National Cancer Strategy 2017-2026 Implementation Report 2022

Objectives

The National Cancer Strategy 2017–2026 seeks to deliver integrated, equitable and evidence-based cancer control across prevention, early diagnosis, treatment, survivorship, palliative care, workforce development and data systems. It prioritises reducing avoidable cancer risk, improving timely diagnosis and access to specialist services, strengthening patient-centred support, and linking primary, community and hospital care throughout the cancer pathway.[1][2][3][4]

• Prevent cancer through Healthy Ireland measures addressing tobacco, alcohol, skin cancer and other modifiable risks; establish a dedicated prevention function; implement the National Skin Cancer Prevention Plan; and extend BowelScreen eligibility towards people aged 55–74.[1][5]
• Improve early detection through targeted awareness for high-risk and underserved groups, clearer referral criteria, Rapid Access Clinics and improved access to diagnostic tests.[2][6]
• Develop coordinated surveillance and care for people with inherited cancer predisposition, particularly familial breast, ovarian and colorectal cancer risk, through genetic testing, counselling, risk reduction and care based on need.[2][7][8]
• Strengthen integrated cancer treatment through designated centres, multidisciplinary decision-making, centralised services where appropriate, precision diagnostics and services for rare cancers, haematological cancers, adolescents and young adults.[3][9][10][11]
• Provide person-centred care through psycho-oncology, community cancer support, specialist palliative care, patient-safety and quality systems, clinical guidance, and meaningful patient participation in policy and service planning.[4][12][13]
• Build sustainable cancer capability through nursing leadership, a comprehensive workforce plan, specialist education and training, and more complete cancer surveillance and data use.[14][15]

Implementation

Implementation combines national policy leadership by the Department of Health with service delivery and clinical governance led principally by the Health Service Executive and National Cancer Control Programme. Delivery relies on national programmes, designated cancer centres, Hospital Groups, primary care, community providers, patient organisations, academic partners and structured stakeholder groups.[1][3][4][14]

• Coordinate prevention with Healthy Ireland and Health Service Executive Health and Wellbeing programmes, using tobacco and alcohol controls, SunSmart communications, school and workplace resources, cancer-awareness information and the Irish Cancer Prevention Network.[1][5]
• Establish steering and working groups, hereditary cancer models of care, testing recommendations and advanced nurse practitioner capacity to streamline familial-risk assessment, surveillance and referral pathways.[2]
• Implement electronic general practitioner referrals across Hospital Groups and develop dedicated pathways for pigmented lesions, high-risk non-melanoma skin cancer and family-history breast cancer referrals.[6]
• Expand diagnostic and early-diagnosis capacity through direct general practitioner access to magnetic resonance imaging, computed tomography, X-ray and dual-energy X-ray absorptiometry, additional posts and hospital access, and the Early Diagnosis of Symptomatic Cancer Plan 2022–2025.[6]
• Standardise multidisciplinary cancer care by formalising discussion of every cancer case, applying common meeting processes and reporting, and rolling out the National Cancer Information System across cancer centres and hospitals.[3]
• Plan infrastructure and specialist capacity through a rolling capital investment plan, a proposed National Programme for Oncology Infrastructure, consultant workforce coordination, radiotherapy expansion and equipment replacement.[3][7][9]
• Organise specialist treatment through centralised, networked and hub-and-spoke models, including a centralised CAR T-cell therapy service in two designated centres, service specifications for haemato-oncology, and national multidisciplinary arrangements for rare cancers.[9][10]
• Develop supported treatment and follow-up models for oral anti-cancer medicines, systemic anti-cancer therapy, stratified self-managed follow-up, community cancer support and paediatric, adolescent and young adult psycho-oncology.[3][10][11]
• Deliver psycho-oncology and community support through designated cancer centres, multidisciplinary teams, standard operating procedures, referral pathways and collaboration with Cancer Support Centres and Services, including the Cancer Support Alliance.[4]
• Embed patient involvement through the Cancer Patient Advisory Committee, Patient Advisory Liaison Services, working groups and consultation with advocacy organisations, including attention to diverse and geographically remote communities.[13]
• Strengthen workforce capability through cancer nursing leadership infrastructure, staffing assessments, a national census of cancer nursing posts, specialty workforce profiles, competency programmes, specialist forums and digital learning partnerships.[14][15]
• Support accountability through cancer awareness surveys, referral and clinic-performance reporting, quality indicators, patient-experience measurement, peer review, guideline development and national cancer registry data-sharing arrangements.[2][6][12][15]
• Resource delivery through reported development funding for early diagnosis, diagnostics, information systems, surgical oncology, radiotherapy, systemic anti-cancer therapy and psycho-oncology, alongside capital projects, grant aid and workforce allocations; an overall programme budget, funding gap and long-term financing framework are not specified.[2][3][9][10][4][15]

Monitoring & Evaluation

Monitoring combines implementation oversight, service-activity reporting, surveillance, quality measurement, audits, patient experience and stakeholder accountability across cancer prevention, diagnosis, treatment and supportive care.[1][2][3][12][15]

• Monitor prevention delivery through the Prevention Plan Implementation Group, evidence reviews, the National Survey of Cancer Awareness and Attitudes, prevention-network communications and campaign activity.[1][5]
• Track prevention outputs, including Irish Cancer Prevention Network membership exceeding 1,000, more than 500 entries to the SunSmart primary-school art competition, skin-protection materials distributed to over 200 schools, and 5,088 BowelScreen referrals for further treatment in 2022 compared with 4,442 in 2021.[1][5]
• Address continuing constraints on BowelScreen recovery, participation and endoscopy capacity following COVID-19 disruption.[5]
• Use cancer-awareness surveys and planned research with marginalised groups to identify barriers to recognising and acting on symptoms and to inform targeted initiatives.[2]
• Report electronic general practitioner referrals weekly to support operational mitigation during the COVID-19 pandemic and cyberattack, and record 55,401 electronic referrals for breast, prostate and lung cancer in 2022, 6% higher than in 2021.[6]
• Track Rapid Access Clinic waiting times and throughput, with the longest waits for the four main cancer types improving in December 2022 relative to the preceding 11 months.[2]
• Undertake pathway audit and evaluation, including the 2022 pilot audit of lung cancer diagnosis pathways; discontinue the pilot because of limited primary-care data access and explore alternative research options.[6]
• Standardise multidisciplinary team governance through defined meeting composition and processes, a cancer conference template, data managers, conference co-ordinators and outcome reporting overseen by the National Cancer Control Programme and hospital groups.[3]
• Maintain molecular-diagnostics oversight through the Cancer Molecular Diagnostics Advisory Group, covering testing guidance, precision-medicine frameworks and tumour-testing recommendations for possible Lynch syndrome.[7][8]
• Monitor surgical and systemic anti-cancer therapy recovery: surgical activity exceeded 16,000 procedures and reached 101% of 2019 levels by the end of 2022, while more than 100,000 systemic anti-cancer treatments reached 105% of 2019 levels.[9][10]
• Apply agreed key performance indicators for the Child, Adolescent and Young Adult Cancer Programme, develop psycho-oncology metrics using the National Clinical Information System, and complete a standard operating procedure for psycho-oncology multidisciplinary team meetings.[11]
• Use self-assessment and peer review for community cancer support services; maintain national cancer safety, quality and process-and-outcome indicators; and develop a cancer patient experience survey for 2022-2024 with the Health Information and Quality Authority, Health Service Executive and Department of Health.[4][12]
• Strengthen accountability through the Cancer Patient Advisory Committee, which met four times in 2022 and contributed to cancer policy and service development.[13]
• Require timely hospital reporting to the National Cancer Registry Ireland, supported by data-sharing agreements, electronic transfer and remote collection, to improve surveillance of cancer incidence and outcomes.[15]
• Use agreed quality metrics for Acute Oncology Service nursing posts and the National Cancer Registry Strategic Plan 2020-2022 to improve cancer data collection, policy support and use of data in care.[14][15]

Costing & Financing

Financing reported for 2021 and 2022 mainly comprises targeted development funding, grant aid, capital investment and an external training grant; the available material does not provide a consolidated National Cancer Strategy budget, long-term financing framework, quantified funding gap or resource-mobilisation plan.[2][6][3][4][15]

• Allocate almost €3.5 million in new development funding in 2022 to Rapid Access Clinics and early diagnosis pathways, supporting extended hours, locum staffing, shorter waits and increased throughput.[2]
• Provide more than €3 million in new development funding in 2022 for service resilience and diagnostic capacity, including additional diagnostic access and posts in diagnostic and Rapid Access Clinic services.[6]
• Continue or commence cancer infrastructure projects through the 2022 Capital Plan, including radiotherapy facilities and equipment, oncology day units, aseptic compounding units and hospital day wards.[3]
• Allocate almost €300,000 in new development funding in 2022 for change enablers supporting rollout of the National Cancer Information System.[3]
• Support hereditary cancer programme recruitment through 2022 funding for cancer genetics and molecular diagnostics, although the monetary amount is not specified.[8]
• Provide 2022 new development funding of €3.1 million for surgical oncology, €2 million for radiotherapy service enhancement and €3 million for systemic anti-cancer therapy services.[9][10]
• Fund additional surgical, radiotherapy, pharmacy and nursing capacity, alongside support for systemic anti-cancer therapy centres, without specifying a wider recurrent funding envelope.[9][10]
• Award €545,743 in grant aid to 24 Cancer Support Centres and national organisations in 2021, and allocate €1 million in new development funding to psycho-oncology services in 2022.[4]
• Approve three palliative-care nursing posts in the 2022 Service Plan, with recruitment ongoing; no associated monetary value is specified.[4]
• Identify a €2 million European grant for the three-year DigiCanTrain digital cancer-care training programme, while recording additional workforce allocations without monetary values.[14][15]
• Apply cost-effectiveness considerations to future prevention programmes and prepare research on the economic cost of skin cancer, without publishing a monetary estimate in the available text.[5]
• Introduce a minimum unit price of 10 euro cents per gram of alcohol in January 2022 and remove value-added tax from nicotine-replacement therapy in Budget 2023; these measures are reported without quantified fiscal effects.[1]