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

Objectives

The New Zealand Cancer Plan 2015–2018 sets a strategic framework for reducing cancer risk and premature mortality while enabling people diagnosed with cancer to live better and longer. Its central goal is more timely, excellent and equitable access to cancer services for all people, regardless of ethnicity, gender, location or socioeconomic status, while maintaining quality of care, quality of life and fiscal responsibility.[1][2][3]The plan gives particular emphasis to improving outcomes for Māori through alignment with He Korowai Oranga and an associated equity framework.[3]

• Reduce cancer incidence and risk factors by promoting healthy eating, physical activity, health literacy, smoking reduction and awareness of cancer risks.[4][5][6]
• Increase early detection through accessible bowel, breast and cervical screening, reduced barriers to participation, improved primary-care referral, and earlier detection of lung cancer.[4][5][7]
• Improve diagnosis and treatment by standardising pathways, strengthening multidisciplinary decisions, accelerating referral and treatment, and increasing access to high-quality services.[7][8][9]
• Achieve faster treatment, including first treatment within 62 days of urgent referral where there is a high suspicion of cancer, and treatment within 31 days of the decision to treat.[3][8]
• Strengthen follow-up, surveillance and palliative care so that people affected by cancer and their families receive consistent physical, psychological, social and informational support.[10][11][12]
• Develop enabling infrastructure through suitable facilities and equipment, comprehensive cancer information, a capable workforce, coordinated care and services designed around patients and families.[3][10][13]

The plan applies a patient-pathway model encompassing prevention and early detection, diagnosis and treatment, and follow-up care, supported by infrastructure, workforce and supportive care.[4]By 2018, it envisages healthier lifestyle choices, reduced smoking, increased screening, rapid referral, informed treatment choices, consistent care, integrated palliative care, improved information and support, appropriate technology and equipment, stronger multidisciplinary practice, and professionals working at the top of their scope.[3][4][14]

Person-centred and family-centred care is a cross-cutting priority. This includes addressing language, cultural, literacy and communication barriers; enabling people to participate in and manage their own care; assessing support needs following discharge; and expanding access to psychological and social support.[10][11]The plan also seeks sustainable service delivery in the context of increasing demand and fiscal constraint.[2]

Implementation

Implementation is led through the National Cancer Programme, which brings together the Ministry of Health, district health boards and regional cancer networks to deliver government priorities and high-quality services for people with cancer and their families and whānau.[2]The Ministry oversees implementation through annual work plans aligned with the plan’s strategic framework, while the plan consolidates nationally implemented programmes, activities and services over a three-year period and identifies potential future initiatives.[2][3]

• Coordinate delivery across primary care, hospitals, community services, palliative care, general physicians, senior nurses and specialist teams to provide integrated care, follow-up and surveillance.[10]
• Use tumour standards, district health board service reviews, multidisciplinary meetings, cancer nurse coordinators and National Patient Flow initiatives to improve service consistency, coordination and timeliness.[15][8][9]
• Expand prevention through health-promotion activity, Healthy Families New Zealand, hospital and primary-care smoking-cessation services, and prostate cancer awareness, information and quality-improvement work.[5][6]
• Improve screening capacity and access for bowel, breast and cervical cancer, strengthen referral processes, and build diagnostic and treatment capacity for people identified through early detection.[5][7]
• Develop supportive-care services through assessment, information provision and personalised care planning, with district health boards implementing a model for psychological and social support.[11]
• Expand access closer to home for rural populations, including telehealth where appropriate, and support access to suitable pharmaceuticals, technologies and medical devices through outcome-focused decisions.[11]

Information infrastructure is a principal operational enabler. Planned measures include common cancer-data definitions, patient-level data capture, a national cancer information repository, regional repositories linked nationally, Cancer Registry upgrades, structured pathology reporting and a Cancer Information Strategy.[13][12]These systems are intended to inform clinical practice, support quality improvement, standardise care and monitor implementation of tumour standards.[13]

Workforce actions include developing a cancer nursing knowledge and skills framework, sustaining the cancer nurse coordinator initiative, increasing radiation-oncology capacity, expanding the colonoscopy-capable workforce, making greater use of primary-care practitioners and allied health professionals, and aligning training with service needs.[13][14]The plan records implementation achievements including appointment of up to 60 cancer nurse coordinators, establishment of the Child Cancer Network, publication of provisional tumour standards and implementation of the 62-day Faster cancer treatment health target.[15]

Delivery involves the Ministry of Health, district health boards, regional cancer networks, primary health organisations, Health Workforce New Zealand, non-governmental organisations, private-sector cancer-care providers, Hospice New Zealand and clinical networks.[7][11][8][14]Consumer and non-governmental organisations are recognised as important contributors to the plan’s vision.[3]

Monitoring includes the 62-day faster cancer treatment target, additional treatment and colonoscopy waiting-time indicators, tumour-standard monitoring, screening performance measures, patient-flow information and cancer data systems.[4][15][8]The Bowel Screening Pilot is monitored quarterly against agreed indicators and independently evaluated, while BreastScreen Aotearoa is monitored every three years against national standards and annually against indicators and targets.[6]The supplied material does not specify a consolidated budget, detailed costings, funding sources or financing gaps, although it identifies substantial government investment in prevention and early detection, new funding for psychological and social support, 10 new linear accelerators, and resource planning for future radiation-oncology needs.[4][10][13]

Monitoring & Evaluation

Implementation is overseen by the Ministry of Health through annual work plans aligned with the Cancer Plan’s strategic framework.[3]Monitoring spans the cancer pathway, linking prevention, screening, referral, diagnosis, treatment, follow-up, palliative care, workforce, information systems and equity.[4][10][13]The principal national timeliness measure is the Faster Cancer Treatment health target, including first treatment within 62 days of urgent referral where cancer is highly suspected.[4][7][8]

• Monitor progress towards the plan’s vision using pathway-wide measures, including one-year and five-year cancer survival, 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.[4]
• Report Faster Cancer Treatment performance through district health boards, including treatment within 62 days of urgent referral with high suspicion of cancer, treatment within 31 days of a decision to treat, and colonoscopy waiting-time indicators.[8]
• Collect clinical information through tumour-specific core data sets, structured pathology reporting, clinical data-capture tools, regional repositories linked nationally, the Cancer Registry upgrade, radiation and chemotherapy waiting-time data, and National Patient Flow data.[15][13][12]
• Use these data systems to support clinical practice, quality improvement, standardisation of care, review of services against tumour standards, and monitoring of tumour-standard implementation.[15][10][13]
• Monitor multidisciplinary meeting coverage and functionality, and assess cancer nurse coordinator implementation through service reporting, evaluation and indicator data.[8][9]
• Track screening performance through quarterly monitoring of the Bowel Screening Pilot against agreed indicators, an independent evaluation of the pilot and the viability of a national programme, and BreastScreen Aotearoa monitoring every three years against national standards and annually against indicators and targets.[6]
• Monitor the National Cervical Screening Programme against applicable standards, indicators and targets.[9]
• Use reported baseline measures, including the decline in daily smoking prevalence from 18.3% in 2006/07 to 15.5% in 2012/13, alongside screening participation measures for bowel, breast and cervical programmes.[5]
• Assess expected 2018 results, including more timely and standardised diagnostic and treatment processes, improved patient-level information, consistent follow-up and surveillance, established cancer nurse coordination, stronger workforce capability, integrated palliative care, improved information access and greater availability of psychological and social support.[8][9][12][14]

The supplied material does not specify a single consolidated evaluation design, complete indicator dictionary, national reporting timetable, surveillance protocol or formal accountability process beyond Ministry oversight, district health board reporting, screening-programme monitoring and the data mechanisms described.[3][4][10][14]

Costing & Financing

The plan is framed by fiscal responsibility and the need to meet growing cancer-service demand equitably, effectively and sustainably.[2][3]It assumes delivery in a fiscally constrained environment, requiring services to maximise available resources while improving quality, timeliness and access.[2]

• Support nationally led prevention and early-detection activities through substantial government investment.[4][5]
• Provide new funding to establish psychological and social support services throughout New Zealand, although no amount, source or period is specified.[10][13][11]
• Plan capital and workforce capacity through the purchase of 10 new linear accelerators and radiation-oncology growth-model scenarios identifying future capital and workforce requirements.[10][13]
• Consider resource-related service investments, including hospital-facility capital proposals, updated mammography technology, radiotherapy linear-accelerator and workforce planning to 2022, and a service-improvement fund for Faster Cancer Treatment.[8][9][12]
• Make funding decisions for pharmaceuticals, technologies and medical devices with attention to cost-effectiveness and outcomes as cancer-related health costs increase, to support efficient, effective and sustainable services.[11]
• Improve use of health resources by supporting district health boards to develop service capacity and coordinate care more effectively.[15]

No quantified overall budget, itemised programme costing, financing allocation, funding-gap estimate, resource-mobilisation target, funding-source breakdown or detailed economic assumption is specified in the supplied material.[4][15][10][9][14]