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The report from the Kings Fund today tells of the differences in spending across each Primary Care Trust in England against a variety of illness categories. The differences are stark and on the face of it worrying - they certainly make for interesting reading.

Two key questions stick out. Firstly should we be concerned? If one PCT prioritises care in one disease area over another in response to local need, surely this is what we would want? PCTs will almost always spend all the money they are allocated on health care so one assumes that demands for different types of services differ in different areas. I am also sure that PCTs have not got the balance of spending right (not that they ever could - this is a complex and fluctuating need) and they certainly don't alway take local preferences and issues into consideration.

Secondly, if there is reason to be concerned what should be done? One of my key issues with PCTs is their lack of accountability to local people. They act to serve local people and have a duty to commission care for local people but the are accountable to the Secretary of State only. Locally ellected representatives don't get a say. Sure they can make a lot of noise but that is all.

Theer seems no reason for PCTs to remain like this. It would be a very simple move to put the under the same line of accountability as social services (generally county councils or unitary councils) and ensure that local democracy has a say.