National Cancer Strategy 2017-2026 Implementation Report 2019

Objectives

The National Cancer Strategy 2017-2026 seeks to strengthen cancer prevention, early detection, diagnosis, treatment, survivorship, palliative care, research and data use through integrated, patient-centred services across the cancer continuum.[1][2][3][4][5]It prioritises equitable access to high-quality specialist care, coordinated pathways between primary and hospital services, and meaningful patient involvement in policy, planning and oversight.[2][6]

• Reduce cancer risk through tobacco cessation, measures addressing alcohol and vaping-related exposure, the Healthy Ireland framework and implementation of the National Skin Cancer Prevention Plan.[1][7]
• Improve early detection by expanding BowelScreen, increasing diagnostic access, strengthening Rapid Access Clinic pathways, promoting targeted public awareness and developing referral criteria for general practitioners.[1][7][2]
• Ensure multidisciplinary decision-making for all people diagnosed with cancer through standardised multidisciplinary team composition, procedures and outcome reporting.[2]
• Develop comprehensive and centralised cancer services, including at least one comprehensive cancer care centre, tumour-specific surgical oncology centralisation, expanded radiation oncology capacity and designated cancer-centre delivery.[8][9]
• Establish a National Cancer Genetics Service and improve access to hereditary cancer assessment, counselling, testing, surveillance and risk-reduction interventions according to need.[7][8][9]
• Provide evidence-based models of care for oral anti-cancer medicines, haematological and rare cancers, adolescents and young adults, older people, and people requiring psycho-social support.[9][10]
• Strengthen palliative and survivorship care by standardising assessment of palliative needs, developing seven-day specialist palliative care availability, supporting children with life-limiting cancer, and addressing physical, psychological and social wellbeing after treatment.[3][4]
• Advance cancer research, workforce development and information systems so that clinical research, nursing leadership, workforce planning and timely cancer data improve patient care.[4][5]

Implementation

Implementation relies principally on the Department of Health, the Health Service Executive, the National Cancer Control Programme, designated cancer centres and Hospital Groups, working with primary care, professional bodies, voluntary organisations, patients and research institutions.[1][7][2][4]Delivery combines national models of care and clinical governance with local service development, centralised specialist provision, multidisciplinary teams, hub-and-spoke arrangements and shared-care pathways.[2][9][10][6]

• Complete phased electronic referrals from general practitioners to hospitals by the end of 2022 and establish direct diagnostic access within agreed timelines, including for patients outside existing Rapid Access Clinics.[2]
• Develop integrated primary and hospital care models, including community oncology nursing, pre- and post-treatment support, Patient Treatment Summaries, Care Plans and shared-care protocols.[2][6]
• Expand workforce and diagnostic capacity by increasing radiographer and sonographer training places, coordinating specialist consultant appointments, and developing workforce plans for medical, nursing and health and social care professions.[2][8][4][5]
• Govern specialist service development through national leads, implementation groups, steering groups, expert advisory groups, project initiation documents, site visits and scoping exercises.[8][9][10]
• Deliver radiation oncology expansion through facilities in Cork, Galway and Dublin, planned development at Beaumont Hospital, and a national equipment refreshment and replacement programme.[9]
• Implement oral anti-cancer medication services through an implementation group and accredited education developed by the Irish Institute of Pharmacy.[9]
• Involve the Cancer Patient Advisory Committee, patient forums and advocacy organisations in psycho-oncology standards, patient safety, community support and survivorship service development.[10][6]
• Support implementation through Service Level Agreements and direct financial allocations to Hospital Groups under Activity Based Funding, while aligning cancer research funding with agreed priorities through the National Cancer Research Group.[4]

Monitoring uses service reviews, referral data, site visits, surveys, scoping exercises, steering-group reporting, published pathways, operating procedures and audits.[2][8][9][10]Quality improvement includes national cancer quality indicators, process and outcome measures, National Clinical Effectiveness Committee-aligned guidelines, and evaluation of the patient safety and quality framework pilot at St James's Hospital Lung Cancer Service.[3]The National Cancer Information System and National Cancer Registry are intended to improve data collection, surveillance, research capacity and use of cancer outcomes data.[10][5]

Capital investment under the National Development Plan 2018-2027 supports oncology units, day wards, diagnostics, aseptic compounding infrastructure and a comprehensive cancer centre.[11]Funding in 2019 supported mammography machines at St James's Hospital, the Mater Hospital and Waterford University Hospital, while Brexit resilience funding supported chemotherapy compounding capacity.[11]Sláintecare Integration Fund support was allocated for recruitment of a Cancer Prevention Officer in 2020 to coordinate the National Skin Cancer Prevention Plan.[1]The supplied material does not specify an overall budget, quantified programme costs, funding gaps, a comprehensive indicator set or a formal reporting timetable for the strategy as a whole.[1][7][11][5]

Monitoring & Evaluation

Implementation is monitored through action reviews, service data, surveys, audits, advisory structures and information-system development, but the supplied material does not establish a single comprehensive performance framework or reporting timetable for the full National Cancer Strategy.[12][1][7][5]

• Review progress against recommendations to the end of 2019, with lead agencies assigned to principal actions.[12][1][7]
• Assess prevention and screening initiatives through evidence reviews, National Screening Advisory Committee participation, genetic-testing infrastructure surveys, early-detection campaign analysis, lung cancer awareness surveys and campaign-effectiveness assessments.[1][7]
• Monitor electronic cancer referral implementation and volumes, including 46,516 electronic referrals in 2019, a 14% increase on 2018.[2]
• Track service performance using operational measures, including the Rapid Access Haematuria Clinic’s management of more than 500 patients, 72% discharge to general practitioners after one visit, approximately 1,500 outpatient visits avoided and a 9% cancer detection rate.[2]
• Oversee diagnosis and treatment services through steering groups, site visits, service reviews, published pathways and standardised multidisciplinary team operating procedures.[2][8]
• Use scoping exercises, data gathering, advisory groups, project initiation documents and steering-group reporting to guide specialised services, including cancer genetics, rare cancers, psycho-oncology and haematological cancer care.[8][9][10]
• Develop Standard Operating Procedures for rare cancers and a quality indicator to support monitoring of these services.[10]
• Use the National Cancer Information System to improve psycho-oncology data collection and support service development.[10]
• Evaluate the national cancer patient safety and quality framework pilot at St James's Hospital Lung Cancer Service in 2020, and develop national process and outcome quality indicators aligned with international standards.[3]
• Use the National In-Patient Acute Care Patient Experience Survey and National Care Experience Programme to address cancer treatment and survivorship, which were prioritised for inclusion in 2021.[3]
• Develop clinical guidelines consistent with National Clinical Effectiveness Committee standards and establish audits in line with its national clinical audit framework.[3]
• Monitor Patient Treatment Summaries, Care Plans, the Beaumont Hospital patient passport trial and follow-up and surveillance protocols through the Survivorship Working Group.[6]
• Improve cancer surveillance and outcome data through electronic collection by National Cancer Registry data registrars, remote data access, strengthened information technology and data protection capacity, and data-sharing arrangements with the Health Service Executive.[5]
• Pursue individual hospital data-sharing agreements in 2020 and engage private providers in cancer data collection, audit and guideline compliance.[4][5]

The supplied sections do not specify a complete indicator set, common evaluation schedule, central reporting cycle, dedicated surveillance dataset or formal accountability process beyond the reviews, surveys, audits, service measures and governance mechanisms described.[1][7][5]

Costing & Financing

Financing combines specified public funding streams for implementation, infrastructure and workforce capacity, although the supplied material provides no monetary values, overall costed budget, funding-gap assessment or economic assumptions.[1][11][4][5]

• Allocate Sláintecare Integration Fund support in 2020 to recruit a Cancer Prevention Officer to co-ordinate implementation of the National Skin Cancer Prevention Plan.[1]
• Use National Development Plan 2018-2027 capital funding to support cancer facilities, including medical oncology units, day wards, diagnostic facilities, aseptic compounding capacity and a comprehensive cancer centre.[11]
• Provide 2019 funding for additional mammography machines at St James's Hospital, the Mater Hospital and Waterford University Hospital.[11]
• Support chemotherapy compounding capacity through Brexit resilience funding in 2019.[11]
• Channel National Cancer Control Programme implementation funding through Service Level Agreements and direct allocations to Hospital Groups under Activity Based Funding.[4]
• Link research funding allocation to agreed priorities through the National Cancer Research Group and support continuity of research funding.[4]
• Provide additional National Cancer Registry resources for Cancer Data Registrars, information technology and data protection staff.[5]

No budgets, expenditure totals, unit costs, financing envelopes, resource mobilisation plan, funding gaps or economic assumptions are specified for specialised cancer services, palliative care, survivorship, radiation oncology, genetics or wider research and workforce actions.[9][10][3][6][5]