National Cancer Strategy 2017-2026 Implementation Report 2020

Objectives

The National Cancer Strategy 2017-2026 frames a comprehensive cancer-control agenda spanning prevention, early detection, diagnosis, treatment, survivorship, palliative care, quality and patient partnership.[1]Its overarching direction is to deliver integrated, person-centred cancer care across primary, community and hospital settings, from prevention and diagnosis through treatment, follow-up and end-of-life care.[2][3]

• Strengthen prevention through Healthy Ireland policies, a National Cancer Control Programme prevention function, the National Skin Cancer Prevention Plan, public awareness and action on emerging evidence.[2][4]
• Improve early detection by expanding BowelScreen when activity has recovered to pre-COVID-19 levels, improving referral pathways and developing services for people with inherited familial cancer risk.[4][5]
• Develop integrated models of care linking general practice, community services and hospitals, and ensure that cancer cases are formally considered by multidisciplinary teams with appropriate oversight.[3]
• Strengthen specialist capacity through investment in radiation oncology, medical oncology, diagnostics, aseptic compounding, molecular diagnostics, hereditary cancer services and at least one comprehensive cancer care centre.[3][6]
• Centralise appropriate cancer surgery, expand radiation oncology capacity, support safe oral anti-cancer medicine treatment and develop suitable arrangements for haematological and rare cancers.[6][7]
• Improve equitable support for specific populations by providing age-appropriate services for adolescents and young adults, strengthening cancer and geriatric-service links, and expanding psycho-oncology, specialist palliative care and children’s palliative care.[7][8][9]
• Improve quality, safety and experience by developing national cancer healthcare indicators, clinical guidelines and audits aligned with National Clinical Effectiveness Committee standards, alongside patient-experience measurement.[9][10]
• Strengthen patient involvement in policy, planning, practice and oversight, while providing treatment summaries, care plans and a survivorship model informed by the National Cancer Survivorship Needs Assessment.[10][11]

Implementation

Delivery relies on coordinated action by the Department of Health, the National Cancer Control Programme, the Health Service Executive, hospital groups, general practitioners, community providers, professional bodies, education authorities, voluntary organisations and patient representatives.[2][4][5][3]The approach combines national clinical leadership and governance with local service delivery, specialist workforce development, capital planning, guidance, digital systems, stakeholder engagement and pilot implementation.[3][6][8]

• Coordinate prevention through the Irish Cancer Prevention Network and the National Skin Cancer Prevention Plan Implementation Group, supported by a Cancer Prevention Officer recruited through Sláintecare funding in December 2020.[2]
• Implement early-detection measures through awareness activity, professional engagement, electronic referrals, evidence review and screening capacity planning; COVID-19 delayed the national lung cancer awareness campaign and reduced BowelScreen activity.[4][5]
• Organise diagnosis and treatment through multidisciplinary teams, standard operating procedures, hospital-group collaboration and ongoing collection of multidisciplinary team information through the National Cancer Information System.[3][7]
• Establish national leadership for molecular diagnostics, hereditary cancer services and haemato-oncology through roles and structures including a National Lead, steering group, expert advisory group and national genetics service.[6][7]
• Progress infrastructure through the National Development Plan 2018-2027, annual review of the rolling capital plan, radiation-oncology expansion in Dublin, Cork and Galway, and equipment replacement and refreshment programmes.[3][6]
• Support service implementation through an oral anti-cancer medicine implementation group, pharmacist training delivered by the Irish Institute of Pharmacy, and Brexit-related funding to improve chemotherapy-compounding resilience in acute hospitals.[3][7]
• Coordinate adolescent and young adult care through a hub-and-spoke model linking the National Centre for Child and Adolescent Cancer with designated cancer centres, supported by relevant clinical leads and specialist appointments.[8]
• Deliver psycho-oncology and community support through the Psycho-Oncology Advisory Group, published guidance for community cancer support centres, pilot self-assessment and virtual support provided through Together 4 Cancer Concern with Cancer Care West and the Irish Cancer Society.[8]
• Advance quality governance through the National Cancer Quality Steering Committee, pilot a national patient-safety and quality framework at St James’s Hospital Lung Cancer Service, and review national data and international indicators with the National Cancer Registry Ireland.[9]
• Engage patients through the Cancer Patient Advisory Committee, Patient Advisory Liaison Services, working groups and a forum matching patient representatives to relevant projects.[10]
• Test patient-support tools by piloting the Colorectal Patient Passport in seven hospitals and evaluating it at patient and service level after six and twelve months before potential national rollout.[10]

Monitoring uses implementation reports, stakeholder surveys, programme activity data, evidence reviews, clinical audits, quality indicators, pilot evaluations and continuing engagement with clinical and professional bodies.[2][4][5][10]Reported activity included 52,343 electronic cancer referrals in 2020, a 13% increase on 2019, and approximately 1,800 BowelScreen referrals for further treatment or surveillance.[4][5]The supplied material does not specify a consolidated programme budget, unified performance framework, reporting timetable or formal accountability sanctions.[10][11]

Monitoring & Evaluation

Monitoring and accountability combine programme reporting, clinical audit, service data, quality measurement, patient experience and implementation oversight, although no single consolidated evaluation framework, reporting timetable or formal sanctions are specified.[2][4][5][10][11]

• Monitor implementation through reports from responsible agencies, stakeholder surveys, programme activity data, evidence reviews and engagement with clinical and professional bodies.[2][4][5]
• Review emerging evidence, international prevention initiatives and prospective public-awareness interventions through the National Cancer Control Programme (NCCP) and Irish Cancer Prevention Network, with plans for a more formal assessment incorporating benefits and cost-effectiveness.[2][4]
• Track screening and referral activity, including approximately 1,800 BowelScreen referrals for treatment or surveillance in 2020 and 52,343 electronic cancer referrals, 13% more than in 2019.[4][5]
• Record multidisciplinary team information continuously through the National Cancer Information System, and oversee team composition, processes and outcomes through the NCCP and hospital groups.[3]
• Apply quality indicators to assess multidisciplinary team functioning and improve data for haematological cancer care, while reviewing the rolling capital investment plan annually to identify facility requirements.[3][7]
• Monitor recruitment, centralisation, service development and infrastructure delivery through implementation activity, recognising that COVID-19 delayed progress in several areas.[6][7]
• Operate a national patient-safety and quality framework, with pilot implementation overseen by the National Cancer Quality Steering Committee and evaluated at St James’s Hospital Lung Cancer Service.[9]
• Develop national cancer quality healthcare indicators using process and outcome measures aligned with international standards, informed by a working-group review of national data and international indicators involving the Department of Health, NCCP and National Cancer Registry Ireland.[9]
• Measure patient experience through the National In-Patient Acute Care Patient Experience Survey and National Care Experience Programme; cancer treatment and survivorship were prioritised for 2021, while the cancer-specific survey was delayed and expected to proceed in 2022.[9]
• Use pilot self-assessment by community cancer support centres as an implementation-monitoring mechanism.[8]
• Develop clinical audits in line with the National Clinical Effectiveness Committee Framework for National Clinical Audit.[10]
• Evaluate the Colorectal Patient Passport at patient and service levels after six and twelve months, using findings to refine the model before potential national rollout.[10]
• Use the National Cancer Survivorship Needs Assessment, completed in August 2019, to inform survivorship policy and service development.[11]

The available sections do not specify target values beyond cited activity and quality measures, a unified indicator set, a regular reporting schedule, detailed evaluation methods or formal accountability sanctions.[3][7][10][11]

Costing & Financing

Financing is described principally through named funding streams for prevention, capital infrastructure and selected service developments; monetary amounts, consolidated budgets, funding gaps, resource-mobilisation targets and economic assumptions are not specified.[2][3][7][8][9][10][11]

• Use Sláintecare initiative funding to support recruitment of a Cancer Prevention Officer in December 2020 to coordinate implementation of the National Skin Cancer Prevention Plan.[2]
• Provide capital funding under the National Development Plan 2018-2027 for cancer facilities, including radiation oncology, medical oncology, diagnostics, aseptic compounding and a comprehensive cancer care centre.[3]
• Provide Brexit-related funding to strengthen chemotherapy-compounding resilience in acute hospitals and reduce dependence on outsourced compounding by United Kingdom manufacturers.[3]
• Provide funding to Beaumont Hospital to develop a national penile cancer service.[7]
• Identify investment requirements for infrastructure, equipment, staffing and service development, without specifying their values or a consolidated programme allocation.[3][6][7]

The supplied sections on patient safety, palliative care, patient involvement, clinical guidance, treatment summaries and survivorship identify posts, pilots, guidance and programme activities but do not specify associated costs, financing sources or funding gaps.[8][9][10][11]