National Cancer Strategy 2017-2026 Implementation Report 2018

Objectives

The National Cancer Strategy 2017-2026 provides a national framework for comprehensive cancer control, spanning prevention, early detection, diagnosis, treatment, survivorship, palliative care, research, quality improvement and information systems.[1]Its overarching direction is to deliver integrated, equitable and patient-centred cancer services across primary, community and hospital care, while developing a comprehensive cancer care centre and strengthening the national cancer workforce, research capacity and data infrastructure.[2][3][4]

• Prevent cancer through Healthy Ireland policies, a national skin cancer prevention plan, coordinated evidence-based prevention messaging, and assessment of prevention initiatives including potential screening and chemoprevention programmes.[5]
• Strengthen early detection by expanding BowelScreen to people aged 55-74 by the end of 2021, improving diagnostic capacity, and developing targeted awareness and early-detection initiatives, initially for lung cancer.[5][6]
• Improve referral, diagnosis and treatment pathways by linking general practice, primary care, cancer centres and hospitals, and ensuring that patients are discussed through multidisciplinary team processes.[6][2]
• Address specialised needs through organised services for hereditary, molecular, haematological, rare, childhood, adolescent and young adult, geriatric and psycho-oncological cancers.[2][7][8][9]
• Enhance quality, safety and experience through national quality frameworks, clinical guidelines, audits, patient experience surveys, cancer-care indicators and patient representation in policy and oversight.[3]
• Support survivorship and supportive care through treatment summaries, care plans, shared-care protocols, community oncology nursing, primary-care engagement and adaptable survivorship programmes.[6][3][10]
• Strengthen specialist palliative care, including children’s palliative care, and promote regular standardised assessment of patient needs.[9]
• Develop a coordinated research system that aligns research priorities and funding with the Strategy, integrates clinical research into care, and protects research time for relevant consultants and Advanced Nurse Practitioners.[4]
• Build sustainable capacity through cancer workforce planning, nursing leadership, expanded radiography training, capital investment and improved cancer information and Registry systems.[6][2][4]

Implementation

The National Cancer Control Programme leads implementation with the Department of Health and Health Service Executive, coordinating prevention, service models, clinical pathways, quality, research, workforce planning, information systems and targeted investment.[5][2][10][4]Delivery relies on structured collaboration among hospital groups, designated cancer centres, primary care, general practitioners, professional bodies, patient organisations, voluntary providers, research funders, the National Cancer Registry and private providers.[6][3][10][4]

• Establish an Irish Cancer Prevention Network through a memorandum of understanding involving the National Cancer Control Programme, Irish Cancer Society, Breakthrough Cancer Research and Marie Keating Foundation to coordinate prevention communications and initiatives.[5]
• Develop the skin cancer prevention plan through a Department of Health and National Cancer Control Programme working group, with voluntary-sector participation and wider stakeholder consultation.[5]
• Expand endoscopy provision for BowelScreen, assess hereditary cancer testing and surveillance infrastructure, and increase undergraduate radiography places at University College Dublin from approximately 45 to 100 annually.[5][6]
• Implement primary-to-secondary care referral pathways, referral criteria, Rapid Access Clinic arrangements and electronic general practitioner referral systems.[6]Electronic referrals represented approximately 66% of cancer referrals in 2018, with targets of 75% by the end of 2019 and 90% by the end of 2022.[6]
• Organise specialist services through linked consultant appointments, national clinical and programme leads, hub-and-spoke networks, centralised provision where appropriate, treatment protocols and transition pathways.[7][8]
• Develop integrated models of care connecting hospital, community and primary-care services, including general practitioner support before and after treatment, evaluation of the Community Oncology Nursing Programme and exploration of supportive care through primary care centres.[6][2]
• Implement a rolling annual capital investment plan under the National Development Plan 2018-2027, covering oncology units, day wards, diagnostics, aseptic compounding, radiation oncology capacity and a comprehensive cancer centre.[2][7]
• Coordinate psycho-oncology, palliative care, survivorship and nursing development through national clinical leadership, working groups, service mapping, demonstration sites and master training.[9][10][4]
• Use Service Level Agreements and targeted allocations to hospital groups, including arrangements envisaged under Activity Based Funding, to support quality and access to cancer services.[10]
• Strengthen governance through the National Cancer Quality Steering Committee, involving the Health Information and Quality Authority and the wider health service, alongside a Cancer Patient Advisory Committee and patient representatives in planning and oversight.[3]
• Deploy the National Cancer Information System for multidisciplinary team and psycho-oncology information, and strengthen National Cancer Registry data-sharing, surveillance and capacity.[2][9][4]A Health Service Executive-National Cancer Registry data-sharing agreement was signed in October 2018, with site-level memoranda of understanding planned for 2019.[4]
• Establish a National Cancer Research Group to coordinate research priorities following engagement with funders, and integrate research roles and protected time into cancer service delivery.[4]

Monitoring & Evaluation

Monitoring combines service implementation oversight, cancer surveillance, data-system development, quality assurance and patient experience measurement, led principally by the National Cancer Control Programme (NCCP), the Health Service Executive and the National Cancer Registry.[2][3][4]

• Monitor the evidence, potential effectiveness and cost-effectiveness of prevention initiatives and prospective screening programmes using international evidence and programmes.[5]
• Assess hereditary cancer services, genetic testing infrastructure, early diagnosis, referral pathways and public-awareness priorities through stakeholder consultation, working groups, surveys of cancer centres and service mapping.[5][6][9]
• Track electronic cancer referrals, which accounted for approximately 66% of referrals in 2018, against targets of 75% by the end of 2019 and 90% by the end of 2022.[6]
• Oversee multidisciplinary team composition, processes and outcome reporting through the NCCP, supported by phased national implementation of the National Cancer Information System.[2]
• Capture multidisciplinary team information nationally and determine, with haematologists and the National Cancer Registry, appropriate arrangements for collecting relevant haematology data.[2][8]
• Establish an implementation group for the Model of Care for Oral Anti-Cancer Medications, planned for the second quarter of 2019, to monitor delivery progress.[8]
• Use the National Cancer Information System for psycho-oncology data collection and analyse existing data with the National Cancer Registry and Department of Health to develop national process and outcome indicators for cancer care.[9][3]
• Measure patient experience through the National In-Patient Acute Care Patient Experience Survey and strengthen quality assurance through cancer-specific guidelines and audits aligned with National Clinical Effectiveness Committee standards and the national clinical audit framework.[3]
• Oversee cancer quality through a National Cancer Quality Steering Committee involving the Health Information and Quality Authority and the wider health service.[3]
• Engage private providers in data collection, audit, guideline compliance and outcome reporting, with hospital licensing legislation expected to improve access to private-sector data.[10]
• Require hospitals to submit cancer data to the National Cancer Registry for surveillance of cancer incidence and outcomes; a Health Service Executive-Registry data-sharing agreement was signed in October 2018, and site-level memoranda of understanding were planned for 2019.[4]
• Review the scope and resources of the National Cancer Registry to strengthen data collection and the use of data in patient care.[4]

Implementation progress is reported through completed, ongoing and planned actions, including steering groups, guidelines, capacity planning and programme commitments.[5][6]A consolidated indicator framework, routine reporting timetable and overarching accountability mechanism are not otherwise specified in the provided material.[2][8][4]

Costing & Financing

Financing information focuses on investment mechanisms, resource requirements and cost-effectiveness assessment rather than quantified expenditure: no overall National Cancer Strategy budget, detailed allocations, funding gaps or economic assumptions are specified in the provided material.[1][5][6][2][4]

• Support cancer-facility development through capital funding under the National Development Plan 2018-2027, including oncology units, day wards, diagnostic facilities, aseptic compounding infrastructure and a comprehensive cancer centre.[2]
• Use targeted NCCP-controlled funding, Service Level Agreements and direct allocations to Hospital Groups under Activity Based Funding to improve service quality and accessibility.[10]
• Assess the cost-effectiveness of prevention measures, including potential chemoprevention and screening programmes, through a developing NCCP mechanism.[5]
• Undertake a cost comparison study of the Community Oncology Nursing Programme in Community Healthcare Organisation Area 2.[6]
• Identify workforce and capacity requirements, including additional endoscopy provision and an increase in annual undergraduate radiography places at University College Dublin from approximately 45 to 100, without specifying associated costs.[5][6]
• Link cancer research funding allocations to national research priorities and seek continuity of research funding.[4]
• Increase National Cancer Registry resources, including funding for human resources and information technology staff.[4]

Monetary values, currency-denominated allocations, total programme costs and quantified funding shortfalls for infrastructure, workforce, research, quality improvement, survivorship, psycho-oncology and palliative care are not specified.[2][9][3][4]