By politics.co.uk staff
The NHS' spending watchdog says billions of pounds spent on tackling health inequalities are not having a big enough impact.
The Audit Commission's Healthy Balance document suggests that primary care trusts and local authorities may be struggling under the weight of excessive policy and guidance from central government.
It argues the effectiveness of the estimated £21 billion spent on health inequalities every year could be being compromised as a result.
"Billions are directed to deprived areas. But it is not always clear how much has actually been spent on reducing health inequalities, and what the impact of this or that programme has been," Audit Commission's health managing director Andy McKeon said.
While cuts in infant mortality and increases in life expectancy have been achieved, there appears to be a widening gap between the poorest and the better-off.
Teenage pregnancy dropped in Oldham by over a third but rose by 14% in neighbouring Manchester, Mr McKeon pointed out. He called overall progress "disappointing".
Total NHS spending has risen from around £40 billion in 1999/00 to around £98 billion in 2009/10.
"The Audit Commission wanted to open discussions on some fundamental questions about improving the nation's health and tackling health inequalities because public spending will be more constrained in the years ahead," Mr McKeon added.
It has launched a new website, Oneplace, which shows public health outcomes across England.