New Zealand Cancer Plan: Better, Faster Cancer Care 2015-2018

Objectives

The New Zealand Cancer Plan 2015-2018 provides a national strategic framework for the Ministry of Health, district health boards, regional cancer networks and the wider cancer sector. Its vision is better, faster cancer care, so that fewer people develop cancer and more people have timely access to excellent services that enable them to live better and longer after diagnosis.[1][2][3]The Plan seeks equitable outcomes regardless of ethnicity, gender, locality or socioeconomic status, with particular emphasis on reducing inequities affecting Māori.[4]

• Reduce cancer incidence through healthy lifestyles, tobacco control, smoking cessation, public awareness of cancer risks, and prevention activity led across communities and health services.[5][6][7]
• Increase early detection through equitable bowel, breast and cervical screening; stronger primary-care referral; improved lung cancer detection; and reduced barriers to accessing screening and diagnostic services.[5][8][6][9]
• Improve diagnosis and treatment by streamlining referral and clinical processes, applying tumour standards, standardising treatment pathways, strengthening multidisciplinary decision-making, and supporting informed patient choice.[8][9][10]
• Achieve timely treatment, including the Faster Cancer Treatment expectation that patients with a high suspicion of cancer receive first treatment or other management within 62 days of urgent referral, with milestones of 85 percent by July 2016 and 90 percent by June 2017.[3]
• Provide coordinated follow-up, surveillance, supportive care and integrated palliative care so that people affected by cancer and their families receive physical, psychological and social support throughout and after treatment.[11][10][12][13]
• Strengthen enabling systems, including facilities, equipment, information technology, comprehensive patient-level data and a sustainable workforce with appropriate multidisciplinary capability.[2][11][14][12]

By 2018, the intended direction was more consistent care irrespective of location, better access to primary care and specialist referral, streamlined and faster diagnostic and treatment processes, stronger workforce capacity, integrated palliative care, and more accessible, nationally consistent information and support.[4][9][12][13]The strategic approach also emphasises fiscal responsibility, quality of life and the sustainable use of available resources in the context of rising demand.[2]

Implementation

Implementation is coordinated through the Ministry of Health's National Cancer Programme, which brings together the Ministry, district health boards, regional cancer networks and cancer-sector partners to deliver Government priorities.[2]Delivery builds on existing national programmes and services, supplemented by targeted initiatives across prevention, screening, diagnosis, treatment, follow-up, palliative care, information and workforce development.[2][3]The Ministry oversees implementation and monitoring through annual work plans aligned with the Plan's strategic framework.[4]

• Deliver prevention and early detection through nationally led programmes, the Health Promotion Agency, district health boards, primary health organisations, screening providers, lead maternity carers and non-governmental organisations.[5][7]
• Provide smoking-cessation advice and support in hospitals and primary care, including for pregnant women who smoke, and promote healthy eating, physical activity and healthy weight.[5][7]
• Improve screening through bowel, breast and cervical screening activity, pilot evaluation, performance monitoring and action to reduce cultural, language, literacy, communication and other access barriers.[6][7]
• Coordinate diagnosis and treatment through streamlined referral pathways, tumour standards, prioritisation, multidisciplinary meetings, cancer nurse coordinators, reviewed clinical guidance and patient-focused models of care.[15][8][9]
• Use telehealth to support diagnosis and treatment closer to home, particularly for rural communities and people unable to access in-person services easily.[6]
• Deliver integrated care across primary care, hospitals, community services and palliative care providers, using workforce models involving primary care practitioners, clinical nurse specialists, allied health professionals, clinical psychologists and pharmacists.[11][14]
• Implement integrated adult palliative care through the Resource and Capability Framework for Integrated Adult Palliative Care Services, with district health boards supporting primary palliative care providers and dedicated end-of-life services.[12]
• Develop psychological and social support services, supportive-care assessment tools, personalised care planning, reliable information resources and coordination with non-governmental and private-sector providers.[14][6][13]
• Strengthen infrastructure and information through upgrades to the New Zealand Cancer Registry, the National Patient Flow project, regional data repositories linked nationally, structured pathology reporting and a Cancer Information Strategy.[14][12]
• Build workforce capability through cancer nursing, radiation oncology, colonoscopy and medical oncology development, alongside planning for radiotherapy linear accelerators and workforce requirements through 2022.[10][12]

Governance and delivery involve the Ministry of Health, district health boards, regional cancer networks, hospitals, primary care, specialist clinical networks, the Health Promotion Agency, screening services, Hospice New Zealand, non-governmental organisations, consumer organisations and private-sector cancer-care providers.[4][15][5][8][14][12]Equity-focused implementation is informed by He Korowai Oranga, the Māori Health Strategy, and its associated equity framework.[4]

Operational accountability relies on annual work plans, district health board reporting, service reviews against tumour standards, Faster Cancer Treatment and colonoscopy waiting-time measures, clinical information systems, patient-level datasets and pathway monitoring.[4][16][9][12]The Plan also identifies new funding for psychological and social support services, a service improvement fund for district health boards delivering faster cancer treatment, and a planned review of the BreastScreen Aotearoa service delivery and funding model; the supplied material does not specify monetary allocations.[11][9][10]

Monitoring & Evaluation

The monitoring framework combines Ministry of Health oversight through annual work plans with pathway-based performance measurement, screening monitoring, service reporting and patient-level information systems.[4]Progress is assessed against the aim of better and faster cancer care, including equitable access, timely treatment, consistent care and strengthened workforce and support services by 2018.[4][12][13]

• Monitor the Faster Cancer Treatment health target, requiring 85 percent of patients to receive first treatment or other management within 62 days of urgent referral by July 2016 and 90 percent by June 2017; the longer-term 2018 expectation was treatment within 62 days where cancer was highly suspected.[3][8]
• Require district health boards to report the 62-day target, the 31-day treatment indicator, urgent and diagnostic colonoscopy waiting times, surveillance colonoscopy delays, and radiation and chemotherapy waiting times.[9][12]
• Analyse Faster Cancer Treatment results by ethnicity to identify inequities and direct equity-focused improvement activity.[3]
• Track cancer survival at one and five years, smoking prevalence, screening participation, healthy-weight prevalence, stage at diagnosis, early-stage diagnosis, waiting times, quality of life, patient-reported outcomes and place of death.[15]
• Monitor the Bowel Screening Pilot quarterly against agreed indicators and commission an independent evaluation of its success and the viability of a national bowel screening programme.[7]
• Monitor BreastScreen Aotearoa every three years against national standards and annually against indicators and targets, and monitor the National Cervical Screening Programme every three years against standards and every six months against indicators and targets.[7][9]
• Use tumour standards, district health board service reviews, treatment and colonoscopy indicators, multidisciplinary meeting coverage and functionality, and cancer nurse coordinator service reporting and evaluation to identify service-improvement needs.[16][9][10]
• Strengthen data infrastructure through core cancer data definitions, structured pathology reporting, tumour-specific datasets, regional repositories linked nationally, clinical data-capture tools, an upgraded New Zealand Cancer Registry and a national cancer information repository.[14][12]
• Implement the National Patient Flow project to track patients from referral to treatment; it is intended eventually to replace separate Faster Cancer Treatment indicator collection.[12]

District health boards, supported by regional cancer networks, had reported baseline Faster Cancer Treatment and colonoscopy waiting-time data, while all district health boards were collecting and reporting Faster Cancer Treatment indicators.[16][11]The supplied text does not specify a single comprehensive evaluation timetable or a formal accountability framework beyond Ministry oversight, annual work plans, service reporting, screening review cycles and the stated performance measures.[4][15][11]

Costing & Financing

Financing is framed by fiscal constraint, growing demand and the need to use available resources efficiently while maintaining or improving cancer-service quality.[2]Fiscal responsibility, sustainability, cost-effectiveness and outcome-focused funding decisions are explicit principles for service development and access to pharmaceuticals, technologies and medical devices.[2][6]

• Prioritise prevention and earlier treatment as cancer-related health costs grow.[6]
• Maintain nationally led investment in prevention and early-detection activity, including Government programmes and Health Promotion Agency public-health work.[5]
• Provide new funding to establish psychological and social support services throughout New Zealand.[11][6]
• Review the BreastScreen Aotearoa service-delivery and funding model and establish a service-improvement fund to support district health boards in delivering faster cancer treatment.[9][10]
• Plan capital investment, facilities, radiotherapy linear accelerators, workforce capability and sustainable medical oncology services in line with population need, including radiotherapy requirements through 2022.[10][12]

No total cancer-plan budget, quantified allocation, named financing source, funding-gap estimate, resource-mobilisation target or quantified economic assumption is specified in the supplied text.[5][8][12]