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

Objectives

The National Cancer Plan for the Isle of Man 2012-2022 provides strategic direction for a comprehensive, quality-assured cancer service, initially comparable with the best-performing region in the United Kingdom. Its overarching aim is to reduce cancer incidence, morbidity and mortality while improving outcomes and experiences for patients, carers and people living with or beyond cancer.[1][2]

• Prevent cancer and reduce exposure to modifiable risks, particularly tobacco use, second-hand smoke, poor diet, obesity, alcohol misuse, physical inactivity and excessive ultraviolet exposure, through coordinated public-health action that makes healthier choices easier.[3][4][5]
• Strengthen primary prevention through tobacco control, weight management, physical activity, sun-safety measures, breastfeeding promotion, alcohol awareness, healthy-lifestyle social marketing and Human Papilloma Virus vaccination, with scope to consider future vaccines and preventive approaches.[6][4][5]
• Improve early detection through cervical, breast and bowel screening programmes, screening quality assurance, informed-choice communications, public awareness of cancer signs and symptoms, and assessment of future screening technologies in line with United Kingdom National Screening Committee recommendations.[1][7][4]
• Develop cancer intelligence and data systems to identify unusual patterns, monitor incidence and prevalence, assess service gaps and effectiveness, compare outcomes internationally, and support service redesign, commissioning and value-for-money decisions.[8][7]
• Improve timely diagnosis, staging, referral, treatment and survival through streamlined pathways, multidisciplinary clinical decisions, access to specialist services, evidence-based treatment protocols and reduced delays across the cancer pathway.[9][10][11]
• Provide person-centred support across the cancer journey, including balanced information, rehabilitation, psychological, social, spiritual, financial and employment support, survivorship care, and end-of-life care that respects individual preferences.[12][13][14]
• Ensure equitable provision for children and young people with cancer, including age-appropriate pathways for people aged 16 to 24 years, long-term follow-up for survivors of childhood cancer, psychological support and attention to family and carer needs.[15][16]
• Provide integrated general and specialist palliative care from early in the course of progressive or incurable disease, according to patients' levels of need and with support for preferred places of care and death.[14][17][18]

Implementation

Delivery combines local Isle of Man provision with coordinated access to United Kingdom specialist and tertiary services where local delivery would not be clinically sustainable, feasible or cost-effective. The Department of Health leads commissioning and works with Noble's Hospital, other government departments, primary and social care, Third Sector organisations, charities, patients, carers, United Kingdom cancer networks and specialist providers.[12][2][19][20]

• Implement an integrated information infrastructure through the Somerset Cancer Register, linking appropriate hospital, screening and patient-record systems so data are collected once, shared securely on a need-to-know basis, and available for clinical management, multidisciplinary working, epidemiology, service planning, quality assessment and monitoring.[21][7]
• Strengthen cancer intelligence through annual cancer figures produced by the North West Cancer Intelligence Service, cancer registration and analysis by the North West Cancer Registry, and repeated adult health and lifestyle surveys planned at least every four years.[8][22]
• Maintain cervical, breast and bowel screening, coordinate breast screening through Coventry under United Kingdom standards, offer bowel screening to people aged 60 to 69 using the Faecal Occult Blood test, and improve uptake through accessible information and action to reduce socio-economic disparities.[7][4]
• Operate multidisciplinary care through a general Cancer Multidisciplinary Team, since separate tumour-site teams are not feasible for the Island's population and case volumes, while referring selected patients to United Kingdom site-specific multidisciplinary meetings through videoconferencing when needed.[9][10]
• Develop tumour-site pathways and referral criteria informed by National Institute for Health and Care Excellence guidance, train general practitioners and other professionals to identify urgent referrals, and use the Cancer Service Review Group to audit pathways, identify bottlenecks and implement remedial plans.[9][10][11]
• Coordinate off-Island care through effective two-way handover arrangements between Noble's Hospital and United Kingdom hospitals, use United Kingdom providers for radiotherapy and other specialist services requiring volumes, infrastructure or expertise unavailable locally, and maintain links with the Merseyside and Cheshire Cancer Network.[2][10][23]
• Build workforce capability through continuing professional development, service-change training, advanced communication-skills training, regular review of roles, chemotherapy workforce planning and visiting specialist expertise alongside resident Island-based staff.[23][11]
• Deliver children's cancer care through shared arrangements between Noble's Hospital and Alder Hey Children's National Health Service Foundation Trust, guided by the Children and Young People's Cancer Clinical Network Group, peer review and a shared care agreement.[15][16]
• Coordinate survivorship and palliative care across hospital clinicians, general practitioners, nurses, psycho-oncology, social care, Social Security, hospice and Third Sector services; implement the Gold Standards Framework in general practitioner practices and use the Liverpool Care Pathway for the Dying Patient across clinical settings.[24][17][18]
• Commission secondary and tertiary cancer services through agreements led by the Department of Health, with standards covering referral-to-diagnosis and treatment waiting times, communication, counselling, staffing, outcomes and patient experience.[20]
• Monitor quality through stage-adjusted five-year survival comparisons, patient and cancer surveys, audits, peer review, screening quality assurance, pathway-delay analysis and periodic review of public information and patient feedback.[7][10][11][20]
• Prioritise resources in response to financial constraints, technological cost inflation and rising demand, linking finance and activity data to assess cost-effectiveness and value for money; the source does not specify a consolidated budget or quantified funding allocations.[2][21][7][20]

Monitoring & Evaluation

The plan establishes a broad monitoring and quality-improvement architecture centred on cancer intelligence, linked information systems, audits, comparative outcomes and commissioning oversight. It does not, however, set out a single consolidated indicator framework, common reporting timetable or comprehensive formal evaluation methodology.[21][8][20]

• Use cancer incidence, prevalence and risk-factor data to detect unusual patterns, monitor trends, assess the effects of interventions such as screening, identify service gaps and compare patient and carer outcomes with those elsewhere.[8]
• Implement the Somerset Cancer Register as an integrated information system supporting patient management, longitudinal follow-up, service planning, quality assessment, monitoring and epidemiological analysis.[21][7]
• Link screening, hospital, activity and finance data to improve evaluation of outcomes, cost-effectiveness and value for money; the plan identifies incomplete linkage of cervical screening data with secondary-care outcomes as a limitation.[7][4]
• Audit Isle of Man cancer outcomes against United Kingdom and European results, standardised by cancer stage, and use comparative five-year survival rates alongside patient and cancer surveys to assess overall care quality.[7][20]
• Apply quality assurance across screening programmes, including United Kingdom arrangements for breast screening, a coordinated programme for cervical screening, and quarterly reporting of cervical screening uptake and inadequate smears by general practice.[4]
• Repeat the adult health and lifestyle survey at least every four years to monitor risk factors, and use lifestyle measures on smoking, alcohol, obesity, diet and physical activity to assess comparative prevention objectives.[8][5]
• Review cancer performance regularly through clinical-pathway audits, Cancer Service Review Group action plans, regional and national audits, and possible external peer review for common tumour types.[10]
• Monitor waiting times for diagnosis and treatment, including pathology and radiology results; map patient pathways; analyse survival and patient experience; and obtain periodic patient feedback to improve services and information.[11]
• Assess children’s and young people’s cancer-service implementation through the National Cancer Peer Review Programme’s Children’s Cancer Measures, including an internal peer review in 2012 and formal reviews thereafter.[15][16]
• Track patients through cancer pathways, collect and collate cancer statistics, use palliative-care registers and multiprofessional meetings, and audit patient and carer information for accessibility, adequacy, comprehension and usefulness.[18]
• Hold the Department of Health responsible for setting commissioning standards and overseeing quality, while using monitoring findings to amend commissioned service specifications. Commissioning standards are to cover waiting times, communication and counselling, staffing, outcomes and patient experience.[20]

Costing & Financing

The plan frames cancer financing chiefly as a resource-prioritisation challenge: rising treatment complexity, technological advances, new anti-cancer drugs, workforce pressures and financial constraints require efficient use of resources and improved expenditure information. No cancer-services budget, quantified allocation, funding source, financing gap or costed implementation plan is provided.[1][21][11]

• Prioritise effective interventions and consider decommissioning services with limited effectiveness or poor value for money so that resources can support innovations with greater health gains.[2]
• Link finance data with activity and service data to enable more rational commissioning, prioritisation, assessment of cost-effectiveness and evaluation of value for money.[7][20]
• Plan staffing and service capacity in response to increasing chemotherapy demand, growing cancer incidence, an ageing population, co-existing conditions and more complex treatments.[6][23]
• Provide treatment locally where this meets cost and quality considerations, while using United Kingdom-based specialist services for rare tumours, radiotherapy and other provision that cannot be sustainably established on the Island.[19][11]
• Maintain United Kingdom-based radiotherapy because local provision would require population scale, treatment volumes, infrastructure, staffing, maintenance and contingency arrangements that do not justify commissioning; no monetary estimate or referral cost is specified.[23]
• Use a general Cancer Multidisciplinary Team rather than separate tumour-site teams, because separate teams are not considered feasible or cost-effective for the Island’s population and case volumes.[9]
• Recognise equitable funding and resources for children’s and young people’s cancer services, including adequate pharmacy support, as an objective without specifying an amount or funding mechanism.[16]
• Invest in staff, services and psychological support within palliative care; psychological support posts were funded by Manx Cancer Help and the Isle of Man Anti-Cancer Association.[17][18]
• Associate the Gold Standards Framework with greater cost efficiency through reduced hospitalisation, while providing no monetary estimate of savings or implementation costs.[18]
• Identify resources to facilitate participation in research studies and clinical trials, while leaving the scale, source and allocation of those resources unspecified.[19][11]