National Cancer Strategy 2017-2026 Implementation Report 2019

Objectives

The National Cancer Strategy 2017-2026 provides Ireland’s framework for cancer control. Its implementation priorities span prevention, screening and early detection, integrated diagnosis and treatment, centralised specialist services, palliative and survivorship care, quality improvement, research, workforce development and strengthened cancer information.[1][2][3][4][5][6]

• Strengthen prevention through Healthy Ireland, tobacco and alcohol risk reduction, a dedicated cancer-prevention function, coordinated evidence-based communications and implementation of the National Skin Cancer Prevention Plan.[7]
• Expand screening and early detection by extending BowelScreen to people aged 55-74 when endoscopy capacity permits, addressing inherited familial cancer risk, increasing public awareness initially for lung cancer, and improving primary-to-secondary-care referral and diagnostic pathways.[8]
• Integrate care across primary, hospital and post-treatment settings through electronic referrals, direct general practitioner access to diagnostics, rapid access clinics, multidisciplinary team discussion and an integrated cancer model of care.[2]
• Develop at least one comprehensive cancer care centre, combining prevention, treatment, education and research, while strengthening hereditary cancer provision through a national cancer genetics service based on patient need.[9]
• Centralise complex services, including tumour-specific surgical oncology, haematological and rare-cancer treatment arrangements, and expand public radiation oncology capacity in Dublin, Cork and Galway.[3]
• Improve equitable, person-centred support through age-appropriate adolescent and young adult services, cancer and geriatric links, psycho-oncology, psychosocial care, specialist palliative care, patient safety, quality standards and survivorship arrangements.[10][4][11]
• Advance research, workforce and data capability by aligning cancer research funding with national priorities, embedding clinical research in routine care, developing cancer nursing leadership and improving timely cancer-registry data.[5][6]

Implementation

Implementation is led principally by the National Cancer Control Programme within the Health Service Executive, working with the Department of Health, Hospital Groups, designated cancer centres, primary care, public-health programmes, professional bodies, researchers, charities, patients and other public authorities.[7][2][4][5]Governance combines national models of care, clinical leadership, steering groups, implementation groups, service-level agreements, capital planning, data systems and patient participation mechanisms.[2][12][3][11]

• Coordinate prevention through the Irish Cancer Prevention Network, which includes the National Cancer Control Programme, Irish Cancer Society, Marie Keating Foundation and Breakthrough Cancer Research, and use legislative and public-health measures addressing tobacco, alcohol and vaping-related risks.[7]
• Implement targeted programmes through the Skin Cancer Prevention Plan Implementation Group, a Steering Group on Public Awareness for Early Detection of Cancer, BowelScreen capacity planning, a Hereditary Cancer Model of Care and updated referral guidance developed with the Irish College of General Practitioners and National Clinical Effectiveness Committee.[7][8]
• Build delivery capacity through radiographer and sonographer training, additional radiology and pathology posts, genomics leadership, genetic counselling, clinical genetics recruitment, expanded oncology and diagnostic infrastructure, day wards and aseptic compounding facilities.[2][12][9]Capital investment is planned on a rolling annual basis, supported by the National Development Plan 2018-2027.[12]
• Implement centralisation and specialist models through site visits, project initiation documents, expert advisory groups, clinical leads and working groups; approved surgical-centralisation proposals were to be progressed over three years from mid-2019.[3]Develop national chemotherapy regimens, standard operating procedures and an implementation group for the oral anti-cancer medicines model of care.[3][10]
• Deliver supportive care through hub-and-spoke adolescent and young adult services, shared care and transition arrangements, dedicated psychosocial services in each designated cancer centre, palliative-care multidisciplinary teams and shared survivorship protocols, care plans and follow-up arrangements.[10][4][11]
• Embed patient involvement through the Cancer Patient Advisory Committee, patient representation on National Cancer Control Programme working groups, and a forum that links patients or representatives with relevant projects.[11]
• Strengthen research and accountability through the National Cancer Research Group, established in June 2019 with Department of Health, National Cancer Control Programme, Health Research Board and Irish Cancer Society representation.[5]Provide protected research time, nursing research support and a National Clinical Lead for Cancer Nursing.[5][6]
• Monitor progress through implementation updates, service activity, pathway publication, recruitment, site visits, steering-group outputs, audits, surveys, registry data and National Cancer Information System development.[2][10][4][6]In 2019, 46,516 electronic cancer referrals were received, 14% more than in 2018.[2]The source does not specify a consolidated indicator set, reporting cycle, overall budget or quantified funding gap.[7][8][12][10][4][5]

Monitoring & Evaluation

Monitoring and accountability combine implementation reporting, service activity data, patient experience evidence, cancer registry information, quality measurement, clinical audit and governance by national programmes and specialist groups. However, the material does not set out a single consolidated performance framework with universal targets, reporting intervals or an overall accountability structure.[7][8][2][9][4][6]

• Review prevention initiatives and prospective screening programmes against international evidence through the National Screening Advisory Committee, which advises the Minister for Health on current and potential screening programmes.[7]Monitor delivery of the National Skin Cancer Prevention Plan through its Implementation Group, initially concentrating on children and outdoor workers.[7]
• Use stakeholder surveys, infrastructure assessments and model-of-care development to shape hereditary cancer services and surveillance.[8]Inform early-detection priorities through National Cancer Registry Ireland analysis, a national lung-cancer awareness survey, assessment of campaign effectiveness and monitoring of referrals outside existing Rapid Access Clinics.[8]
• Track delivery through implementation updates, service activity information, steering-group outputs, site visits, published pathways, recruitment progress and approved standard operating procedures.[2][9]In 2019, 46,516 electronic cancer referrals were received, a 14% increase from 2018, and an electronic pigmented-lesion referral pilot commenced in Cork.[2]
• Assess service-pathway performance using operational results. The Roscommon pilot Rapid Access Haematuria Clinic had managed more than 500 patients, discharged 72% to general practitioners after one visit, avoided approximately 1,500 outpatient visits and recorded a 9% cancer detection rate.[2]All common tumours were discussed at multidisciplinary team meetings; procedures had been completed for haematology, melanoma and breast cancer, with others under development.[2]
• Undertake scoping, data gathering, site visits and service reviews for cancer genetics, psycho-oncology, haematological cancer centralisation and related service design.[3]Support data collection through the National Cancer Information System, including enhanced psycho-oncology data.[10]Develop a quality indicator for rare cancers, although its final specification and target are not provided.[10]
• Include cancer patient representatives in psycho-oncology and community cancer-support working groups, and use the Cancer Patient Advisory Committee and a patient-representative forum to involve patients and families in policy and service development.[10][11]
• Monitor palliative care, safety and quality through multidisciplinary service development, a national patient-safety framework and evaluation of the St James's Hospital Lung Cancer Service pilot planned for 2020.[4]Use the National In-Patient Acute Care Patient Experience Survey and National Care Experience Programme to address cancer treatment and survivorship, identified as priorities for 2021.[4]
• Develop national cancer quality indicators covering process and outcome measures, informed by available data, national review work and systematic reviews from the European Union Innovative Partnership for Action Against Cancer.[4]Apply National Clinical Effectiveness Committee-aligned guidelines and audits under the national clinical audit framework; ovarian and oesophageal guidelines were published in August 2019, while colon and rectal guidelines were being prepared for submission in 2020.[4]
• Use the Cancer Survivorship Needs Assessment, launched in August 2019, to inform policy and determine whether survivorship care meets patient needs.[11]Strengthen surveillance by securing timely hospital reporting to the National Cancer Registry, supported by electronic collection, remote access, data-sharing agreements and additional registry, information technology and data-protection staff.[6]
• Promote accountability among private providers through participation in cancer-data collection, audit, guideline compliance and outcome reporting; proposed hospital-licensing legislation was expected to support improved private-sector data access.[5]

Costing & Financing

Financing information is limited: the material identifies capital investment, activity-based allocations, workforce and infrastructure needs, and one funded prevention post, but does not provide a consolidated cancer-strategy budget, programme costs, quantified funding gaps or economic assumptions.[7][8][12][3][4][5]

• Allocate Sláintecare Integration Fund support for recruitment of a Cancer Prevention Officer in 2020 to coordinate implementation of the National Skin Cancer Prevention Plan. The amount is not specified.[7]
• Provide additional endoscopy capacity before extending BowelScreen to people aged 55 to 74; neither the required resources nor associated cost is quantified.[8]
• Use capital funding under the National Development Plan 2018-2027 for cancer-facility development, including medical oncology units, day wards, diagnostic facilities, aseptic compounding infrastructure and a comprehensive cancer centre.[12]Monetary allocations are not provided.[12]
• Support additional mammography machines at St James's Hospital, the Mater Hospital and Waterford University Hospital in 2019, and use Brexit resilience funding for chemotherapy-compounding capacity. The source does not state amounts for either funding stream.[12]
• Plan annual rolling capital investment while expanding diagnostic, oncology, radiation oncology, genetics, surgical and psychosocial service capacity; the available extracts identify infrastructure and equipment requirements but not budgets or funding sources for most activities.[12][3][10]
• Use service-level agreements and activity-based funding arrangements to give the National Cancer Control Programme a direct role in financial allocations to hospital groups.[5]Align cancer-research funding with priorities set through the National Cancer Research Group, while seeking continuity of research funding.[5]
• Recognise staffing requirements for radiology, pathology, genomics, genetic counselling, clinical genetics, nursing, registry and information functions, but do not quantify related expenditure, vacancies, resource gaps or affordability assumptions.[2][9][6]