Despite having a good record in improving cancer services, the Department of Health and NHS England have lost momentum in the last two years. The incidence of cancer has grown whilst the resources available have reduced. Leadership has been lost, the support for commissioners and providers to support improvement reduced, and fragmentation of accountability has made progress more difficult. The NHS needs to adapt to cope with the growing demand, but it is struggling to meet waiting time standards. Whilst survival rates continue to improve, nearly a third of people still die within a year of being diagnosed and around half do not survive for five years, placing the UK in a poor position when compared with the rest of Europe In addition, the inequalities and variations that were highlighted in 2011 persist. Survival rates and access to treatment are unjustifiably poor for older people in particular, and this is especially concerning because three-in-five cancers are diagnosed in people aged over 65. NHS England does not understand what lies behind the variations and is not using the available data to hold poorly performing local areas to account. While the information to support improvements in cancer services is better than it was, important gaps remain, for example in the completeness of 'staging data' (which record how advanced a person's cancer is at diagnosis). There are also insufficient data to evaluate properly the impact of the Cancer Drugs Fund on patient outcomes.