Barriers andenablers

Stakeholders identified Australian Government endorsement of the Plan, and the shared strategic direction it provides, as a foundational enabler of implementation. The Plan’s status as a nationally endorsed framework enabled organisations to justify priorities, align activity, and strengthen funding bids in ways that voluntary frameworks cannot replicate. The Plan's shared priorities, language, and policy narrative provided a nationally recognised reference point that organisations could draw on to support advocacy, partnership development, funding proposals, and policy negotiation. Stakeholders reported that where this authorising environment was actively leveraged, organisations were better positioned to act on and justify alignment with Plan priorities and account for that action to funders, governments, and partners.

Dedicated funding and formal partnership structures were identified as the most direct enablers of on-the-ground implementation, helping to convert strategic intent into coordinated activity. Funded initiatives and grant programs, including the Australian Cancer Nursing and Navigation Program, Partnerships for Culturally Safe Cancer Care grant program, and MRFF-aligned grant rounds, were consistently reported as enabling organisations to initiate, scale, and sustain the Plan’s implementation activity that would otherwise not have been possible within existing operational budgets.

Formal partnership structures — particularly the Implementation Partnership model — were identified as important mechanisms for translating goodwill and informal collaboration into defined commitments and coordinated action. Stakeholders noted that collaboration was most productive and most likely to drive implementation when linked to specific funding streams, accountability arrangements, and formal agreements. Where these structures were absent, collaboration was often more diffuse and harder to sustain over time.

In addition to the foundational system reforms, state and territory cancer agencies and dedicated jurisdictional cancer governance, networks and programs were identified as key enablers of implementation. They serve as intermediaries, translating national direction into local action. Their capacity to maintain institutional knowledge, coordinate across health service providers, and align jurisdictional cancer plans with the Plan was consistently highlighted as essential to sustained implementation progress. Stakeholders noted that jurisdictions with dedicated cancer agencies or established cancer networks were better positioned to engage with and act on Plan priorities, with implications for consistency of implementation across jurisdictions.

Cancer Australia's role as a dedicated national cancer agency was consistently identified as a distinct enabler of implementation — extending beyond the Plan itself through its influence, leadership, and active engagement with jurisdictions, convening sector partners, building capability, and maintaining relationships across the cancer control system.

This leadership and coordinating role was reflected in a range of ways in practice, including the establishment of national initiatives such as the ACCN, the generation and brokering of evidence through data initiatives, reports, standards and frameworks, and active support for jurisdictional alignment and implementation.

This coordinating role was particularly valued by smaller organisations and less-resourced jurisdictions, where Cancer Australia's direct engagement provided implementation support that complemented – and in some cases supplemented – existing state and territory infrastructure and capacity. Stakeholders across all groups consistently regarded Cancer Australia's leadership as a significant factor in enabling coordinated national action and strengthening system-wide coherence in cancer control, with its effectiveness as a convener and relationship-builder consistently cited as a genuine system asset.

The absence of dedicated, sustained implementation funding is the most consistently reported barrier across all stakeholder groups. Funding constraints limit the scale, pace, and sustainability of initiatives, with smaller organisations, priority population sectors, and less-resourced jurisdictions most affected. Stakeholders highlighted a fundamental tension between the Plan's ambitions and available resourcing, with implementation often reliant on short-term project funding or discretionary organisational effort rather than investment explicitly aligned to Plan priorities.

Fragmented, delayed and poorly integrated data systems constrain both implementation and outcome achievement. Without reliable, timely, and linked data, the system cannot effectively monitor progress, target interventions toward areas of greatest need, or demonstrate impact.

Stakeholders identified key data constraints including the absence of a single national data system, delays in cancer registry data, limited integration of patient-reported measures (Patient-Report Experience Measures (PREMs)/Patient Reported Outcome Measures (PROMs)) into routine care, and underutilisation of existing data assets for system learning.

Progress on the Data Framework was recognised as an important step, with stakeholders noting that realising its full potential — alongside other national foundational frameworks — will require sustained, coordinated investment and implementation across governments and sectors.

Australia's federated health system creates persistent complexity in roles, responsibilities and accountability across Commonwealth, state and territory, and sector partners. Stakeholders identified role ambiguity – particularly between Cancer Australia, the Commonwealth Department of Health, Disability and Ageing, and state and territory governments - as a barrier to coordinated implementation, contributing to duplication of effort, inconsistent adoption of Plan priorities, and challenges translating national frameworks into local service delivery contexts. Differences in jurisdictional capacity mean some states are better positioned to implement the Plan than others, with implications for consistency of implementation and equity of outcomes nationally.

Workforce shortages and organisational capacity constraints represent a direct limit on the system's ability to deliver and sustain new initiatives. Stakeholders identified shortages in nursing, allied health, and the Aboriginal and Torres Strait Islander cancer care workforce, and in regional, rural and remote settings where services are already under pressure. Implementation activity is frequently undertaken in addition to existing workloads without additional resourcing or dedicated support, contributing to implementation fatigue and uneven progress across settings. Workforce development — including culturally safe training, pipeline investment, and Aboriginal and Torres Strait Islander leadership pathways — was identified as both a significant constraint and a priority for the next phase of the Plan.

Aboriginal and Torres Strait Islander stakeholders identified implementation challenges that, while connected to broader system barriers, reflect their distinct position within the cancer control landscape.

The coexistence of the Plan and the NACCHO Aboriginal and Torres Strait Islander Cancer Plan — while broadly understood as complementary — has created some uncertainty about roles, responsibilities, accountability, and where to direct engagement. The absence of clear guidance on how the two plans interact has added to implementation complexity and consultation burden for Aboriginal and Torres Strait Islander stakeholders and organisations.

Stakeholders also identified a consistent mismatch between equity commitments and available implementation support — with insufficient resourcing of the Aboriginal and Torres Strait Islander community-controlled sector, high consultation burden, and limited shared accountability across the broader system. Stakeholders expressed concern that responsibility for achieving equity outcomes may fall disproportionately on under-resourced Aboriginal and Torres Strait Islander organisations, and emphasised that realising the Plan’s equity ambitions will require sustained investment and genuine system-wide accountability.