Patients are being forced to undergo painful, unnecessary and ineffective treatments because of widespread inequities in the NHS that are wasting billions of pounds a year, according to the Government’s chief medical officer.

Sir Liam Donaldson, England and Wales's most senior doctor, used his annual report yesterday to call for urgent action to reduce wide-ranging variations in the provision of care across the NHS.

A patient's location can determine whether a child has their tonsils removed or the type of treatment given to a heart attack victim, reported Sir Liam. He called for a much tighter system of checks and controls, including tariffs for improper prescribing.

"Inappropriate variation runs contrary to the moral contract agreed in 1948 between the NHS and the public," he said.

The National Institute for Health and Clinical Excellence (Nice), which advises on best practice for the NHS, should also issue guidance on which treatments to stop providing, he said. Ending wasteful use of interventions that are no longer effective or appropriate could save "a very large sum of money", he added.

Sir Liam said that the differences in treatment could not be explained by the various needs of patients or their economic status alone. Instead he found that doctors and managers ordered operations according to habit and preference. He said the NHS could learn from the airline industry about standardising its procedures and instilling a strong culture of safety awareness.

His report identified tonsillectomies and hysterectomies as examples of expensive, traditional operations that were being perfomed less and less frequently in the country's best and most affluent hospitals but are still ordered routinely in more deprived areas.

He pointed out that if tonsillectomies were administered to the entire country at the same rate as they are given to well-off children, around 8,000 fewer operations would be performed every year and £6 million saved.

Hysterectomy rates, on the other hand, have fallen by 64 per cent in north and central London, but just 15 per cent in Northumberland and Tyne and Wear in recent years. "If the average rate of hysterectomy in England could be reduced to that achieved in the 20 per cent of the country with the lowest current rates, then 5,900 operations, costing £15 million could be avoided per annum," he wrote.

Citing the broad range of surgeries performed on the victims of heart attacks as further evidence of the "postcode lottery" of practice, Sir Liam said the NHS needed to explore new techniques for sharing knowledge and ordering changes in treatment.

"In my view this variation in clinical practice is not acceptable," he added. "Traditionally, changing clinical behaviour has been a relatively slow task and has been really driven by either education programmes or circulating paper copies of guidelines, but maybe there’s another way to do it."

Sir Liam said that as many as 10 million clinical decisions were taken every day by NHS staff and said that Nice should find a way to reward effective decisions and penalise poor use of treatments. Among other ideas, Sir Liam suggested taking away money from treatments that are "no longer appropriate or effective or do not provide good value for money".

In the wide-ranging report, Sir Liam also recommended the establishment of an ethics committee to consider how the NHS should deal with a bird flu pandemic, should the virus mutate to spread among humans: "Who gets priority for the vaccine and on what basis are critical beds allocated?" He asked.

On the subject of patient safety, Sir Liam urged the NHS to learn from the aviation industry, with its perceptive "anoraks" and clear procedures for reporting and investigating accidents and malpractice.

"We need to ask ourselves what we can learn from other industries," he said. "There are many more anoraks looking at safety information in the airline industry... We don’t have any anoraks in healthcare, in the safety field."

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