NHS care for children varies starkly depending on where families live, a new report suggests.
There are wide variations between some health trusts in England when it comes to areas such as emergency admissions for bowel disease, epilepsy and asthma, and the number of A&E attendances among under-fives.
While some of the difference can be explained by socio-economic factors, health needs, ethnicity and the choices families make, variation is also down to concerns about inappropriate clinical practice and unequal access to care.
The report, NHS Atlas of Variation in Healthcare for Children and Young People, is based on health service data from primary care trusts.
A&E attendances among children under five resulted in a 36-fold variation between the best and the worst PCTs in England, the report showed.
When the five PCTs with the highest rates and the five PCTs with the lowest rates were excluded, the variation was still 3.5-fold.
The report said deprivation was not the sole reason for the difference as there was still variation even among the most deprived PCTs.
The report said “differences in the provision of local primary and community care, and in particular out-of-hours urgent care, are likely to account for much of the variation in the demand for emergency care in young children”.
Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health, said: “The extent of variation is a real concern and not explained solely by deprivation.
“We need to bring the worst up to match the best.
“The key now is to iron out inconsistencies, make sure guidelines are implemented across the board, use clinical networks and effectively share best practice - so that any unwarranted variation is minimised to make a significant difference to the health of children across England.”
The study also found a 25-fold variation between the best and worst PCTs when it came to emergency admissions among children with asthma.
This dropped to a 4.8-fold difference when the top and bottom five PCTs were excluded.
The number of children having their tonsils removed also varied six-fold between the best and the worst, and was still 2.9-fold when top and bottom PCTs were excluded.
Emergency admission rates for inflammatory bowel disease varied 10-fold between the best and the worst, and was still five-fold when considering the vast majority of PCTs.
For children with epilepsy, there was a nine-fold difference between the best and the worst, while emergency admissions for babies born at home, and for those re-admitted to hospital within 14 days of being born there, resulted in a six-fold difference between the best and worst PCTs.
There was still a 3.6-fold difference when the top five and bottom performing PCTs were excluded.
A 3.6-fold difference in perinatal mortality - stillbirths and babies who die within seven days of birth - emerged between the top and bottom PCTs, and this was still 2.2-fold after excluding the best and worst five.