National Cancer
Programme
Work Plan 2012/13
Citation: Ministry of Health. 2013. National Cancer Programme: Work Plan 2012/13.
Wellington: Ministry of Health.
Published in January 2013 by the
Ministry of Health
PO Box 5013, Wellington 6145, New Zealand
ISBN 978-0-478-40243-8 (online)
HP 5614
This document is available at www.health.govt.nz
Contents
Overview
1
Introduction
1
Strategic context
1
Cancer is the leading cause of death
1
Survival ratios are improving
2
Health care costs are rising
2
Priority areas have been identified to provide better and faster services for cancer
patients
3
National Cancer Programme for 2012/13
4
Work Plan 2012/13
5
Key work plan initiatives
5
Wait times: all people get timely services
5
Access: all people have access to services that maintain good health and
independence
7
Quality: all people receive excellent services wherever they are
8
Financial sustainability: All services make the best use of available resources
9
National Cancer Programme: Work Plan 2012/13
iii
Overview
Introduction
The National Cancer Programme brings together the work of the Ministry of Health
(the Ministry), district health boards (DHBs) and regional cancer networks to
implement the Government’s priorities for cancer.
This high-level work plan for 2012/13 covers the national priorities for cancer. Ministry
business plans, DHB annual plans and regional cancer network annual plans include
more specific detail on the work these groups are leading.
The National Cancer Programme is an integrated work programme. At a national level
the Ministry team works with the National Health Board, Health Workforce New
Zealand and the National Health IT Board to improve the coordination of health sector
planning and service delivery, and achieve the National Cancer Programme priorities.
While this work plan focuses on cancer-related initiatives, there are established links
between the delivery of this work plan and initiatives being led by the National Health
Board, Health Workforce New Zealand and the National Health IT Board.
Strategic context
The National Cancer Programme Work Plan is organised under four focus areas
aligning with the Government’s vision of Better, Sooner, More Convenient Health Care.
The work plan supports the overall purpose of the New Zealand Cancer Control
Strategy to reduce the incidence and impact of cancer, and reduce inequalities with
respect to cancer incidence and mortality.
Cancer is the leading cause of death
Cancer is the country’s leading cause of death (29 percent) and a major cause of
hospitalisation. Most New Zealanders will have some experience of cancer, either
personally or through a relative or friend.
The incidence of cancer is 20 percent higher for Māori than for non-Māori, but cancer
mortality is nearly 80 percent higher for Māori. Māori are also more likely than nonMāori to have their cancer detected at a later stage of disease spread.
Residents of more socioeconomically deprived areas are more likely to develop cancer,
less likely to have their cancer detected early, and have poorer survival than residents of
less deprived areas.
National Cancer Programme: Work Plan 2012/13
1
While the overall risk of developing cancer in New Zealand is decreasing, New Zealand
has an increasing number of people who are developing cancer, mainly because of
population growth and ageing. The total number of cancer registrations is projected to
increase by approximately 21 percent from 2006 to 2016.
In addition, once people are diagnosed with cancer they are now less likely to die from
it. This means that people are surviving longer, and being treated for longer periods of
time, with different treatments.
Survival ratios are improving
The Ministry’s most recent cancer survival publication (2012) shows that between 1994
and 2009, the five-year cumulative relative survival ratios showed statistically
significant improvement for adults (both males and females).Survival increased for
both Māori and non-Māori, however the Māori increase was not statistically significant.
The Organisation for Economic Cooperation and Development (OECD) Health Care
Quality Indicators Data 2009 used three cancers as indicators of how well countries
were delivering cancer care (breast, cervical and colorectal cancer). The indicators
showed New Zealand’s relative survival ratios for all three cancers were above the
OECD average. The OECD data also showed improved survival rates for patients with
breast and cervical cancer from 2002 to 2007 compared to 1997 to 2002 (the data was
unavailable for colorectal cancer).
Health care costs are rising
Overseas studies indicate that cancer costs are likely to increase at a faster rate than
overall health expenditure. As the population ages, the total number of people treated
for cancer will increase at a faster rate than the overall population. Costs are also likely
to increase as new, more advanced and more expensive treatments are adopted.
The Ministry (based on 2008 registrations and 2008/09 prices) estimates that
$511 million per year was spent on cancer treatment services by the publicly funded
New Zealand health system. This represented about six percent of the total public
health expenditure, which is in line with estimates from the United States and
Australia.1
1
2
This estimate does not include costs borne by individuals, insurance-funded or out-of-pocket
expenditure in the private system, expenditure by non-government organisations (NGOs)
supported by charitable funding, the value of volunteer contributions, and expenditure on
research. It also does not include the cost of preventive or screening programmes. The two
national screening programmes, BreastScreen Aotearoa and the National Cervical Screening
Programme, currently cost approximately $80 million per annum. The estimate does not
consider the costs of morbidity and mortality nor the savings that might result from reduced
morbidity and mortality.
National Cancer Programme: Work Plan 2012/13
By 2021, the Ministry estimates public expenditure on cancer treatment services will
increase by an additional $117 million (23 percent). This estimate is based on current
models of care and projected cancer incidence growth. The estimated expenditure does
not adjust for the impact of new technologies, improved survival, reduced mortality or
earlier detection of some cancers. As a result the estimated expenditure for 2021 is
likely to be an underestimation.
Priority areas have been identified to provide
better and faster services for cancer patients
Budget 2012 is delivering an additional $33 million in operating funding over the next
four years for better and faster services for cancer patients. The $33 million includes
funding for dedicated nurses, who will coordinate care and support individual patients
during their cancer treatment. From 1 July 2012, DHBs will collect data at key points
along each cancer patient’s clinical journey to begin measuring the length of time it
takes for patients to track through the diagnostic and treatment pathway.
The Budget 2012 ‘Faster cancer treatment initiative’ builds on the success of the
‘Shorter waits for cancer treatment’ health target that has focused on radiotherapy wait
times. From 1 July 2012 chemotherapy wait times was also included in the health
target.
In Budget 2010 the Government prioritised funding for a four-year bowel screening
pilot (undertaken in the Waitemata DHB region) to inform future decisions on whether
bowel screening should be rolled out nationally. To support a possible national roll-out
of bowel screening, a quality improvement programme is being implemented to
support endoscopy service provision. A key feature of this work is the Global Rating
Scale (GRS), a web-based tool that allows endoscopy units to self-assess against a set of
standards. The GRS tool is currently being trialled at four DHBs (Waitemata, Lakes,
Wairarapa and Canterbury).
The Government is committed to improving national and regional planning of services,
improving essential infrastructure, and improving clinical leadership and engagement.
The projects over 2012/13 that address this include:

implementing a new model of care for medical oncology

national service planning for radiation oncology services

developing a quality improvement plan for prostate cancer.
Budget 2009 provided additional funding for hospices as part of the Government’s
commitment to improving access to essential palliative care services. The Budget also
provided funding to widen access to Herceptin (drug used in the treatment of breast
cancer).
The diagram below shows how cancer programme priorities link to the Government’s
priorities.
National Cancer Programme: Work Plan 2012/13
3
National Cancer Programme
for 2012/13
4
National Cancer Programme: Work Plan 2012/13
Work Plan 2012/13
Key work plan initiatives
Over 2012/13 DHBs, the Ministry and regional cancer networks will deliver the
following initiatives in each of the four focus areas. The lead agency is named under
each initiative.
Wait times: all people get timely services
The Government is committed to Better, Sooner, More Convenient Health Care. For the
National Cancer Programme this means improving access to, and shorter waiting times
for cancer treatment.
Key performance
indicators
Initiatives
Everyone needing radiation
Report against the ‘Shorter waits for cancer treatment’ target
treatment or chemotherapy will on a monthly basis.
have this within four weeks.
Undertake national radiation oncology capital and service
planning by June 2013.
Planning will provide national direction to DHBs on future
service requirements to support DHBs to sustainably meet
the health target. It will also update previous plans.
Implement phase one of the medical oncology models of care
plan by June 2013.
A new model of care for medical oncology has been
developed to ensure services can effectively, equitably and
sustainably meet future demand, given workforce and
resource trends. Over 2012/13 the priority areas are:

workforce (senior medical officers and nursing)

service configuration (assessing the new model against
current service provision)

quality standards across tumour streams.
Lead: The Ministry, DHBs
National Cancer Programme: Work Plan 2012/13
5
Key performance
indicators
Initiatives
Baseline reporting against three Implement the faster cancer treatment work programme.
new faster cancer treatment
1. Appoint cancer nurse coordinators across all DHBs by
pathway indicators:
June 2013.
 62 day indicator – all
The cancer nurse coordinators will act as a single point
patients referred urgently
of contact and assist patients and their families across
with a high suspicion of
different parts of the health service, ensuring care is
cancer receive their first
coordinated and appropriate support is provided.
cancer treatment (or other
management) within 62 days
2. Develop treatment standards across eight tumour types
 14 day indicator – all
by June 2013.
patients referred urgently
Treatment standards aim to improve overall care by
with a high suspicion of
ensuring consistency of care. Nationally developed
cancer have their first
standards will be implemented regionally. The
specialist assessment within
standards will be used to develop key performance
14 days
indicators that will be audited and used to drive
 31 day indicator – all
improvement in services.
patients with a confirmed
3. Report baseline data against the three faster cancer
diagnosis of cancer receive
treatment indicators by March 2013.
their first cancer treatment
(or other management)
Reporting against these indicators will provide
within 31 days of the
information to support service improvement so that
decision-to-treat.
patients have faster access to a specialist once cancer is
suspected, and then faster access to treatment once
there is a confirmed diagnosis.
Lead: The Ministry, regional cancer networks, DHBs
6
National Cancer Programme: Work Plan 2012/13
Access: all people have access to services that
maintain good health and independence
Reducing risk factors and improving early diagnosis contribute to reducing the
incidence of cancer and improving survival rates. The National Cancer Programme is
focused on ensuring people have access to smoking cessation advice and participate in
appropriate screening programmes.
Key performance indicators



95 percent of patients who
smoke and are seen by a health
practitioner in public hospitals
will be offered brief advice and
support to quit smoking.
Initiatives
Implement the ABC approach for smoking cessation in
the hospital and primary care settings.
The ABC approach is:

Ask all people about their smoking status

provide Brief advice to stop smoking to all people who
smoke
90 percent of patients who
smoke and are seen by a health
practitioner in primary care will 
be offered brief advice and
support to quit smoking.
offer evidenced-based Cessation treatment.
Lead: DHBs and primary health organisations
Progress will be made towards
90 percent of pregnant women
who smoke being offered advice
and support to quit.
Monitor the bowel screening pilot,
including finalising the service
delivery model and the interim
quality standards by December
2012.
Update the service delivery model with Waitemata DHB
by December 2012.
Migrate all BreastScreen Aotearoa
lead providers from provision of
analogue to digital mammography
by December 2013.
Complete national procurement process of digital
equipment by August 2012 to ensure value for money for
equipment purchased. Implement centralised Picture
Archiving Communication System (PACS). Centralise the
information system for all BreastScreen Aotearoa lead
providers.
Finalise the interim quality standards by December 2012.
Lead: The Ministry and Waitemata DHB
Lead: The Ministry,
BreastScreen Aotearoa lead providers
Increase cervical screening
coverage2 to 80 percent for all
ethnic groups by 30 June 2014.
Monitor the National Cervical Screening Programme
against national standards, indicators and targets.
Implement the recommendations of Parliamentary
Review Committee (June 2011 Report).
Lead: The Ministry
2
Women aged 20 to 69 years screened in the previous three years.
National Cancer Programme: Work Plan 2012/13
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Quality: all people receive excellent services
wherever they are
Differences in access to and quality of health services may generate inequalities in
cancer survival. Standardising models of care and treatment pathways can help reduce
unnecessary variation in treatment and outcomes.
Key performance indicators
Initiatives
Prostate Quality Improvement Plan Develop a quality improvement plan relating to the early
presented to Cabinet by March
detection and treatment of prostate cancer.
2013.
Lead: The Ministry with the Prostate Cancer Taskforce
Increase the percentage of lung and
bowel cancer patients reviewed at
multidisciplinary team meetings by
DHB and by ethnicity (reported
six-monthly to the Cancer
Programme Steering Group).
Implement the Budget 2012 initiative to roll out
multidisciplinary meetings for all main cancer types and
increase the number of cases discussed at
multidisciplinary meetings.
Multidisciplinary team meetings support quality clinical
decision-making and identify appropriate treatment
options, which ultimately improve patient outcomes.
Lead: DHBs and regional cancer networks
Provide advice to the Minister of
Health on implementing the
endoscopy quality improvement
tool (Global Rating Scale) by
January 2013.
Evaluate endoscopy quality improvement tool (Global
Rating Scale) and develop advice on implementing the
tool nationally.
Build the National View of Cancer
by June 2013.
Work with the National Health IT Board to develop a
datamart, combining six national collections to provide a
nationwide view of cancer diagnoses and treatments.
Lead: The Ministry
Lead: The Ministry
Finalise the Palliative Care
Resource and Capability
Framework by November 2012.
Finalise the Palliative Care Resource and Capability
Framework.
The Resource and Capability Framework describes levels
of service for New Zealand to inform DHB planning and
purchasing of palliative care services.
Lead: The Ministry
8
National Cancer Programme: Work Plan 2012/13
Financial sustainability: All services make the best
use of available resources
Cancer and palliative care services could easily absorb significant amounts of new
funding. However, in a constrained economic environment there is limited new funding
available. The National Cancer Programme is focused on improving service delivery
within existing funding by developing new models of care and patient pathways, and
improving the productivity of existing services. Analysing cost and cost drivers for
cancer services is crucial to inform planning and prioritisation decisions.
Key performance indicators
Initiatives
Complete national capital and
service planning for radiation
oncology services by June 2013.
Undertake national radiation oncology capital and service
planning by June 2013.
Planning will provide national direction to DHBs on
future service requirements to support DHBs to
sustainably meet the ‘Shorter waits for cancer treatment’
Health Target. It will also update previous plans.
Lead: The Ministry
Monitor the implementation of
national service plans on a sixmonthly basis.
Monitor national service plans:

Bone Marrow Transplant Services in New Zealand for
Adults – Service Improvement Plan

National Plan for Child Cancer Services in New
Zealand.
Lead: National Health Board, the Ministry
National Cancer Programme: Work Plan 2012/13
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