disease."
It was only relatively recently that PCTs were able to compare disease-prevalence data such as premature death statistics with their budgets, Mr Sobanja added.
Now they had that information they needed to act on it, even if that meant areas that had traditionally been well resourced were disadvantaged in favour of poorer areas, he said.
King's Fund chief economist John Appleby said: "You would hope that spending reflected need, but the data does not show that. There is quite a range of spend per death and the relationship between the two is not as strong as you would like."
Because the figures on premature death rates do not include deaths over the age of 75 they could make more affluent areas with higher life expectancies appear to spend more per premature death.
However, the figures show that the majority of those spending the most per premature death also spent higher than average per head of population.
Even PCTs with similar rates of premature death spend hugely different amounts. Hastings and Rother PCT has a premature death rate from heart disease of 5.5 per 10,000 population and spent£114,534 per death in 2006-07. Medway teaching PCT's death rate is slightly lower at 5.1 per 10,000, but at£39,288 its heart disease spend per premature death is a third of Hastings and Medway's.
The data on premature deaths was published by the NHS Information Centre in late December. It shows, for each PCT area as well as each local authority, the actual numbers and rates of premature death due to a selection of diseases, including heart disease. The data also gives an assessment of the severity of premature death by measuring the years of life lost up to 75 years.
Measured on that scale, Blackpool has the highest rate of years of life lost at 100 per 10,000 population. Its spend per premature death was£49,262, well below the English average of£75,072.
See GPs failing to pick up patients at most risk of heart disease for related coverage
To download the data, follow the link in the resources box, bottom right.