Strong accountability offers a chance to focus on the neediest

While this may not be a surprise, an explicit comparison between spending and need does help trusts focus on what action they should take.

National director for heart disease and stroke Roger Boyle tells us the way funding is allocated is much more closely linked to deprivation than in the past.

As the advisory committee on resource allocation considers its recommendations to government on further changes to funding, there is surely scope for it to be even more tightly aligned in future.

But public expectations must be addressed too. The people in the greatest need often cost the most to treat, because they have other health problems and poorer standards of living. Significantly, they are also less vociferous in demanding better healthcare, hence calls to incentivise GPs to seek out those at greatest risk.

The differences between need and demand also leave PCTs in an awkward position: if they spend more on preventive services, they are likely to have to spend less on something else.

As calls for greater accountability grow, PCTs will have to be able to show they are adjusting their spending to target inequalities in their patch and, at the same time, ensure they find ways of hearing from and speaking to those with the poorest health but the quietest voice. They will also need to convey to the more demanding how and why they are cutting services to pay for others.

As the NHS Confederation concedes this week, PCTs' success hangs on them finding better ways to communicate with patients and the public.

As the confederation says, promoting a reduction in health inequalities and being able to deliver difficult investment decisions are two essential ingredients.

Renewed accountability and better communication represent a chance to really take action to prevent premature deaths by spelling out the costs and consequences of not doing so.