National Cancer Strategy 2017 - 2026

Objectives

The National Cancer Strategy 2017-2026 provides a whole-population framework to reduce the cancer burden, deliver optimal care, maximise patient involvement and quality of life, and enable and assure system change. It covers prevention, screening, earlier diagnosis, treatment, survivorship, palliative care, research, workforce, data, governance and quality improvement.[1][2][3]Its overarching outcome ambition is to bring survival for common cancers into the top quartile of European countries by the end of the Strategy period.[1][3]

• Reduce preventable cancer by addressing tobacco, unhealthy diet, excess body weight, physical inactivity, alcohol, sun exposure, infections, occupational hazards and other modifiable risks.[4][5][6]
• Achieve a tobacco-free Ireland by 2025, defined as adult smoking prevalence below 5%, while protecting children and further denormalising smoking.[5]
• Reduce inequalities in cancer incidence, awareness, screening uptake, diagnosis, treatment and survival, particularly for socioeconomically deprived, hard-to-reach and minority populations.[7][8][9]
• Improve earlier diagnosis through public and professional awareness, timely diagnostics, direct general practitioner access, rapid referral pathways and expanded screening.[8][10]
• Maintain and extend organised screening, including incremental extension of BreastCheck to women aged 65-69 and BowelScreen to people aged 55-74 by the end of 2021.[11][12]
• Provide safe, timely, evidence-based and patient-centred care across prevention, diagnosis, treatment, follow-up, survivorship and end-of-life care.[7][13]
• Centralise complex cancer surgery and specialist care where volumes, multidisciplinary expertise and infrastructure support better outcomes, while delivering appropriate lower-complexity services closer to home.[14][15]
• Strengthen survivorship, psychosocial and palliative support so that patients and families receive care for physical, psychological, social and spiritual needs throughout and beyond treatment.[16][17][18]
• Develop research, clinical trials, biobanking, molecular diagnostics, genetics, workforce capacity and cancer intelligence as enablers of sustainable improvement.[19][20][21][22]

Implementation

Implementation is led nationally by the National Cancer Control Programme (NCCP) within the Health Service Executive (HSE), working with the Department of Health, Hospital Groups, community healthcare organisations, primary care, designated cancer centres, professional bodies, voluntary organisations, patients and research institutions.[23][24][25]The approach combines nationally defined standards, commissioning and performance oversight with integrated, networked care pathways tailored to cancer type, treatment complexity and patient need.[26][27]

• Deliver treatment through eight designated cancer centres, using multidisciplinary teams, hub-and-spoke chemotherapy arrangements, specialist referral networks and coordinated links between primary, secondary and tertiary care.[28][29]
• Require formal multidisciplinary team discussion for every diagnosed patient, with expert teams directing care in the clinically optimal location and national planning for rare cancers.[7][30]
• Strengthen primary-care integration through national referral guidance, electronic general practitioner referrals, direct diagnostic access, urgent criteria and additional Rapid Access Clinics where required.[10][31]
• Expand diagnostic and treatment infrastructure through rolling capital investment, including imaging, endoscopy, radiation oncology facilities, linear accelerator replacement, ambulatory care and medical oncology capacity.[32][33][34][35]
• Develop nationally coordinated molecular diagnostics and cancer genetics services through accredited laboratories, a National Lead for Cancer Molecular Diagnostics, specialist steering arrangements and a National Cancer Genetics Service.[36][37]
• Develop a Comprehensive Cancer Centre during the Strategy period, subject to resources and international developments, integrating high-volume clinical care, education and research.[32][33]
• Provide personalised survivorship care through Patient Treatment Summaries and Care Plans, shared-care protocols, primary-care follow-up, nurse-led services and rapid re-entry to specialist care where necessary.[38][18][39]
• Deliver palliative care through integrated generalist and specialist provision across home, primary care, hospital and hospice settings, based on need rather than prognosis.[17][40]
• Embed patient participation through the Cancer Patient Forum, a Cancer Patient Advisory Committee, representation in policy and service oversight, and local structures for patient and public input.[41][38]
• Use Service Level Agreements, Activity Based Funding, commissioning, service specifications and the HSE Performance and Accountability Framework to align resources with strategic priorities, agreed outputs and quality standards.[27][25]
• Develop the workforce through a comprehensive cancer workforce plan, interim staffing assessment, specialist clinical leadership and expansion of oncology, nursing, radiography, pharmacy and health and social care professional roles.[42][43][44][22]
• Coordinate research through a National Cancer Research Group, integrate clinical research into cancer care, protect research time where feasible and strengthen clinical-trial participation towards 6% of cancer patients annually.[45][21]
• Monitor implementation through annual Department of Health reporting, regular NCCP and HSE service monitoring, nationally collected Key Performance Indicators and review of recommendations towards the end of 2021.[23][46]
• Track outcomes including smoking prevalence, stage at diagnosis, referral access, screening uptake, treatment summaries, palliative assessment, trial participation, survival and deprivation-related inequalities.[47][48][9]
• Use national quality indicators, clinical guidelines, audit, patient-experience surveys, incident reporting and public quality reporting to promote accountability, safety and continuous improvement.[49][50][51]
• Apply health technology assessment and economic evaluation to new medicines, diagnostics, equipment, prevention interventions and service developments, considering clinical effectiveness, cost-effectiveness, resource implications and budget impact.[52][49]

The Strategy identifies substantial workforce, infrastructure, equipment, information-system and service-capacity requirements, but does not specify a consolidated implementation budget, detailed allocations or quantified funding gap.[53][32][22]

Monitoring & Evaluation

The Strategy establishes a national monitoring and accountability system centred on annual implementation reporting, Key Performance Indicators (KPIs), cancer intelligence, quality assurance, clinical audit, patient experience and public reporting. The Department of Health is to publish an annual report on implementation, recommendations and KPIs, informed by stakeholders.[23][46]Recommendations are to be reviewed towards the end of 2021 to assess whether the Strategy remains relevant and effective in achieving optimal patient outcomes.[54][23]

• Measure performance across prevention, screening, diagnosis, treatment, survivorship, palliative care, research and inequalities using KPIs that can be refined during the Strategy period.[46][47]
• Track smoking prevalence, early-stage diagnosis, electronic general practitioner referrals, diagnostic and clinic access, emergency presentation, screening uptake, surgery in approved centres, multidisciplinary team review, waiting times, care plans, end-of-life chemotherapy, palliative assessment, trial participation, survival and deprivation-related inequalities.[47][48][9]
• Monitor specific targets including 95% electronic general practitioner referrals by the end of 2022, a 10% relative increase in early-stage colorectal, breast and lung cancer diagnosis by 2020, and 95% attendance within recommended timeframes for Rapid Access and symptomatic breast disease clinics in 2017.[47][48]
• Track screening performance, including a 70% BreastCheck uptake target, 80% five-year rolling CervicalCheck coverage, 45% interim BowelScreen uptake by the end of 2018, and programme-level quality assurance against international guidelines.[11][12][47][48]
• Measure patient-centred care through the target that 95% of patients receive a Patient Treatment Summary and Care Plan by 2020, alongside focused patient experience surveys on treatment and survivorship.[38][47][48][49]
• Monitor palliative and research targets, including fewer than 25% of patients with metastatic cancer receiving chemotherapy in their final month of life by 2019, 90% specialist palliative-care assessment for stage IV disease by 2019, and 6% participation in therapeutic clinical trials by 2020.[48][9]

The National Cancer Control Programme (NCCP) has responsibility for setting standards and guidance, commissioning and monitoring services, leading quality improvement and overseeing cancer-centre performance.[41][24]Service Level Agreements with Hospital Groups are to define outputs and outcomes, be audited annually, and support action where performance or standards are inadequate, including discontinuation or transfer of non-compliant services.[27]

• Collect, collate and report KPIs nationally and, where relevant, by geography and institution, using internationally comparable clinical outcomes together with process and activity measures to identify variation and inform policy and resource allocation.[46]
• Strengthen surveillance through timely National Cancer Registry data on incidence, staging, treatment and survival, supported by mortality data from the Central Statistics Office.[55][22][46]
• Publish and monitor national cancer-care quality indicators aligned with international standards, and monitor guideline implementation through Health Service Executive Performance Assurance Reports, safer-care standards and clinical audit.[50]
• Report adverse events through the National Incident Management System, support open disclosure, and incorporate clinical activity, workforce, regulatory notifications, claims information and patient safety data into a National Patient Safety Surveillance System.[50][49]
• Audit patient-centred pathways, multidisciplinary team arrangements, molecular diagnostics and new technologies, using health technology assessment and clinical evidence before adoption or discontinuation.[26][32][36][52]

Patient and public participation form additional accountability mechanisms through the Cancer Patient Forum, a Cancer Patient Advisory Committee, representation in policy and oversight, and local structures for patient input.[30][51][38]The Strategy also requires regular measurement and reporting of public awareness campaign results, including their contribution to earlier diagnosis.[56]

Costing & Financing

The Strategy identifies substantial resource pressures from increasing cancer incidence, treatment complexity, diagnostics, infrastructure, workforce requirements and expensive new therapies, but does not provide a consolidated implementation budget, quantified funding gap or overall financing envelope.[7][53][3]New-to-market cancer therapeutics are described as exceedingly expensive, requiring continuing affordability and value-for-money decisions by the NCCP, the Health Service Executive and the Department of Health.[30][57]

• Prioritise prevention as the most cost-effective long-term approach to cancer control, while using systematic evidence-based assessment of benefits and cost-effectiveness to select future prevention initiatives.[1][4][58]
• Apply economic evaluation and health technology assessment to prevention, screening, diagnostics and treatment, examining clinical effectiveness, cost-effectiveness, resource implications and budget impact to inform investment and disinvestment.[52]
• Link cancer-service funding and commissioning to strategic priorities, performance and quality through Service Level Agreements and Activity Based Funding.[27]
• Maintain rolling capital investment for radiation oncology, imaging, diagnostics, endoscopy, ambulatory facilities, medical oncology units, equipment replacement and cancer-centre development.[32][34]
• Invest in workforce supply, specialist training, retention and leadership across oncology, nursing, radiography, pathology, pharmacy and health and social care professions.[53][43][44]

The NCCP coordinates funding for new cancer developments, including oncology medicines and new Health Service Executive-funded posts, and participates in commissioning decisions.[24][27]Molecular diagnostic testing is partly funded by the NCCP at two hospitals under a collaborative Memorandum of Understanding, but the Strategy identifies the need for a clear payment mechanism for testing and a rolling budget for laboratory equipment replacement and upgrading.[36][19]

State funding for cancer research is estimated at approximately 25 to 30 million euro annually, sourced from the Health Research Board, Science Foundation Ireland, the Irish Cancer Society, industry and other charities.[55][45]The Strategy seeks more stable research funding, including for Cancer Trials Ireland, and stronger alignment between allocations and national research priorities.[45]

Projected deaths from invasive cancers between 2011 and 2030 were estimated to result in 73 billion euro in lost productivity, including paid work and household activity.[59]Specialist palliative care is predominantly delivered by voluntary hospices funded through Health Service Executive service-level agreements and hospice fundraising, though no monetary allocation is specified.[40]