Building the NSW Cancer Plan 2011–15
The development of this third cancer plan for the people of NSW – the NSW Cancer Plan 2011–15 – reflects an integrated and collaborative approach to reducing the burden of cancer in NSW. We have coordinated priorities, resources and efforts among all individuals, organisations and governments involved in cancer control. This cancer plan provides an opportunity to consolidate the efforts over the past seven years and identify key cancer agencies responsible for specific programs.
Stakeholders who helped build the plan
This statewide cancer plan provides an opportunity to identify areas where we have succeeded and where we need to improve in cancer control. The plan sets out the most important principles and actions that need to take place over the next five years to improve cancer outcomes. The investment in cancer control will be carefully targeted to ensure the greatest impact for the people of NSW.
In accordance with the Cancer Institute (NSW) Act 2003, the Cancer Institute NSW has taken the leadership role in developing this cancer plan, in collaboration with consumers, state government, other cancer control organisations, health care professionals and a broad range of others affected by cancer and/or involved in cancer control.
The Cancer Institute NSW, in leading the development of the cancer plan, was guided by the goals of cancer control as stated in the Cancer Institute (NSW) Act 2003.
Our goals are:
- to increase the survival rate for people diagnosed with cancer
- to reduce the incidence of cancer in the community
- to improve the quality of life of people diagnosed with cancer and their carers
- to operate as a source of expertise on cancer control for the government, health service providers, medical researchers and the general community.
The Act also identifies the guiding principles to be observed when developing key cancer control actions to support these goals.
These key principles include the need for:
- effective partnerships between the public sector (national and state), the private sector and the general community
- equitable, evidence based, patient centred approaches to the care and treatment of people with cancer
- cancer-related research that focuses on improving cancer outcomes
- high quality, coordinated and multidisciplinary care available for all people diagnosed with cancer
- maximise the benefit of resources available for cancer control
- provision of expert and up to date information about cancer control.
In developing this plan it was important to consider the context in which this cancer plan will be undertaken in NSW in the next five years, in terms of: existing state and national government strategic plans, responsibilities and priorities; health system reform; the experiences of people with cancer and their carers; other cancer agencies; research institutions; and the private sector including primary care.
NSW Government
The NSW Government, through the NSW Department of Health, is responsible for ensuring the people of NSW are provided with the best health care possible within available resources. It develops and implements policy, advises the Minister and State government on strategic direction, plans for the provision of comprehensive health services and monitors the performance of the health system.
The NSW State Plan 2010 sets out key priorities and targets for healthy communities. Those relevant to cancer control and which align to the goals of the Cancer Institute (NSW) Act 2003 are:
- Promote healthy lifestyles. (Aligns with Goal 1)
- Reduce preventable hospital admissions. (Aligns with Goals 1 and 2)
- Improve and maintain access to quality healthcare in the face of increasing demand. (Aligns with Goal 2)
- Improve survival rates and quality of life for people with potentially fatal or chronic illness. (Aligns with Goals 2 and 3)
A number of additional strategic documents and policies have been developed by the NSW Government and the Department of Health that provide the foundation for the delivery of health services and, in particular, cancer services. These documents address issues such as an ageing population, inequities in service provision, a greater focus on patient-centred care and greater community engagement in service delivery.
The State Health Plan – Towards 2010 highlights major challenges in the healthcare system, particularly the ageing population. Future Directions for Health in NSW – towards 2025 highlights major challenges to the health system in the years ahead, particularly in providing quality care in rural areas.
In addition, Caring together: The Health Action Plan for NSW identifies health reforms made in response to the Garling Inquiry. This plan sets out a new direction for engaging with the community and health care professionals in service delivery that will ensure a greater focus on the patient.
There are a number of key cancer control roles and responsibilities across NSW Health. Programs such as tobacco control, obesity and physical activity are supported by state plans, which have been developed by NSW Health (in consultation). Statewide Services Branch of NSW Health has overarching responsibility for services such as radiotherapy including planning of capital projects, and has recently released the Radiotherapy Services in NSW – Strategic Plan to 2016. The Branch is also responsible for a number of other cancer services provided across the State that underpins the network model for NSW.
Local Health Networks are responsible for the planning and delivery of health services in a wide range of settings, within defined geographical areas and with an emphasis on primary care. Structures for cancer services have been developed by the Cancer Institute NSW and supported by funding for key positions, such as directors of cancer services and cancer services development managers and many other frontline positions, especially in psycho-oncology. A number of key cancer networks are embedded and multidisciplinary teams are well established.
The cancer services structure developed as a direct result of programs and policies implemented during the previous cancer plans is a key platform on which achievements in cancer control sit. The improvements in cancer control to date must now be built upon while simultaneously being part of, and responsive to, current health reform.
Australian Government
The Australian Government’s commitment to cancer control is reflected in the establishment of an expanded cancer control agency – Cancer Australia (now incorporating National Breast and Ovarian Cancer Centre) – the national government agency working to reduce the impact of cancer on all Australians. This agency provides advice to government about cancer policy and priorities, and works in partnership with key stakeholders to improve outcomes for all people affected by cancer, particularly for those people whose survival rates or cancer experiences are poorer.
The Australian Government also contributes substantial funding and provides overall coordination and policy formulation for screening for cancers such as breast and cervical cancers. For breast cancer, funding to State governments supports their primary responsibility for the implementation of the program at their local level. For cervical cancer, general practitioners and women’s health nurses provide the majority of Pap tests.
The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes sets out specific action to be taken by all levels of government to address the gap in health outcomes experienced by Aboriginal and Torres Strait Islander people. The states have specific responsibilities in areas including tackling smoking. Strategies in this cancer plan to improve cancer control for Aboriginal people will reflect this national agreement.
Importantly, the NSW Cancer Plan 2011–15 will be delivered in an environment characterised by large scale reforms to health within Australia. The implementation of Local Health Networks, use of activity based funding and other reforms will deliver opportunities for cancer control.
General practice, community health services and Aboriginal health services are key collaborators if we are going to achieve better cancer outcomes. This plan seeks to work closely with all service providers.
The NSW Cancer Plan 2011–15 will be flexible to ensure it can adapt to the changing operating environment in which it will be implemented.
People with cancer, their carers and consumer groups and organisations
Consumer preferences, attitudes and experiences help to inform the priorities in cancer control and delivery of services. The ability to respond to issues and ensure inclusion of consumer priorities is paramount in developing this cancer plan.
Equally important is the need to ensure the community is aware of the need to support cancer control initiatives based on best evidence and best use of available resources.
Cancer charities
Cancer fundraising by not-for-profit foundations and charities is an essential and critical part of the cancer control effort in NSW. The cancer charities sector raises in excess of $100M per annum, which is directed towards cancer research, support and control programs. The Cancer Institute NSW engages the NSW cancer charities, particularly to strengthen coordination and collaboration of research and support activities.
The Cancer Council NSW is the largest cancer charity in NSW, supporting programs in excess of $50M per annum. The Cancer Council plays a major role in cancer control in NSW and is dedicated to working with the community to prevent cancer and reduce the impact through research, education, advocacy and the care and support of people affected by cancer.
Private sector
More than 50 per cent of all cancer care is provided by the private sector. Ensuring best models of care and equitable outcomes across the health system are crucial if cancer outcomes are to further improve.
Consultation with key stakeholders
A comprehensive consultation process has been undertaken by Cancer Institute NSW to seek input from key stakeholders in cancer control, including
- Evaluation of the programs implemented in response to the NSW Cancer Plan 2007–10 to determine the extent to which they achieved their desired outcomes and their impact
on cancer control. - An invitation to provide written submissions to the Cancer Institute NSW about key issues in cancer control.
- Ten workshops involving key stakeholders – consumers, government, health care professionals, researchers in:
Prevention
- Tobacco control
- Skin cancer prevention
- Strategic research
Screening
- BreastScreen
- Cervical screening
Services and education
- NSW Oncology Group Rural Forum
- General strategic forum
Research
- Strategic research
- Clinical Trials
Improving cancer outcomes for Aboriginal people
Subsequently, a workshop was held with key cancer control leaders in the State. Internationally recognised experts were also invited from interstate to provide a broader perspective on cancer control. This workshop synthesised the key themes that emerged from previous consultations and reviewed and suggested potential strategies that will lead to maximising the cancer control effort in NSW.
The Board of the Cancer Institute NSW also provided key direction in the NSW Cancer Plan 2011–15.
Key strategic themes
During this planning process a number of key strategic themes emerged that have informed the development of this cancer plan:
The need to further decrease the variation in outcomes
- Focus on developing individual strategies that are embedded in the cancer plan for the next five years and beyond for Aboriginal people, culturally and linguistically diverse communities and geographically isolated people.
- Understand the variations in outcomes at a systems level such as: outcomes in low volume, high complexity surgical treatment; using data to understand reasons for the variations; and to identify and implement ways of improving care.
The need to build new and enhance existing partnerships and collaborations
Enhance and strengthen the engagement and partnerships between key stakeholders in cancer control between:
- cancer patients and their carers
- governments
- health service providers, in particular the primary and community care sector
- cancer control agencies/research institutions/funding agencies
- private organisations
- sectors beyond cancer control.
The need to more effectively use data to develop evidence and drive policy and practice
- Use the breadth of data available to monitor performance and support the implementation of best evidence practice.
The need to more rapidly translate evidence into clinical practice
- Understand better how to facilitate uptake of new evidence into practice and develop a system wide approach to the implementation of research outcomes.
The Cancer Institute NSW then developed a concise matrix of key objectives, strategies, activities and measures for anticipated outcomes. This document was the basis of further consultations.
