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.

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.

Cambridge-MIT Institute Ltd (CMI) is a limited company jointly owned by two leading research universities, Cambridge University and the Massachusetts Institute of Technology (MIT). It was set up in June 2000 by the Treasury, with the aim of enhancing UK entrepreneurship, industry productivity and competitiveness through collaborative scientific research work; and received about £65 million in public funding over six years with a remit to "think the unthinkable" in generating innovative business ideas which might have long-term economic benefits. In response to a request from the Committee of Public Accounts, this NAO report examines how CMI was set up and managed, its achievements, and the role of the Department of Trade and Industry in monitoring the progress and management of CMI's programme. It finds that although CMI is an experimental initiative whose key outcomes are complex, intrinsically difficult to measure and unlikely to be realised for some time, there have been some early successes and considerable potential for others. The Treasury and the Department were right not to try to follow the usual arrangements for setting up initiatives, but aspects of CMI's establishment could have been managed better. The report highlights important lessons for departments on setting up and managing similar innovative projects in the future.

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.