Improvements and efficiencies have been made in key areas of cancer care since the Cancer Reform Strategy was published in 2007. The NAO estimates that cancer cost the NHS approximately £6.3 billion in 2008-09, but it is not clear if 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. 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. The Strategy aimed to minimise emergency admissions for cancer patients, but these are still increasing, with wide variations between PCTs and poor understanding of the reasons for those variations. There are opportunities to achieve better outcomes and free up resources. 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. 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. 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.