National Cancer Strategy 2017 - 2026

Objectives

Ireland’s National Cancer Strategy 2017–2026 sets a whole-population, integrated framework to reduce the cancer burden, improve early detection and treatment, maximise quality of life from diagnosis through end of life, and enable accountable service change. It seeks equitable access to safe, high-quality, evidence-based and patient-centred care across prevention, screening, diagnosis, treatment, survivorship and palliative care.[1][2][3]The overarching outcome ambition is to bring cancer survival for common cancers into the top quartile of European countries by the end of the Strategy period.[1][4][5]

• Reduce preventable cancer by addressing tobacco, alcohol, obesity, diet, physical inactivity, ultraviolet exposure, infections, occupational hazards and other modifiable risks, with particular attention to deprived and hard-to-reach groups.[6][7][8]
• Increase early-stage diagnosis through public and professional awareness, screening, rapid-access clinics, clear referral criteria and timely diagnostic capacity.[9][10][11]
• Maintain organised, quality-assured population screening, including BreastCheck, CervicalCheck and BowelScreen, while developing personalised surveillance for people with inherited cancer predisposition.[12][13][10]
• Deliver optimal treatment through designated cancer centres, multidisciplinary team working, appropriate surgical centralisation, modern radiation oncology, systemic anti-cancer therapy, molecular diagnostics and genetics services.[9][14][15][16]
• Address inequalities in incidence, access, presentation, stage at diagnosis, treatment and survival linked to deprivation, age, sex, geography and social circumstances.[17][7][5]
• Support people living with and beyond cancer through survivorship pathways, psychosocial care, rehabilitation, self-management, return-to-work support, palliative care and end-of-life care.[3][18][19][20]
• Strengthen patient involvement in policy, planning, practice and oversight, including representation through a Cancer Patient Advisory Committee and accessible patient information, treatment summaries and care plans.[21][22]
• Develop research, workforce capacity, cancer intelligence, technology and data systems as enabling foundations for service improvement and innovation.[23][24][25][26]

Implementation

The National Cancer Control Programme (NCCP), operating within the Health Service Executive, is the principal national implementation, commissioning, monitoring and service-development body. It works with the Department of Health, Hospital Groups, community healthcare organisations, primary care, screening services, professional bodies, patients, voluntary organisations, universities and research bodies.[27][28][4]Implementation combines national standards and care pathways with designated specialist centres, hub-and-spoke provision, shared care between hospitals and communities, and evidence-based prioritisation of investment and innovation.[29][30][23]

• Align prevention with Healthy Ireland, establish an NCCP prevention function, coordinate with public-health and voluntary-sector partners, and use population policy, brief interventions and public education to support behaviour change.[1][7][31]
• Expand diagnostic and referral pathways by improving general-practitioner access to diagnostics, extending Rapid Access Clinics where appropriate, implementing electronic referrals, and appointing Hospital Group diagnostic leads.[11][32][33]
• Organise treatment through eight designated cancer centres, networked with local hospitals and primary care so that complex care is concentrated where expertise and volume improve outcomes while routine care is provided closer to home when clinically appropriate.[30][34][35]
• Require formal multidisciplinary team discussion for cancer cases, develop agreed protocols and pathways, and centralise surgery for appropriate tumour types, generally in no more than four centres.[9][35][14]
• Invest through rolling capital planning in cancer-centre facilities, diagnostic imaging, endoscopy, pathology, radiation oncology equipment, information systems and workforce capacity, although the supplied material does not specify a total Strategy budget or quantified funding gap.[36][37][15][38]
• Establish national leadership and network arrangements for molecular diagnostics, cancer genetics, psycho-oncology, geriatric oncology, cancer nursing and research.[16][39][40][41][25]
• Use Service Level Agreements and Activity Based Funding to link cancer-service resources to strategic priorities, agreed performance criteria and compliance with standards; enable the NCCP to address substandard performance and reconfigure services where needed.[28][23]
• Implement an annual Department of Health progress report, supported by NCCP collection and reporting of indicators by geography and institution where relevant.[4]Monitor outcomes through cancer-registry and health-service data, patient-experience surveys, adverse-event reporting, audits, national clinical guidelines and public quality reporting.[42][43][26]
• Track headline targets including adult daily smoking of 5% by 2025, 95% electronic general-practice cancer referrals by end-2022, a relative 10% increase in early-stage colorectal, breast and lung cancer diagnoses by 2020, and treatment summaries and care plans for 95% of patients by 2020.[44][45]Monitor additional targets for palliative-care assessment, chemotherapy near end of life, clinical-trial participation, survival ranking and deprivation-related inequalities.[5]
• Review Strategy recommendations towards the end of 2021 and refine indicators during implementation where necessary.[4][44]

Monitoring & Evaluation

The Strategy establishes a national monitoring and accountability model led principally by the National Cancer Control Programme (NCCP), supported by the Department of Health, Health Service Executive (HSE), National Cancer Registry and National Screening Service. It combines annual implementation reporting, service-level performance monitoring, cancer intelligence, audit, public quality reporting and review of recommendations.[46][28][4]

• Publish an annual Department of Health implementation report, informed by stakeholders and focused on delivery of recommendations and Key Performance Indicators (KPIs); review recommendations at the Strategy’s halfway point and, separately, towards the end of 2021.[46][4]
• Monitor services through Service Level Agreements with Hospital Groups under the HSE Performance and Accountability Framework, audit agreed outputs and outcomes, and publish audit findings annually.[28]
• Use the NCCP cancer-intelligence function, National Cancer Registry data, Central Statistics Office mortality data, electronic health information and the Individual Health Identifier to support surveillance, outcome reporting, workforce planning and service improvement.[28][47][26][4]
• Collect and report indicators nationally and, where relevant, by institution and geography to identify variation and inform policy and resource-allocation decisions.[4]

The performance framework includes prevention, screening, diagnosis, treatment, survivorship, patient safety, palliative care, research and equity measures. It aims to raise cancer survival to the top quartile of European countries, with targets including adult daily smoking of 5% by 2025, 95% electronic general-practice cancer referrals by the end of 2022, and a combined 10% increase in early-stage colorectal, breast and lung cancer diagnoses relative to 2013 by 2020.[1][44][45]

• Track screening participation, coverage and quality assurance, including BreastCheck cancer detection, CervicalCheck coverage and BowelScreen uptake, with monitoring aligned to international standards.[12][13]
• Measure monthly Rapid Access Clinic performance against waiting-time KPIs, implementation of electronic referral, and reductions in cancers diagnosed through emergency departments.[11][32]
• Assess care quality through multidisciplinary team discussion, centralisation of cancer surgery, urgent colonoscopy timeliness, radiology, endoscopy and histopathology quality assurance, and emergency access during active treatment.[36][48][37][4]
• Monitor palliative care through indicators on chemotherapy in the final month of life and specialist palliative-care assessment for people with stage IV cancer; targets include less than 25% and 90%, respectively, by 2019.[5]
• Measure research participation, with a goal for 6% of patients with cancer to enrol in therapeutic clinical trials annually, compared with a reported 3% baseline in 2014.[47][24]
• Assess equity through deprivation-related differences in age-standardised incidence and five-year survival, targeted to be no more than 3% by 2026.[5]

Patient safety and quality oversight use national standards, clinical-effectiveness guidance, clinical audit, incident reporting, open disclosure, patient-experience measurement and a National Patient Safety Surveillance System. The National Healthcare Quality Reporting System publicly reports indicators including screening uptake, five-year relative survival for breast, cervical and colorectal cancers, and breast, colon and rectal surgical activity.[49][42][43]

The NCCP may address substandard services through funding and commissioning levers, including directing discontinuation or transfer of services that fail to meet agreed standards, policy or performance requirements.[28]The source nevertheless leaves several operational details unspecified, including complete indicator definitions, reporting formats and a comprehensive evaluation methodology for all service areas.[11][4]

Costing & Financing

The Strategy identifies substantial resource pressures and investment needs across prevention, diagnostics, treatment, workforce, infrastructure, research, data systems and survivorship, but it does not provide a total implementation budget, comprehensive financing plan or quantified funding gap.[50][1][4]

• Align funding, commissioning, staffing, infrastructure, indemnity, performance management and regulation with cancer-care pathway requirements and strategic priorities.[1]
• Use Service Level Agreements and Activity Based Funding to link Hospital Group resources with performance and service quality, while retaining NCCP responsibility for new HSE cancer-service funding and related posts.[28][23]
• Plan rolling capital investment for cancer-centre facilities, diagnostic equipment, radiation oncology, imaging, endoscopy, inpatient and ambulatory capacity, with annual review of the cancer capital investment plan.[36][5]
• Resource additional specialist staff, including medical oncologists, haematologists, surgeons, nurses, pharmacists, radiographers, diagnostic professionals, genetics staff and wider health and social care professionals.[51][52][38]
• Develop diagnostic capacity within available and expected resources, including molecular diagnostics, pathology, radiology, endoscopy and information systems.[17][37][53]

Prevention is characterised as the most cost-effective long-term cancer-control approach, while earlier diagnosis may improve health-system efficiency by reducing treatment intensity and improving outcomes.[54][55][6]The Strategy also requires evidence-based assessment of prevention initiatives, new medicines, technologies and service developments through health technology assessment, pharmacoeconomic review, economic evaluation and Budget Impact Assessment.[12][56][57][23]

New cancer therapeutics are described as exceedingly expensive, creating pressure to balance benefits for defined patient groups against affordability, competing needs and value for money.[21][56]Molecular diagnostics receive partial NCCP support at two hospitals, while cancer genetics services are described as underfunded and requiring significant investment.[16][39]

Research funding is drawn from public, charitable and industry sources. National state funding for cancer research is estimated at euro 25 million to euro 30 million annually, while the Strategy seeks to align research allocations with national priorities and improve continuity of funding.[47][58]Specialist palliative care is mainly provided by voluntary hospices through HSE service-level agreements and hospice fundraising.[49]

The source identifies important non-budgetary economic effects, including projected productivity losses of euro 73 billion from invasive-cancer deaths between 2011 and 2030, and potential economic benefits from cancer survivors returning to work.[59][3][18]