Website of the Department of Health

In particular, the report makes an economic case for smoke-free work and public places. It draws on specially commissioned research to show that a smoking ban would boost business for the hospitality industry, rather than harm it as the pro-smoking lobby argues.

The public is generally aware that smoking poses a threat to health. But it is not so well known that it has a serious impact on a person's looks as well. The report spells out the ageing effects of cigarette smoke, even from passive exposure, and the phenomenon of 'smoker's face' -- a mix of wrinkles, damaged blood vessels and bad skin colouring.

Young people working in bars and clubs should be aware of the risk, the report says, and the fashion industry should do more to distance itself from a habit that is incompatible with beauty.

The report takes a close look at the national blood transfusion service, which has faced a shrinking donor pool and a growing number of 'wrong blood type' medical accidents.

To preserve stocks and prevent mistakes, the CMO calls for every hospital to review its procedures against best practice guidelines and introduce methods to manage stocks efficiently.

Education and training programmes should put more emphasis on safe, appropriate use of blood and blood products and hospitals should have contingency plans for coping with potential blood shortages.

In medical research, England does extremely well in the international league tables, coming second only to the USA for the quality of its work. A number of trends threaten this record, however. The annual report pinpoints unclear career structures and time pressures that work against a clinician combining research and practice, and calls for a change in career rewards and NHS culture.

The incidence of HIV infection has been relatively low in England but now shows a worrying upward trend, with the number of people diagnosed as HIV-positive up by 126% since 1996. Many new cases concern people infected abroad, through heterosexual sex, in countries with a high rate of HIV infection.

In addition, around a third of those diagnosed are unaware of their condition. Earlier detection would help prevent behaviour that only spreads the disease further. The answer, says the report, is to do more to promote safer sex and identify the infection at an early stage.

The  report can be downloaded in its entirety or section by section by clicking on the links below.