Following on from a NAO report (HCP 364, session 2003-04; ISBN 010292757X) published in March 2004, the Committees report examines the extent of progress being made to improve the prevention and early detection of cancer, to improve the quality of cancer treatments, and to reduce regional variations in cancer survival and mortality rates in England. Findings include: research shows that people in more deprived areas are likely to have their cancer identified at a more advanced stage, and further work needs to be undertaken to tackle the underlying reasons for late presentation; action is needed to help GPs improve early detection rates, with the development of GP cancer specialists to spread good practice amongst the profession; and improved recording mechanisms are required to monitor the time taken for patient assessment, referral, diagnosis and treatment, with better availability of public information on provision of local cancer services.

The NAO will produce three studies on cancer services in England. This is the first and looks at whether survival rates are being improved. One person in three will develop cancer at some point in their life, and in the 1990s England suffered from a higher mortality rate than other European countries. However the survival rate is improving and the latest figures show that 36 per cent of men and 49 per cent of women will survive for 5 years or more. England's position in terms of the proportion of people who die from cancer is improving relative to other comparable countries. There is though a class divide, with the better off improving more than the less well off. There are variations in service but one of the factors is that people in more deprived areas are likely to have their cancer identified at a more advanced stage. The recommendations from this report cover the need to be more effective in stopping smoking, ways of identifying cancer earlier and the need for national clinical audits.

In recent years a great deal of effort has been put into improving risk management in departments and in 2002 this was given further impetus when a two year risk programme was launched by the Prime Minister. This report looks at the progress made since the previous NAO report in 2000 (HC 864 1999-2000, ISBN 0105569488). It is based on a survey of the 20 main Whitehall departments, focus groups of 27 departmental risk managers, comparisons with the private sector, academic research and five case studies. The general conclusion is that significant improvement has been made but more needs to be done to make effective risk management a central part of general management processes. The ability to take risks and innovate, keep projects on track and handle complex service delivery needs to be further developed.

There were about 12.7 million visits to accident and emergency (AandE) services in the last year, and in around a fifth of these, patients were admitted to hospital. AandE departments are only one in a variety of NHS emergency care providers, which include ambulance services, GPs, primary care trusts, out-of-hours services; NHS Direct; and open access minor injury centres. This NAO report examines the extent of progress made towards achieving the key target for maximum total time spent waiting for AandE services, as well as with the wider modernisation of emergency care. The report's conclusions include that, given the high level of demand, there has been a significant and sustained progress towards reducing waiting times in AandE departments and improving the patient's experience, largely due to improved working practices and increased local investment. However, there is further room for improvement in the case of patients with more complex needs, such as older people and those with mental health needs; and regional variations still exist with the performance of the worst performing trusts still some way behind. Further major improvements will depend on tackling the remaining bottlenecks and barriers to modernisation within wider emergency care services. The establishment of local emergency care networks is highlighted as a promising development, as a means to secure greater emergency care service integration and joint-working.

Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem. In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person's experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.

Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.