1.  The Department failed to act promptly on a number of reviews of its procurement processes which would have provided an opportunity to achieve significant financial savings much earlier. For example, the Department's procurement unit was under-resourced and had not been able to introduce management information systems to provide readily available data on what was being spent with a particular supplier.

2.  The Department claims general procurement savings of some £5 million per year but has also identified scope for a further £5 million which has yet to be realised. These additional savings arise from the introduction of a new financial and business management system, the co-ordination of procurement activity under the auspices of a newly appointed Commercial Director and a strengthening of its Procurement Policy Advisory Unit. The Department will need to be able to demonstrate that it has achieved the financial savings from successful implementation of these initiatives.

3.  At around the same time the Department was letting a contract for the purchase of the smallpox vaccine, political donations were made by the successful bidder. We found no evidence that these donations had influenced the award of the contract. As in this case, however, officials dealing with contracts need to see that proper procedures are followed and that there is a clear audit trail, so that decisions on the award of contracts can always be shown to follow from an objective evaluation of tenders.

4.  Increasing dependence on a small number of suppliers entails a growing risk of interruptions in the supply of vaccines. To help mitigate this risk, the Department needs to encourage suppliers to stay in the market and make the necessary investment to assure long term vaccine supplies. Greater opportunity for suppliers to influence the development of the Department's immunisation policies, perhaps through the Joint Committee on Vaccination and Immunisation, might enable them to plan more strategically to meet the Department's medium and longer term vaccine requirements.

5.  Vaccines have been very effective in controlling or eliminating major diseases, but important risks remain to be managed. Tuberculosis, for example, is again emerging as a threat, and the Department and the NHS will need to work closely with other agencies, including the Home Office, Prison Service, Immigration Services, and local authorities to tackle it. The Chief Medical Officer is shortly to publish an action plan setting out the efforts needed to keep this disease under control.