Journal of the New Zealand Medical Association, 08-August-2008, Vol 121 No 1279
Lack of progress in New Zealand’s Cancer Control Strategy
Failure to implement New Zealand’s Cancer Control Strategy according to agreed timelines will cost New Zealand many deaths from preventable cancer. The audit of the first 2 years' progress on implementing the strategy (Tracey et al. Mapping progress: the evaluation and monitoring work of the Cancer Control Council of New Zealand 2005–2007. http://www.nzma.org.nz/journal/121-1279/3192) gives cause for concern. Eighty-five percent of agreed milestones have not been reached.
The Cancer Control Strategy 2003 is a framework for reducing the incidence and impact of cancer in New Zealand, and reducing cancer-related inequalities. It extends across the cancer continuum from prevention and screening, to treatment, and palliative care. The Cancer Control Council (CCC) is responsible for making sure that the Strategy is turned into action. It is an independent advisory body appointed by the Minister of Health and gives strategic advice to the Minister and the cancer community. Its first key task is to monitor and review implementation of the Cancer Control Strategy. To that end, it agreed on an action plan in 2005, which outlined in detail how the Strategy’s objectives can be achieved.
The action plan included measurable goals for 152 milestones to be assessed after the first 2 years of the 5-year action plan. The Council is to be commended for pre-specifying the processes of evaluation, monitoring, and reviewing progress in implementation of the plan. If Tracey’s article was the basis of a school student’s NCEA report card, the report would look like this:
Although Tracey’s paper is described as a viewpoint article, it could also be classified as an audit. Just as clinical medicine can audit treatment outcomes, bureaucracies can audit performance against pre-specified goals. The methods of information acquisition for this audit have revealed ongoing problems. Sector interest groups were asked to provide data to Council specifically for this report, but commented that the data, in many cases, had already been provided to another arm of Government. For any organisation to be efficient, information systems need to be able to provide timely, accurate and relevant data and provider arms should need only to provide input into one system.
The data gathered and reported here by Tracey formed the basis of the Cancer Control Council publication The first two years of the Cancer Control strategy activation plan 2005–2010. Following publication of that report, stakeholders—including Ministry of Health, DHBs, and NGOs—met in late 2007 to discuss progress. Four themes emerged from that meeting:
Feedback has provided clear directions for the Cancer Control Council. Suggestions included: identify key indicators that reflect the breadth of work across the cancer control continuum rather than monitor 152 milestones; actively engage with the Ministry of Health to reduce duplication of monitoring effort; identify project areas where more in-depth investigation would add value to monitoring the action plan; re-define the list of phase II priorities; and ensure sufficient infrastructure is in place for the success of phase II.
It must be noted that the CCC monitors progress, or lack of it, but it is not responsible for implementing the strategy. That is the role of the DHBs and the MOH, hopefully involving NGOs and consumers, presumably co-ordinated by the four regional cancer networks.
The successful cancer control programme in the UK is a model worth revisiting. Unlike New Zealand, significant additional financial resource was applied to the cancer sector including funding of research and treatment. It is possible that New Zealand’s slow progress has resulted from failure to commit financial resource despite developing a significant organisational infrastructure. Similarly, the rapid progress in cancer control in NSW, Australia has been achieved by having a clear strategy, strong leadership including an assistant minister of health (cancer services), and improved funding.
In New Zealand, the failure to meet phase I milestones should provide further impetus to the challenge of fighting cancer. There are people with talent; there are organisations with drive and energy, and there are processes in place that should allow successful implementation of the cancer control strategy. The next annual report from the Cancer Control Council should be keenly awaited by all who are interested in reducing the impact of cancer in New Zealand.
Competing interests: None known.
Author information: Christopher Wynne, Oncologist, Radiation Oncology, Christchurch Hospital, Christchurch
Correspondence: Dr Christopher Wynne, Radiation Oncology, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand. Email: Chris.Wynne@cdhb.govt.nz
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