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“The chances of surviving cancer are improving all the time. Under the determined leadership of the National Cancer Director, Professor Mike Richards, the Department and NHS have achieved a great deal in a short time. Saving an even larger number of lives requires more of us to know and act promptly on the possible symptoms of cancer.

“But the Department and NHS need to act to further reduce inequalities, geographical and between the affluent and deprived, and go on improving cancer prevention, screening, referral, diagnosis and treatment services. These are essential steps in meeting the Department’s goal to make England’s cancer services among the very best in Europe by the end of this decade.”

“Where patient safety is considered to be at risk or there are allegations of misconduct, it is vitally important for NHS trusts to be able to exclude clinical staff from work or restrict their activities so that the situation can be thoroughly and promptly investigated. At present, however, there is evidence of many cases of exclusion being allowed to drift on without resolution or proper management. This represents a serious waste of resources for the NHS and can harm the career and even personal well-being of the accused clinicians themselves.

“The Department of Health should now take further steps to achieve a system for managing the exclusion of clinical staff in which both staff and patients can have confidence.”

“I am pleased that the measures taken since my last report have resulted in significant improvements, especially as this means a better service for customers, who include some of the most vulnerable members of society. It is crucial that assessments are undertaken fairly and efficiently, while ensuring that benefits are paid only to those genuinely entitled to them. I look to the Department to do more to improve the quality of evidence on which decisions are based and to tackle the problem of people failing to attend examinations.”

“Trusts have made good progress in the early stages of implementing the clinical governance programme. It is important, however, that they maintain the momentum that has been built up and overcome barriers in order to ensure that the National Health Service derives the intended benefits and, crucially, that patients see a clear improvement in their treatment and the quality of their healthcare.”

“Since my last report on hip replacements three years ago, the NHS has improved its procedures thereby providing better quality of care for patients. There is still further progress to be made, however, including the spreading of good practice, to ensure that the service provided by the NHS is as good as possible.

“Hip replacement is one of the most common and effective major surgical procedures. But there are some question marks over how hospitals are managing the process, not least to ensure that the replacement hip used has a satisfactory track record. Strong leadership within hospitals is the key to ensuring that these risks are managed effectively for the benefit of patients.”

More needs to be done to reduce the number of staff accidents in NHS trusts. Good progress has been made through the initiatives such as the Back in Work campaign but too many trusts are still not implementing good practice and there are wide variations in terms of access to counselling and other support to get staff back to work more quickly. At a time when it is crucial to recruit and retain staff, the NHS must show that the health and safety of its staff is a top priority.”

“On the basis of investigation into the first procurement of smallpox vaccine by the Department of Health, we found no link between the personal donations to the Labour Party by the Chief Executive of PowderJect and the award to his company of the contract to supply the vaccine.

“However, even where national security dictates that the Department of Health cannot follow normal procurement procedures, the Department must still be as transparent as possible. There must be robust protocols for the special procurement procedures which are to be followed so that the Department can demonstrate that it has acted properly and fairly.

“Regarding shortages in the supply of vaccines, the public health consequences may be very serious indeed. The Department faces a challenge in ensuring vaccine supplies where the number of suppliers is diminishing and some suppliers enjoy a near monopoly, resulting sometimes in increased prices. The Department should define its long-term strategy for ensuring adequate vaccine supplies as a complement to its short-term handling arrangements to deal with vaccine shortages.”

“It is unacceptable that the very people who are trying to help the sick and injured are themselves subject to violence and aggression on a daily basis. Apart from the immediate impact on the individuals concerned, the experience or threat of violence causes increased stress and sickness absence, lowers staff morale and drives individuals out of the health sector at a time of serious staff shortages. Good progress has been made through the zero tolerance zone campaign, but the NHS needs to demonstrate clear improvement across Trusts in incident follow up, staff training and partnerships with other public agencies.”

“Older people are major users of public services and many of them find the divisions between service providers confusing. Often those most in need have to contact the largest number of agencies.

“The Government has been successful in finding new ways of developing services for older people that are joined up and avoid duplication. But there is scope to build on this. Improved co-ordination across government on older people’s issues could be addressed by the publication of an Older People strategy. At the same time, Government must ensure it continues to provide feedback to those it consults in order to maintain commitment and to avoid raising expectations that are later undermined”.