The National Cancer Plan for the Isle of Man 2012-2022

Objectives

The National Cancer Plan for 2012 to 2022 provides the strategic direction for a comprehensive, quality-assured cancer service in the Isle of Man. Its overarching aim is to use resources efficiently and effectively to reduce cancer incidence, morbidity and mortality, improve outcomes and experience for patients and carers, and develop services initially comparable with the best region in the United Kingdom.[1][2][3]

• Reduce preventable cancer risk by addressing tobacco use, poor diet, obesity, alcohol misuse, physical inactivity, sun exposure and other modifiable factors, while making healthier choices easier.[4][5]
• Strengthen prevention through tobacco control, Human Papilloma Virus vaccination, physical activity, public education, awareness of cancer signs and symptoms, and accessible information that supports earlier recognition and informed choices.[4][6][5]
• Maintain and improve quality-assured cervical, breast and bowel screening, promote equitable participation, provide balanced screening information, and introduce future programmes in line with United Kingdom National Screening Committee recommendations.[1][7][8]
• Improve early diagnosis, referral, staging and timely treatment through streamlined pathways, professional education, multidisciplinary planning and reduced delays.[9][10]
• Provide high-quality cancer treatment locally where this meets quality and cost considerations, while securing appropriate United Kingdom-based specialist care for rare tumours, radiotherapy and highly specialised treatment.[11][12][10]
• Develop cancer intelligence, including complete and linked data on cancer stage, screening, activity and finance, to support epidemiology, service planning, quality improvement and assessment of cost-effectiveness.[13][7]
• Support children, young people and survivors through age-appropriate pathways, psychological and social support, long-term care planning, seamless transitions between services, and support for independent living after treatment.[14][15][16][17]
• Provide palliative and end-of-life care that relieves physical, psychosocial and spiritual suffering, supports families and bereavement, and enables patients to remain active and choose their preferred place of care where possible.[18][19]

Implementation

Implementation depends on coordinated commissioning, local service development and partnerships across the Department of Health, other Government Departments, statutory providers, clinicians, patients, carers, cancer charities and Third Sector organisations. The Department of Health is expected to lead cancer services and develop an implementation plan with stakeholders to determine delivery arrangements and costs.[1][11][3]

• Commission secondary care through Noble's Hospital and tertiary care through United Kingdom providers, including the Clatterbridge Centre for Oncology, Alder Hey Children's NHS Foundation Trust and the Royal Liverpool University Hospital, using agreements based on current and future population health needs.[20]
• Maintain close integration with the Merseyside and Cheshire Cancer Network, using compatible care plans, National Health Service-approved drug protocols, specialist multidisciplinary advice, research links and clinical-trial opportunities.[3][12]
• Operate a general Cancer Multi-disciplinary Team for local patients across tumour types, and refer cases requiring specialist site-specific advice to United Kingdom teams, including through videoconferencing where appropriate.[21]
• Strengthen referral, handover and transfer arrangements between primary care, Noble's Hospital and United Kingdom hospitals, using National Institute for Health and Care Excellence guidance, referral pro formas, urgent fast-track appointments and tumour-specific clinical pathways.[9][21][10]
• Develop workforce capability through continuing professional development, advanced communication-skills training, workforce reviews, appropriate pharmacy support and reduced unnecessary demarcation between staff groups.[22][10][15]
• Implement the Somerset Cancer Register as a linked information system for diagnosis, treatment, pathway tracking, planning, monitoring and epidemiology; link it with screening, hospital, community and finance data, and provide user training and back-up.[6][7][19]
• Use annual cancer figures from the North West Cancer Intelligence Service, cancer-registration analysis by the North West Cancer Registry, and periodic adult health and lifestyle surveys to inform local intelligence and risk-factor monitoring.[13]
• Coordinate screening quality assurance, horizon scanning and public-information campaigns, working with partners to improve informed choice, awareness and participation across population groups.[8]
• Deliver survivorship and palliative support through hospital clinicians, general practitioners, specialist and community nurses, psycho-oncology, social care, Hospice Isle of Man and Third Sector providers.[16][18][23]
• Apply the Children's Cancer Measures through peer review and a formal shared-care arrangement between Noble's Hospital and Alder Hey Children's NHS Foundation Trust for children and young people with cancer.[14][15]
• Monitor service quality through pathway reviews, waiting-time monitoring, survival and patient-experience comparisons with United Kingdom and European results, regional and national audits, external peer review, and patient and carer feedback.[21][10][20]
• Prioritise interventions and service configurations that offer better health gains and value for money in response to financial constraints, rising treatment costs and the limited population volume available for some specialist services.[3][6][12]

Monitoring & Evaluation

The Plan establishes a cancer intelligence, monitoring and quality-improvement approach based on linked data, clinical review, audit, benchmarking and patient feedback. It aims to use information to improve commissioning, service planning, clinical outcomes, screening quality, patient experience and accountability, although it does not set out a complete indicator framework or universal reporting timetable.[6][13][20]

• Use the Somerset Cancer Register as a single, linked cancer information system for diagnosis, patient management, pathway tracking, aggregated planning, epidemiology, quality monitoring and cancer statistics.[6][7][19]
• Record and analyse cancer registrations through the North West Cancer Registry and North West Cancer Intelligence Service, with annual cancer figures produced for the Isle of Man and North West England.[13]
• Monitor cancer incidence, prevalence, unusual patterns and trends, including trends associated with screening interventions, and investigate possible contributing factors.[13]
• Monitor service quality, effectiveness, provision gaps, waiting times, pathway progress, treatments, survival, patient experience and outcomes for patients and carers.[13][10]
• Compare Isle of Man outcomes with United Kingdom and European results, including five-year survival rates adjusted for cancer stage, and use findings to amend service specifications where improvement is needed.[7][10][20]
• Review cancer service performance regularly to identify bottlenecks, investigate delays in tumour-site pathways, and implement remedial action plans through the Cancer Service Review Group.[21]
• Use clinician participation in regional, Royal Colleges' and national audits, local review arrangements and external peer review, particularly for common tumours, to assess service quality.[21][10]
• Monitor inter-hospital transfers and review handover arrangements for patients receiving assessment or treatment in United Kingdom hospitals.[21][10]
• Apply screening quality assurance, link screening with hospital data to assess programme effectiveness, and monitor screening uptake and inadequate smear data quarterly.[7][8]
• Recognise current information limitations: cervical screening detection rates and cancer-stage data are unavailable, and cervical screening data are primarily produced for finance purposes rather than linked to secondary-care outcomes.[7][8]
• Repeat the adult health and lifestyle survey at least every four years to monitor smoking, obesity, diet and other major cancer risk factors, while interpreting comparisons with English regions cautiously because survey methods differ.[13][24]
• Audit public, patient and carer information periodically for accessibility, adequacy, comprehensibility and usefulness, and revise materials in response to findings.[8][5][19]
• Use patient feedback and cancer surveys alongside quantitative evidence to inform service improvement, while the Cancer Services User Forum gives patients and carers a voice in service-related matters.[3][10][20]
• Undertake internal and subsequent formal peer reviews for children and young people's cancer services using the Children's Cancer Measures as implementation and capability standards.[14][15]
• Maintain palliative-care registers and multidisciplinary discussions in general practices using the Gold Standards Framework, supported by continuous electronic records across hospital, hospice and community settings.[23]

Explicit commissioning standards are intended to cover referral-to-diagnosis and treatment-initiation waiting times, communication, counselling, staffing, outcomes and patient experience.[20]The Plan does not specify numerical targets for these standards, a comprehensive reporting schedule, named audit leads, or a detailed formal accountability framework.[10][20]

Costing & Financing

The Plan emphasises efficient use of resources, value for money and prioritisation in a context of financial constraints, rising healthcare costs, cost inflation from technological advances, and growing demand for cancer services and new treatments.[1][3][6][10]It does not provide an overall cancer-services budget, quantified funding gap, financing model, funding allocation or costed implementation plan.[1][25][21]

• Develop implementation details and costs through a separate implementation plan involving the Department of Health and other stakeholders.[1]
• Prioritise interventions, discontinue services with limited effectiveness or poor value for money, and redirect released resources towards advances with greater health gains.[3]
• Link finance data with activity and service data to assess cost-effectiveness, value for money, commissioning requirements and rational prioritisation.[7][19][20]
• Improve the quality of expenditure information on cancer services so that commissioners can use resources efficiently and improve outcomes.[6]
• Balance cost and quality when determining local provision, maximising treatment on the Island where feasible while accessing specialised services off-Island where necessary.[12][10]
• Maintain a general Cancer Multi-disciplinary Team model because separate tumour-site teams would not be feasible or cost-effective for the Isle of Man's population and patient numbers.[21]
• Avoid commissioning local radiotherapy because insufficient population and treatment volume, staffing and contingency requirements, and set-up and maintenance costs do not justify a local service.[12]
• Ensure equitable funding and resources for children and young people's cancer services and provide adequate pharmacy support in line with advice from the Principal Treatment Centre and peer review.[15]
• Recognise that the cancer-dedicated clinical psychologist and part-time counsellor posts are funded by Manx Cancer Help and the Isle of Man Anti-Cancer Association.[23]
• Consider the Gold Standards Framework as a potential means of improving cost efficiency through reduced hospitalisation, without a monetary estimate.[23]

The financial context includes constraints linked to the wider economic recession and changes to the local value-added tax sharing agreement.[3]Appropriate treatment is also characterised as potentially the most cost-effective treatment.[9]No quantified budgets, programme costs, savings, resource allocations, funding sources beyond the specified charitable support, or economic assumptions are provided.[5][9][23]