National Cancer Strategy 2017–2026

Objectives

Ireland’s National Cancer Strategy 2017–2026 sets out a population-wide cancer-control framework to prevent cancer and improve the treatment, health, wellbeing, experience and outcomes of people living with and beyond cancer. It aims to provide uniformly high-quality, safe, evidence-based, equitable and person-centred care, and to bring survival for common cancers into the top quartile of European countries by the end of the Strategy period.[1][2]

• Reduce the cancer burden through prevention, healthier lifestyles, tobacco control, screening, improved symptom awareness, earlier presentation and earlier diagnosis, with particular attention to inequalities associated with deprivation, age and gender.[3][4]
• Provide optimal care across prevention, diagnosis, treatment, follow-up, survivorship, palliative and end-of-life care, supported by clinical guidelines, quality assurance, multidisciplinary working and appropriately centralised specialist services.[3][5]
• Maximise patient involvement and quality of life by embedding patients in policy, service planning, practice and oversight, strengthening accessible information and advocacy, and developing adaptable survivorship programmes addressing physical, psychological and social wellbeing.[6][7]
• Enable and assure change through National Cancer Control Programme leadership, workforce planning, research, data, technology, transparent prioritisation and performance measurement.[2][8]
• Expand organised screening and early diagnosis, including BreastCheck, CervicalCheck and BowelScreen, direct access to diagnostics, timely referral pathways and public-awareness campaigns.[9][10]
• Develop cancer services and infrastructure for molecular diagnostics, cancer genetics, surgery, radiation oncology, systemic anti-cancer therapy, rare cancers, paediatric cancer, adolescent and young adult care, geriatric oncology, psycho-oncology and palliative care.[11][12][13][14]

Implementation

Implementation combines national oversight with integrated delivery across primary, community, hospital, specialist and voluntary-sector settings. The National Cancer Control Programme (NCCP), established within the Health Service Executive, is the principal leadership, commissioning, standards-setting, monitoring and service-development body; it works with the Department of Health, Hospital Groups, Community Healthcare Organisations, primary care, professional bodies, patient organisations and research institutions.[15][16]

• Deliver care through designated cancer centres, linked local and regional services, hub-and-spoke arrangements, multidisciplinary teams and agreed patient pathways, while centralising complex, rare and high-volume treatment where evidence supports better outcomes.[17][18]
• Require formal multidisciplinary discussion and treatment planning for cancer diagnoses, review team composition and outcomes, and support direct referral to designated centres when specialised treatment is needed.[18][19]
• Strengthen prevention through Healthy Ireland, Tobacco Free Ireland, the European Code Against Cancer, brief interventions in healthcare contacts, vaccination, environmental and occupational risk reduction, and targeted activity for disadvantaged and hard-to-reach groups.[4][20][21]
• Improve diagnostic access through electronic general practitioner referrals, referral criteria and timelines, Rapid Access Clinics, additional imaging and endoscopy capacity, specialist workforce development and national quality-assurance arrangements.[22][23][24]
• Develop survivorship shared-care protocols between cancer centres and primary care, supported by Patient Treatment Summaries and Care Plans, nurse-led and remote follow-up where appropriate, psycho-social support and rapid re-entry to specialist services.[25][26]
• Establish formal patient participation through a Cancer Patient Advisory Committee and local structures in hospitals, cancer centres and community healthcare organisations.[27][28]
• Coordinate research through a National Cancer Research Group, strengthen clinical-trial and biobanking infrastructure, and seek to increase annual therapeutic-trial participation from 3% to 6% of patients with cancer.[29][30]
• Plan workforce capacity across medical, nursing, diagnostic, pharmacy, health and social care professions, including national leadership roles in cancer nursing, molecular diagnostics, geriatric oncology and psycho-oncology.[31][32]

Governance links funding, commissioning and capital planning to strategic priorities and performance. The NCCP is to use Service Level Agreements aligned with Activity Based Funding, monitor services through the Health Service Executive Performance and Accountability Framework, audit agreed outputs and outcomes, publish findings annually, and act on substandard performance, including potential service transfer where necessary.[16][33]A rolling capital-investment plan, reviewed annually, is intended to cover facilities, equipment replacement, diagnostic capacity, radiation oncology and ambulatory services.[19]

Performance monitoring uses Key Performance Indicators spanning prevention, screening, referral, diagnosis, treatment, survivorship, palliative care, research, survival and inequalities. Explicit targets include smoking prevalence below 5% by 2025; a 10% increase in early-stage colorectal, breast and lung cancer diagnoses against the 2013 baseline by 2020; a 50% reduction in emergency-department cancer diagnoses by 2026; 95% multidisciplinary-team discussion of invasive cancers by the end of 2020; and a top-quartile European Union ranking for five-year overall survival by 2026.[20][34][35]The Department of Health is to publish an annual implementation report with stakeholder input, while recommendations were scheduled for review towards the end of 2021.[36][37]

The Strategy identifies substantial resource pressures but does not provide a total implementation budget, programme allocations or quantified funding gap. It calls for investment in workforce, diagnostics, cancer-centre infrastructure, research and new technologies, and applies health technology assessment, clinical effectiveness and pharmacoeconomic evaluation to support prioritisation of medicines, treatments and service developments.[38][39][40]

Monitoring & Evaluation

The Strategy establishes a national monitoring and accountability system centred on Key Performance Indicators, annual implementation reporting, service audit, quality assurance and National Cancer Control Programme oversight. It aims to measure outcomes across prevention, screening, diagnosis, treatment, survivorship, palliative care, research and equity, while allowing indicators to be refined during the Strategy period.[34]

• Publish an annual Department of Health report on implementation progress, recommendations and Key Performance Indicators, informed by stakeholders.[37]
• Review the Strategy’s recommendations towards the end of 2021 to confirm that its direction remains appropriate for optimal patient outcomes.[37]
• Monitor cancer services through the Department of Health, the National Cancer Control Programme, the National Screening Service, Hospital Groups, Community Healthcare Organisations and primary care.[34]
• Collect, collate and report Key Performance Indicators nationally and, where relevant, by geography and institution, to identify variation between organisations, regions and population groups and inform policy and resource-allocation decisions.[34]
• Track prevention and screening measures, including the goal of reducing adult daily smoking prevalence to 5% by 2025, BreastCheck uptake of 70%, CervicalCheck five-year rolling coverage of 80%, and BowelScreen uptake of 60% by 2020.[34][41]
• Measure earlier diagnosis through targets for electronic general-practice referrals, access to diagnostics within agreed timelines, attendance at Rapid Access Clinics, reduced emergency-department diagnoses, and increased stage I and II diagnoses for colorectal, breast and lung cancers.[34][41]
• Assess treatment delivery through targets for surgery in approved centres, multidisciplinary-team discussion of invasive cancers, waiting times for surgery and radiotherapy, and admission to dedicated cancer units.[41]
• Monitor survivorship, palliative care and research through Treatment Summaries and Care Plans, chemotherapy use in the last month of life, specialist palliative-care assessment for stage IV cancer, and therapeutic clinical-trial participation.[41][35]
• Use survival performance as a central outcome measure, aiming to place Ireland in the top quartile of European Union Member States for five-year overall survival by 2026.[35]
• Assess equity by reducing differences in age-standardised cancer incidence and five-year survival between the most and least deprived groups to no more than 3% by 2026 for specified cancers.[35]

The National Cancer Control Programme is the principal performance and commissioning body. It monitors services under the Health Service Executive Performance and Accountability Framework, audits implementation against agreed outputs and outcomes, and publishes audit findings annually.[33]Its cancer-intelligence function, the National Cancer Registry and other data sources support surveillance, audit, service planning and workforce planning.[33][42]Hospitals are expected to provide cancer data to the National Cancer Registry within an appropriate timeframe, while the Registry’s remit is to be reviewed to improve use of data for cancer care.[37]

Quality assurance includes national cancer-care indicators, patient-experience surveys, patient-safety surveillance, adverse-event reporting through the National Incident Management System, clinical guidelines and national clinical audit.[43][44]The National Healthcare Quality Reporting System includes screening uptake, five-year relative survival for breast, cervical and colorectal cancers, and surgical activity for breast, colon and rectal cancer.[43][44]Service Level Agreements link funding, performance management and remedial action: services that do not meet agreed standards or targets may have funding reviewed, and the National Cancer Control Programme may direct discontinuation or transfer of services and associated resources.[16][33]

Several specialist monitoring arrangements supplement the overall framework, including screening quality assurance, molecular-test validation and review, genetic-test audit, multidisciplinary-team outcome reporting, capital-plan review, palliative-care needs assessment and research monitoring.[9][11][45][18][19][46][29]Although the Strategy specifies many targets and responsible bodies, the supplied material does not provide complete indicator definitions, data specifications, reporting methodologies, surveillance protocols or accountability sanctions for every programme area.[34][40]

Costing & Financing

The Strategy identifies substantial resource requirements for modern cancer control but does not provide a total implementation budget, programme-level allocations, quantified financing gaps or a consolidated economic model.[38][47]Financing is intended to be aligned with strategic priorities, commissioning and performance through the National Cancer Control Programme, Service Level Agreements and Activity Based Funding.[16]

• Prioritise prevention as the most cost-effective long-term means of cancer control and assess the benefits and cost-effectiveness of prevention initiatives, including chemoprevention.[8][9]
• Use health technology assessment, clinical-effectiveness evidence, pharmacoeconomic evaluation and budget-impact analysis to assess new diagnostics, medicines, equipment, procedures and service models.[48][39]
• Manage continuing expenditure pressures from new cancer therapeutics, described as exceedingly expensive, by balancing clinical benefits, affordability, value for money and competing needs.[49][48]
• Develop and annually review a rolling capital-investment plan for radiation oncology, linear-accelerator replacement, diagnostic equipment, ambulatory and day-care facilities, medical-oncology units and cancer-centre infrastructure.[19]
• Address staffing, training, information-system, diagnostic, laboratory, molecular-diagnostics, genetics, survivorship and research-infrastructure requirements, for which the source identifies needs but generally gives no monetary values.[50][51][45][31]
• Support cancer research through public, charitable, industry and other funding sources, while seeking stable multi-annual funding for Cancer Trials Ireland.[29][30]

The National Cancer Control Programme coordinates funding for new cancer developments, including oncology medicines, and is to retain responsibility for new Health Service Executive cancer-service funding and related posts through annual national service planning.[16]It is also expected to link both new and existing funding to strategic priorities and performance monitoring, and to lead commissioning and capital planning for health infrastructure with a cancer component.[16][33]

Explicit economic evidence includes an estimated €73 billion in lost productivity from projected deaths due to invasive cancers in Ireland during 2011–2030, comprising €13 billion in paid work and €60 billion in household activities.[52]National state funding for cancer research is estimated at approximately €25 million to €30 million annually, while research funding is described as low relative to the healthcare budget compared with the United Kingdom.[42]Science Foundation Ireland had invested approximately €100 million in cancer research since 2000, and the Irish Cancer Society had invested more than €25 million in research over the previous decade.[29]

Specialist palliative care is funded mainly through Health Service Executive service-level agreements with voluntary hospices and through hospice fundraising.[46]The source also identifies local funding as affecting access to voluntary-sector survivorship support.[53]No quantified funding commitment is supplied for the broader Strategy, capital plan, workforce expansion, medicines, diagnostics, screening expansion or survivorship services.[19][54]