Two quotes stick out from the executive summary of the thoughtful and thorough-looking Extent and causes of international variations in drug usage report by cancer czar Professor Mike Richards for the SoS, published today by the DH.

”Experts have identified a number of common themes which, often working in combination, appear to influence the level of usage in the UK compared with other countries. These include the impact of health technology assessment processes; the effectiveness of service planning, organisation and direction setting; and clinical culture. These are worthy of further exploration. Although the level of spending on health was suggested as a potential hypothesis for variations in usage, it does not appear to be a strong determinant. Put simply, countries that spend the most on health do not always have the highest levels of usage and low spenders can be high users of drugs”.

”Although this report makes no attempt to assess what the appropriate level of drug usage would be for different categories, I would encourage all those with a stake in improving services in the disease areas that have been studied to assess the findings and consider whether the levels of usage observed in the UK are appropriate”.

And there is an apparently new £50 million to get the National Cancer Drugs Fund under way this October. Managers will be pleased that this money is not in the baseline.

They may also note that pro rata, if this were the ongoing level of funding for the Fund, its annual budget would be half of the previously-used £200 million figure.