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Improvements and efficiencies have been made in key areas of cancer care since the Cancer Reform Strategy was published in 2007, according to an NAO report today. However, a lack of high quality information on costs of cancer services and their outcomes inhibits substantial further improvements. The performances of Primary Care Trusts (PCTs) still vary significantly and there is scope for greater efficiencies, worth hundreds of millions of pounds each year, in the delivery of care.

There have been high levels of achievement against cancer waiting times standards and significant reductions have been made in the number of days cancer patients spend in hospital - largely as a result of increasingly treating patients as day cases. However, whilst the Strategy aimed to minimise emergency admissions for cancer patients, these are still increasing, with wide variations between PCTs and poor understanding of the reasons for those variations.

The NAO estimates that cancer cost the NHS approximately £6.3 billion in 2008-09, but the Department of Health has limited assurance as to whether the implementation of the Strategy is achieving value for money. Reported spending on cancer care varies between PCTs - in 2008-09 varying from £55 to £154 per head - and there is unexplained variation from year to year.

There are opportunities to achieve better outcomes and free up resources to meet the increasing demand for cancer services. For example, by reducing the average length of stay in hospital to the level of the best performing PCTs, efficiencies worth some £113 million a year could be achieved. And if the number of inpatient admissions per new cancer diagnosis was reduced to the level of the best performing PCT, bed days equivalent to around £106 million each year could be saved. In addition, radiotherapy machines could be used more productively to help the NHS meet increasing demand.

High quality information is essential to be able to commission services successfully and to monitor performance. Some information on cancer has improved, but significant gaps still remain. For example, data on chemotherapy activity and outcomes are poor and the introduction of a national chemotherapy dataset is almost two and a half years behind the original commitment made by the Department.

Amyas Morse, head of the National Audit Office, said today:

"The Department of Health's strong direction and high profile leadership has resulted in improved cancer services in key areas. Further improvement depends, to a significant degree, on raising standards of practice around the country up to the best. A key factor in driving this is a much improved approach to information on cancer services."

Notes for Editors

1. In 2000, the Department published the NHS Cancer Plan, which set out a 10-year strategy to improve cancer services, which included setting up cancer networks, introducing waiting time standards, as well as increasing the cancer workforce and additional funding of £570 million. In 2007, the Department published its five-year Cancer Reform Strategy which acknowledged that, although improvements had been made, the gap in mortality rates between England and the best European countries had not closed.
2. The NAO's report examines how effectively three of the Strategy's actions to drive delivery have been utilized to improve services for patients. The actions examined were: improving the quality of information, strengthening commissioning and making better use of resources.
3. About 255,000 people are diagnosed with cancer each year and around 130,000 will die from the disease. There are an estimated 1.7 million cancer survivors in England. There are more than 200 different types of cancer, with breast, lung, colorectal and prostate cancer making up over half of all new cases. While the incidence rate for cancer has increased recently, mortality rates have fallen. However, this trend is not consistent across all cancer types or between sexes. The overall incidence rate will reach a plateau by 2015, but because of the ageing population, the number of new cases will continue to rise and reach 300,000 by 2020.
4. Press notices and reports are available from the date of publication on the NAO website, which is at www.nao.org.uk. Hard copies can be obtained from The Stationery Office on 0845 702 3474.
5. The Comptroller and Auditor General, Amyas Morse, is the head of the National Audit Office which employs some 900 staff. He and the NAO are totally independent of Government. He certifies the accounts of all Government departments and a wide range of other public sector bodies; and he has statutory authority to report to Parliament on the economy, efficiency and effectiveness with which departments and other bodies have used their resources.

• Full report - Delivering the Cancer Reform Strategy

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