National Cancer Strategy 2017-2026 Implementation Report 2018

Objectives

The National Cancer Strategy 2017–2026 provides a national framework for cancer control, with implementation activity spanning prevention, early detection, diagnosis, integrated treatment and care, survivorship, quality, research, workforce development and surveillance.[1]The strategy seeks to provide coordinated care across primary and hospital services throughout the cancer continuum, from diagnosis to post-treatment support, and to ensure that patient cases are considered by multidisciplinary teams with appropriate processes and outcome reporting.[2]

• Strengthen prevention through the Healthy Ireland framework, action on tobacco and alcohol consumption, a National Cancer Control Programme prevention function, and an Irish Cancer Prevention Network that supports consistent evidence-based public messages.[3]
• Develop a national skin cancer prevention plan for children, outdoor workers, sunbed users and people undertaking outdoor leisure activities.[3]
• Assess the benefits and cost-effectiveness of prevention interventions, including possible chemoprevention, and improve surveillance and integrated care for people with inherited breast, ovarian and colorectal cancer risks.[3][4]
• Expand bowel screening capacity, improve early detection and referral pathways, and strengthen links between general practice, primary care and hospital cancer services.[3][4]
• Develop specialist cancer services, including cancer genetics, molecular diagnostics, haematological and rare-cancer services, and age-appropriate arrangements for adolescents, young adults and older people with cancer.[5][6]
• Establish at least one comprehensive cancer care centre supporting prevention, treatment, education and research.[2]
• Strengthen psycho-oncology and palliative care through equitable, nationally led and networked services, including dedicated provision in designated cancer centres, specialist staffing and regular assessment of patient need.[7]
• Improve quality and safety through hospital-level frameworks, national quality indicators, clinical guidelines and audits aligned with national and international standards.[8]
• Enhance survivorship through treatment summaries, care plans, needs assessments, shared-care protocols and support addressing physical, psychological and social effects of cancer.[8][9]
• Increase patient involvement in cancer policy, planning, service practice and oversight, including participation by diverse patient groups and people living in remote areas.[8]
• Strengthen national coordination of cancer research, align research priorities and funding with the strategy, integrate clinical research into care delivery, and build cancer nursing and wider service workforce capacity.[10]
• Improve cancer surveillance and use cancer data to drive improvements in patient care.[10]

Implementation

Implementation is led principally by the National Cancer Control Programme (NCCP), working with the Department of Health, the Health Service Executive (HSE), Hospital Groups, cancer centres, primary-care bodies, professional organisations, patients and voluntary-sector organisations.[3][2][9]Delivery combines nationally directed models of care and clinical leadership with multidisciplinary teams, designated centres, hub-and-spoke services, steering groups, workforce planning, capital investment, data systems and targeted funding.[5][6][9]

• Coordinate prevention through a memorandum of understanding between the NCCP, Irish Cancer Society, Breakthrough Cancer Research and Marie Keating Foundation, and develop the skin cancer plan through a Department of Health and NCCP working group, stakeholder consultation and voluntary-sector participation.[3]
• Build endoscopy capacity for extending BowelScreen to people aged 55–74, develop service-capacity plans, and review evidence for potential new screening programmes.[3]
• Identify people at possible hereditary cancer risk, refer them for genetic counselling and testing where indicated, coordinate surveillance, recruit for the hereditary-cancers programme and assess genetic-testing infrastructure across cancer centres.[3][4][5]
• Deliver early-detection campaigns through targeted multimedia activity, initially prioritising lung cancer, alongside symptomatic breast guidance, revised prostate rapid-access clinic referrals and criteria for patients outside existing rapid-access pathways.[4]
• Phase in electronic cancer referrals from general practitioners through Hospital Groups, expand radiography education places, support general practitioners in pre- and post-treatment care, and explore primary-care centres and community oncology nursing for supportive care.[4]
• Organise specialist care through national clinical and programme leads, standard multidisciplinary-team protocols, designated cancer surgery centres and implementation groups for models such as oral anti-cancer medicines.[5][6]
• Develop psycho-oncology through a National Clinical Lead and National Working Group with cancer-centre and patient representatives, using hub-and-spoke and multidisciplinary-team delivery.[7]Develop specialist palliative care towards seven-day availability through the HSE Palliative Care Clinical Programme.[7]
• Develop survivorship and quality initiatives through service mapping, needs assessments, pilot sites, training, demonstration programmes, shared-care arrangements and collaboration among the NCCP, cancer centres, primary care, patients and voluntary organisations.[7][9]
• Support infrastructure through the rolling capital-investment plan and National Development Plan 2018–2027, including oncology units and day wards, diagnostics, aseptic compounding, radiation oncology facilities and a comprehensive cancer centre.[2][5]
• Strengthen accountability through Service Level Agreements, targeted NCCP-controlled funding, Hospital Group allocations under Activity Based Funding, and engagement with private providers on data collection, audit, guideline compliance and outcome reporting.[9]
• Establish a National Cancer Research Group to coordinate research, set priorities and support continuity of funding, while providing protected research time for many consultants and Advanced Nurse Practitioners.[10]
• Develop nursing and workforce leadership through appointment of a National Clinical Lead for Cancer Nursing and a cross-sector cancer-services workforce plan covering medical, nursing, health and social care staff.[10]
• Strengthen information governance by requiring hospital cancer-data provision to the National Cancer Registry, implementing the HSE and Registry Data-Sharing Agreement, planning site-level memoranda of understanding, and reviewing Registry scope and resourcing.[10]

Monitoring & Evaluation

Monitoring combines annual implementation reporting, programme-specific milestones, service data and planned national information systems. The National Cancer Control Programme oversees several delivery and reporting arrangements, but the available material does not set out a single comprehensive performance framework, fixed reporting cycle beyond the 2018 implementation report, sanctions, or a formal accountability mechanism for non-performance.[3][4][2][11][6]

• Report progress annually against named strategy recommendations, responsible agencies and implementation status, including progress recorded to the end of 2018.[3]
• Assess prevention measures through international programmes and emerging evidence, including review of the effectiveness of prospective screening programmes and assessment of prevention initiatives’ benefits and cost-effectiveness.[3][4]
• Track operational milestones such as establishment of prevention, early-detection and referral groups; stakeholder consultation; capacity planning; clinical guidance; and development of hereditary-cancer, molecular-diagnostics and service-model arrangements.[3][4][5][6]
• Measure implementation of electronic general-practitioner cancer referrals against reported and planned coverage targets of approximately 66% at the time of reporting, 75% by the end of 2019 and 90% by the end of 2022.[4]
• Monitor radiography workforce capacity through the planned increase in University College Dublin undergraduate radiography places from approximately 45 to 100 annually.[4]
• Oversee multidisciplinary-team composition, processes and outcome reporting through the National Cancer Control Programme and Hospital Groups, supported by planned national collection of multidisciplinary-team information through the National Cancer Information System.[2]
• Use the National Cancer Information System for psycho-oncology service data and preliminary haematology-related data collection, while engaging the National Cancer Registry on wider cancer-data collection.[6][7]
• Establish national cancer quality indicators spanning process and outcome measures, drawing on data held by the National Cancer Control Programme, National Cancer Registry and Department of Health.[8]
• Monitor patient experience through the National In-Patient Acute Care Patient Experience Survey, with work under way to make cancer treatment and survivorship more visible in a future survey.[8]
• Develop clinical guidelines and audits in accordance with National Clinical Effectiveness Committee standards and the national clinical-audit framework.[8]
• Use service mapping, needs assessments, pilot evaluations, steering groups, working groups and patient representation to review survivorship, quality, psycho-oncology and patient-engagement activity.[7][8][9]
• Strengthen cancer surveillance by requiring hospitals to provide data to the National Cancer Registry, supported by a Health Service Executive and Registry Data-Sharing Agreement signed in October 2018 and planned site-level memoranda of understanding during 2019.[10]
• Review the National Cancer Registry’s scope and resourcing, including human-resources and information-technology requirements, and implement recommendations from the 2018 Scoping Inquiry into the CervicalCheck Screening Programme.[10]

Costing & Financing

The material identifies substantial resource implications for cancer-control delivery and refers to capital, direct and activity-based funding mechanisms, but it provides no quantified cancer-strategy budget, expenditure total, funding gap, unit cost, currency amount or economic assumption.[1][3][4][7][8][9][10]

• Resource additional endoscopy capacity for extension of BowelScreen, radiography education places, genetic-testing infrastructure, electronic-referral systems and supportive-care services.[3][4]
• Support cancer infrastructure through the rolling capital-investment plan and National Development Plan 2018-2027, including medical-oncology units and day wards, diagnostics, aseptic compounding, radiation-oncology facilities and a comprehensive cancer centre.[2][5]
• Undertake a cost-comparison study of the Community Oncology Nursing Programme in Community Healthcare Organisation Area 2.[4][2]
• Use targeted direct funding controlled by the National Cancer Control Programme to improve cancer-service quality and accessibility, alongside financial allocations to Hospital Groups under Activity Based Funding.[9]
• Link cancer-research funding allocation to national priorities and promote continuity of research funding, without specifying funding levels or sources.[10]
• Identify workforce and service-capacity needs through cross-sector planning for medical, nursing, health and social-care professionals, although no associated cost estimates are specified.[10]