National Cancer Strategy 2017-2026 Implementation Report 2020

Objectives

Ireland’s National Cancer Strategy 2017-2026 seeks to deliver an integrated, equitable and high-quality cancer system spanning prevention, screening, early diagnosis, treatment, survivorship, palliative care, quality improvement and patient participation.[1][2][3][4]It prioritises coordination across primary care, community services and hospitals, alongside specialised and centralised care where this improves outcomes.[2][5][6]

• Strengthen prevention through the Healthy Ireland framework, with emphasis on smoking, alcohol-related risks, skin-cancer prevention, public awareness and evidence-based assessment of prevention interventions, including chemoprevention.[7][8]

• Expand and improve screening and early diagnosis by increasing endoscopy capacity for BowelScreen, developing inherited-cancer surveillance, raising symptom awareness, improving general-practice referral pathways, and widening access to diagnostics and Rapid Access Clinics.[8][9]

• Provide coordinated cancer treatment across settings, including multidisciplinary decision-making, systemic anti-cancer therapy, oral anti-cancer medicines, radiation oncology, surgery, diagnostics, molecular diagnostics and hereditary cancer services.[2][5][6]

• Centralise cancer surgery and selected specialist services where appropriate, while developing evidence-based arrangements for rare and haematological cancers and increasing public radiation-oncology capacity.[5][6]

• Improve age-appropriate care for children, adolescents and young adults, including dedicated facilities, specialist inpatient capacity, transition arrangements and psychosocial support.[6][3]

• Enhance survivorship, psycho-oncology, community cancer support and palliative care through integrated services that address patients’ clinical, psychosocial and follow-up needs.[2][3][10][11]

• Strengthen safety, quality and patient experience through national clinical guidelines, audits, quality indicators, patient-experience measurement, treatment summaries and care plans.[10][4]

• Ensure meaningful patient representation in cancer policy, service planning, practice and oversight, including through a Cancer Patient Advisory Committee that reflects the diversity of people living with cancer.[4]

Implementation

Implementation relies on national leadership by the Department of Health, the Health Service Executive and the National Cancer Control Programme, working with Hospital Groups, primary-care professionals, designated cancer centres, voluntary organisations, patient representatives and specialist advisory structures.[7][9][2][4]Delivery combines national models of care, clinical guidance, service centralisation, workforce and capital planning, digital referral systems, collaborative networks and phased pilots.[2][5][6][10]

• Coordinate prevention through Healthy Ireland, the Irish Cancer Prevention Network and the National Skin Cancer Prevention Plan Implementation Group; the prevention network includes the National Cancer Control Programme, Irish Cancer Society, Marie Keating Foundation, Breakthrough Cancer Research and Irish Skin Foundation.[7]

• Support prevention and early detection through public information, education, stakeholder engagement, curriculum resources and targeted community awareness activity.[7][8]

• Develop hereditary cancer services through identification and assessment of potential inherited risk, referral for counselling and testing, coordinated surveillance, and consideration of an Advanced Nurse Practitioner-led follow-up model for people with known familial risk.[8]

• Phase electronic cancer referrals from general practice to hospitals, supported by the Irish College of General Practitioners, the National Clinical Effectiveness Committee, Hospital Groups and the Health Service Executive Radiology Programme.[9]In 2020, 52,343 electronic cancer referrals were received, 13% more than in 2019.[9]

• Use national models of care and tumour-specific standard operating procedures to connect primary, community and hospital services, including psycho-oncology, community cancer support, systemic therapy and oral anti-cancer therapy.[2][6][3]

• Require formal multidisciplinary team discussion of cancer patients, with the National Cancer Control Programme and Hospital Groups supporting team composition, processes and outcome reporting.[2]Collect multidisciplinary-team information through rollout of the National Cancer Information System and use quality indicators to improve functioning, including for haematological cancer services.[2][6]

• Maintain a rolling, annually reviewed capital investment plan for cancer facilities under the National Development Plan 2018-2027, covering radiation oncology, medical oncology and day wards, diagnostics, aseptic compounding and a comprehensive cancer care centre.[2]The source does not specify quantified capital allocations or total programme expenditure.[2][5][6]

• Develop hub-and-spoke links between the National Centre for Child and Adolescent Cancer and designated cancer centres, with joint appointments, flexible transition arrangements and age-appropriate support.[3]Align cancer and palliative-care developments through collaboration between the National Cancer Control Programme and the National Clinical Programme for Palliative Care.[10]

• Engage patients through the Cancer Patient Advisory Committee, Patient Advisory Liaison Services, working groups, patient groups and advocacy organisations.[4]Develop a minimum treatment-summary data set and pilot the Colorectal Patient Passport in seven hospitals, with evaluation at six and twelve months before any national rollout.[4]

• Monitor quality through the National Cancer Quality Steering Committee, national audits, evaluated pilots, service assessments, international indicator review and patient-experience programmes.[10][4]A consolidated indicator framework, formal reporting timetable and full accountability schedule are not specified.[7][8][9][2][6]

Monitoring & Evaluation

Monitoring and evaluation combine programme oversight, service-activity data, quality indicators, audits, patient experience measures and implementation reviews across Ireland’s National Cancer Strategy.[7][2][10][4]The source does not set out a single consolidated indicator framework, evaluation timetable, target set, public reporting schedule or comprehensive accountability architecture.[7][8][9][2][6]

• Monitor prevention delivery through agency progress reporting, stakeholder networks, the National Skin Cancer Prevention Plan Implementation Group and the Irish Cancer Prevention Network.[7]Review emerging evidence, international initiatives and the effectiveness of prevention and awareness interventions, while developing a more formal evidence-based assessment process for prevention measures and chemoprevention.[7][8]
• Track BowelScreen activity and endoscopy capacity. Approximately 1,800 people were referred for further treatment or surveillance in 2020, with reduced activity attributed to the COVID-19 pandemic; restoring pre-pandemic activity is the immediate priority before considering extension from the existing 60-69 age group towards people aged 55-74.[8]
• Measure electronic referral implementation through recorded activity and phased rollout. Electronic cancer referrals totalled 52,343 in 2020, 13% higher than in 2019.[9]Monitor the Pigmented Lesion Electronic Cancer Referral Form pilot and national implementation of electronic referrals from general practice to hospitals.[9]
• Assess early-diagnosis and referral improvements through updated general practitioner guidance, review of cancers not covered by existing Rapid Access Clinics, development of colorectal referral pathways and work to improve access to gynaecological cancer services.[9]
• Collect multidisciplinary team information continuously through rollout of the National Cancer Information System.[2]Oversee team composition, operating processes and outcome reporting through the National Cancer Control Programme and Hospital Groups.[2]Use quality indicators and initial data collection to assess multidisciplinary team functioning and improve haematological cancer services.[6]
• Apply tumour-specific standard operating procedures, including for colorectal cancer, haematology, melanoma and breast cancer, to support consistent clinical processes.[2]Undertake research towards a systematic, evidence-based method for prioritising further rare cancers for multidisciplinary team and centralised-service arrangements.[6]
• Monitor paediatric, adolescent, young adult, psycho-oncology and palliative-care implementation through programme leadership, advisory groups, service assessments and dissemination of national guidance.[3][10]Assess children’s palliative-care services through a subgroup of the Steering Group for Children, Adolescents and Young Adults, and use treatment-summary records for children treated at Children’s Health Ireland.[10]
• Oversee cancer safety and quality through the National Cancer Quality Steering Committee, a national patient-safety and quality framework and evaluated pilot projects.[10]Review national data and international approaches, including the Innovative Partnership for Action Against Cancer joint action, to identify Irish process and outcome indicators for cancer care.[10]
• Use the National In-Patient Acute Care Patient Experience Survey and the National Care Experience Programme to address treatment and survivorship experience.[10]Cancer patient-experience work was prioritised for 2021, but COVID-19 delayed the survey, with progress expected in 2022.[10]
• Develop audits in line with the National Clinical Audit Framework.[4]Evaluate the Colorectal Patient Passport at patient and service level after six and 12 months, using findings to decide design changes before national rollout.[4]Review patient experience, COVID-19 impacts and oncology-service developments through the Cancer Patient Advisory Committee.[4]
• Use the National Cancer Survivorship Needs Assessment, completed in August 2019, to inform survivorship policy and service implementation during 2020.[11]

Costing & Financing

Financing information is primarily descriptive: the source identifies capital support, specified service funding and staffing measures, but provides no consolidated cancer-strategy budget, expenditure total, funding-gap assessment, unit costs or quantified economic assumptions.[1][2][5][6][3][10][4][11]

• Support cancer-facility development through capital funding under the National Development Plan 2018-2027, covering radiation oncology, medical oncology units and day wards, diagnostic facilities, aseptic compounding infrastructure and a comprehensive cancer care centre.[2]The source does not quantify allocations for these developments.[2]
• Provide Sláintecare funding for recruitment of a Cancer Prevention Officer in December 2020 to coordinate implementation of the National Skin Cancer Prevention Plan; no funding amount is reported.[7]
• Provide funding in 2020 for a national penile-cancer service at Beaumont Hospital and for Brexit-related measures intended to strengthen chemotherapy-compounding resilience in acute hospitals; no monetary values are specified.[2][6]
• Increase chemotherapy-compounding resilience through recruitment of 17 additional staff in 2020 and plans for a further 10 posts in early 2021.[2]Provide previous additional staffing to the hereditary cancer service at St James’s Hospital, including a Consultant in Cancer Genetics who took up post in 2020.[5]
• Identify resource-related developments in specialist staffing, joint clinical appointments and two proposed advanced nurse practitioner posts in palliative care, without associated financial values.[3][10]
• Plan to assess the cost-effectiveness of prevention interventions, including chemoprevention, through a formalised process that was still under development.[7][8]