National Cancer Strategy 2017-2026 Implementation Report 2022

Objectives

The National Cancer Strategy 2017-2026 seeks to reduce cancer risk, improve early detection and diagnosis, deliver integrated and equitable cancer care, and strengthen survivorship, palliative, psychosocial, workforce, data and quality systems across Ireland.[1][2][3][4]It combines population prevention with specialised, person-centred services for people with cancer and those at increased hereditary risk.[5][6][7]

• Prevent cancer by implementing Healthy Ireland measures, reducing smoking, delivering skin-cancer prevention, assessing prevention interventions and their cost-effectiveness, and extending BowelScreen eligibility progressively to people aged 55 to 74.[5][8]
• Improve early diagnosis by increasing awareness of cancer signs and symptoms, addressing barriers affecting high-risk and underserved groups, and strengthening referral, diagnostic and Rapid Access Clinic pathways.[6][9]
• Provide coordinated hereditary-cancer care by identifying inherited predisposition to breast, ovarian, colorectal and other cancers, expanding genetic testing and counselling, and implementing risk-reduction interventions according to need.[6][10][7]
• Deliver integrated care across diagnosis, treatment and follow-up through links between primary care, hospitals and community services, multidisciplinary decision-making, designated cancer centres and networked specialist provision.[2][11][12]
• Consolidate and centralise specialist services, including cancer genetics, surgery, radiation oncology, systemic anti-cancer therapy and haematology, according to clinical need, demand and international best practice.[11][12]
• Tailor services for children, adolescents, young adults and older people, including age-appropriate treatment, psychological support, geriatric oncology links and palliative care for children with life-limiting cancer.[13][14]
• Ensure equitable psycho-oncology, psychosocial, survivorship and palliative care, with regular assessment of palliative needs and phased development of specialist palliative care towards seven-day availability.[3][14]
• Strengthen patient safety, experience, clinical guidance, quality indicators, nursing leadership, workforce planning and cancer surveillance to support continuous improvement in cancer services.[14][15][4]

Implementation

Implementation is led principally by the Department of Health, the Health Service Executive and the National Cancer Control Programme, using national models of care, designated centres, hub-and-spoke networks, multidisciplinary teams, service specifications, advisory groups and collaboration with patients, voluntary organisations, professional bodies, hospitals, schools and community services.[5][2][11][16]Delivery combines prevention communications and screening with investment in clinical capacity, digital information systems, workforce development, quality improvement and infrastructure.[8][9][2][4]

• Coordinate prevention through Healthy Ireland, Health Service Executive Health and Wellbeing programmes and the National Cancer Control Programme, using awareness campaigns, professional e-learning, prevention resources, the Irish Cancer Prevention Network, SunSmart materials and targeted initiatives for children, outdoor workers, sunbed users and outdoor leisure participants.[5][8]
• Expand screening and early diagnosis by recovering BowelScreen participation, addressing endoscopy-capacity constraints, using targeted communication, establishing evidence-based referral criteria, introducing electronic referral forms and increasing diagnostic access and Rapid Access Clinic capacity.[8][6][9]
• Coordinate hereditary-cancer services through the National Cancer Control Programme Advisory Group for Hereditary Cancer, a national model of care, BRCA1 and BRCA2 needs assessment, mainstreamed genetic testing and universal tumour testing for possible Lynch syndrome.[6][7]
• Standardise cancer treatment through published models of care, mandatory formal multidisciplinary discussion, standard cancer conference templates, multidisciplinary coordinators and data managers.[2]The National Cancer Information System supported multidisciplinary meeting management in nine hospitals, including four designated cancer centres, in 2022.[2]
• Develop specialist capacity through surgical-centre designation, radiation oncology expansion and equipment replacement, systemic anti-cancer therapy and haematology centralisation, molecular diagnostics advisory structures, specialist genetics input and rare-cancer tumour conferences.[10][11][12]
• Support psychosocial and palliative care through designated cancer centres, multidisciplinary teams, Cancer Support Centres and Services, the Cancer Support Alliance, published models of care, peer review, self-assessment and collaboration between the National Cancer Control Programme and Health Service Executive Palliative Care Programme.[3][14]
• Embed patient participation through the Cancer Patient Advisory Committee, Patient Advisory Liaison Services, working groups and consultation with patient and advocacy organisations.[16]The Committee met four times in 2022 and contributed advice on models, strategies and service-development projects.[16]
• Build workforce and information capacity through cancer-nursing leadership, specialist nursing forums, competency programmes, cross-sector workforce planning, radiography education, Acute Oncology Service quality frameworks, DigiCanTrain and data-sharing arrangements between the Health Service Executive and National Cancer Registry Ireland.[15][4]
• Monitor implementation through skin-cancer prevention implementation-group meetings, cancer-awareness surveys, evidence reviews, newsletter reporting, screening and treatment activity, electronic-referral reporting, waiting-time monitoring, service audits, annual capital-plan review, quality metrics and national registry data improvement.[8][6][9][2][13][4]
• Resource service development through new 2022 funding for Rapid Access Clinics and early diagnosis, diagnostic resilience, National Cancer Information System rollout, surgical oncology, radiotherapy, systemic anti-cancer therapy and psycho-oncology, alongside cancer infrastructure projects and workforce posts.[6][9][2][11][12][3]The material does not specify a consolidated overall cancer-plan budget, financing gap or unified financing framework.[2][10][7][15][4]

Monitoring & Evaluation

Monitoring combines programme-level implementation oversight, service-activity reporting, quality assurance, patient involvement and cancer-registry data sharing. However, the material does not set out a single consolidated evaluation framework, common reporting timetable or comprehensive public accountability structure for the whole strategy.[2][10][7][15][4]

• Monitor prevention delivery through National Skin Cancer Prevention Plan implementation-group meetings, cancer-awareness survey publication, evidence reviews and quarterly Irish Cancer Prevention Network newsletters.[5][8]
• Track prevention and screening outputs, including a network membership exceeding 1,000, more than 500 SunSmart primary-school art-competition entrants, lesson plans distributed to over 200 schools, and approximately 5,088 BowelScreen patients referred for further treatment in 2022, compared with 4,442 in 2021.[5][8]
• Strengthen evaluation of cancer-prevention interventions, particularly through systematic assessment of benefits and cost-effectiveness, which remained an area for further development.[8]
• Assess hereditary-cancer needs through the 2022 assessment of people with BRCA1 and BRCA2 variants, and use its findings to identify unmet needs in cancer and related services.[6]
• Monitor referral and diagnostic performance through weekly electronic-referral reports, waiting-time and throughput data for Rapid Access Clinics, and diagnostic-pathway audits. Electronic referrals for breast, prostate and lung cancer totalled 55,401 in 2022, a 6% increase on 2021.[9]The longest waits for the four main cancer types improved in December 2022 relative to each of the preceding 11 months.[6]
• Use multidisciplinary-team standards, cancer-conference templates and the National Cancer Information System to standardise meeting management, reporting and outcome documentation. The system was live in nine hospitals, including four designated cancer centres, in 2022.[2]
• Review the rolling cancer capital investment plan annually and use advisory groups and needs assessments to inform molecular diagnostics and hereditary-cancer service development.[2][10][7]
• Track core treatment activity, with cancer surgery exceeding 16,000 procedures and reaching 101% of 2019 activity by end-2022, while systemic anti-cancer therapy exceeded 100,000 treatments and reached 105% of 2019 activity.[11][12]
• Apply key performance indicators, standard operating procedures, tumour-conference review and service-data analysis to children, adolescent and young adult cancer services and haematology centralisation.[12][13]
• Develop psycho-oncology metrics, quality indicators, clinical guidelines, clinical audits and a Cancer Patient Experience Survey, alongside peer review and self-assessment of cancer support centres.[3][14]
• Support accountability through patient representation, including the Cancer Patient Advisory Committee, which met four times in 2022 and advised on service models, strategies and development projects.[16]
• Maintain data-sharing agreements between the Health Service Executive and the National Cancer Registry Ireland, improve electronic and remote hospital data transfer, and use agreed quality metrics for Acute Oncology Services.[15][4]

Costing & Financing

Specified funding is primarily new development funding, grants and capital-supported service investment in 2021 and 2022. The material does not provide an overall National Cancer Strategy budget, a detailed financing or resource-mobilisation model, quantified funding gap, or common economic assumptions.[5][8][6][9][2][10][7][15][4]

• Allocate almost 3.5 million euro in 2022 to Rapid Access Clinics and early-diagnosis pathways, and more than 3 million euro to service resilience and diagnostic capacity.[6][9]
• Allocate almost 300,000 euro in 2022 to change enablers for National Cancer Information System rollout.[2]
• Continue or commence capital-plan projects for radiotherapy facilities and linear accelerator replacement, oncology day units, aseptic compounding units and new day-ward facilities; no project values are specified.[2]
• Provide 3.1 million euro in 2022 for surgical oncology recruitment and planning for designated cancer centres, more than 2 million euro for radiotherapy enhancement, and more than 3 million euro for systemic anti-cancer therapy services.[11][12]
• Provide grant aid of 545,743 euro to 24 Cancer Support Centres and National Organisations in 2021, and more than 1 million euro in new development funding for psycho-oncology services in 2022.[3]
• Approve three palliative-care nursing posts in the 2022 Service Plan, although no monetary allocation for these posts is reported.[3]
• Allocate unspecified 2022 funding to cancer genetics and molecular diagnostics recruitment for the hereditary cancers programme, and identify a 2 million euro grant for the three-year DigiCanTrain programme.[7][15]
• Record a minimum alcohol unit price of 0.1 euro per gram of alcohol from January 2022 and removal of value added tax from nicotine-replacement therapy in Budget 2023.[5]
• Prepare research on the economic cost of skin cancer for publication in 2022, without reporting a monetary estimate.[8]