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‘Post-code’ lottery criticised by Seanad hopeful

22 Apr 2016

Dr Paul D’Alton

Cancer care, end-of-life care and mental health are the main priorities for Dr Paul D’Alton, a first-time candidate for Seanad Eireann in the NUI constituency.

Dr D’Alton, a Senior Clinical Psychologist, is Clinical Lead of the Department of Psycho-oncology at St Vincent’s University Hospital and Adjunct Lecturer at the School of Psychology at UCD. His platform will principally centre around health and education.

Dr D’Alton, who has worked at national policy level in the fields of cancer care, end-of-life care and mental health, explained: “It would be a real shame if Prof John Crown’s work in highlighting cancer issues were not maintained, in the wake of his exit from the Seanad.”

As part of his campaign, Dr D’Alton — who has contributed to Prof John Kennedy’s national cancer strategy (2016 to 2025) — aims to highlight the deficiencies in psycho-oncology services nationwide.

While he believes psycho-oncology must be central in implementing the new strategy, only two of the eight cancer centres have a dedicated psycho-oncology service.

“There is a post-code lottery. In one hospital services meet international recommendations, in other hospitals they do not. That is not fair: it is not the kind of cancer service that we want or what patients deserve. It is a very serious gap in cancer care — across all cancers. There are national recommendations going back 18 years, stating that psycho-oncology is key in cancer treatment. The first report was in 1998,” Dr D’Alton told IMT.

Service gaps were particularly evident in the adolescents and young adults (AYA) with cancer services. “At a national level, in terms of specific services, we are decades behind recommended practice and decades behind our European and North American counterparts,” he said. “We see from the literature that patients are not being diagnosed until much later in their disease trajectory, for a whole host of reasons.

“When patients are being treated, they are not being treated in the right environment. Cancer patients are often treated in hospitals that are inappropriate to their ages,” he said.

In Britain by contrast, there were dedicated AYA services, which were multi-disciplinary in nature. These range from the pre-diagnosis stage and include behavioural interventions, treatment and end-of-life care.

In some cases, patients with significant mental health issues — who contract cancer — are twice as likely to die, as people who do not have such issues. That, Dr D’Alton said, was unacceptable, and mental health patients needed additional supports to make their way through a medical system.

“It can be very challenging for mental health patients to keep appointments and to keep with particular medical regimes, for example. The system does not always facilitate them and they need support,” he said. “They have provided the required supports for people with mental health difficulties in other parts of the world.”

There have been more than 500 suicides yearly in this country for the last decade. That issue also needed to be addressed as a matter of urgency at primary care and Child and Adolescent Mental Health Services (CAMHS) level. Yet there was great variation across the country, in terms of access to CAMHS, he pointed out.

Minister Kathleen Lynch, whose brief includes mental health, had accepted that in some areas there were difficulties with CAMHS.

An investigation last year sought to determine the reasons why there were 3,200 people on the CAMHS waiting list as well as the lengths of their waits.

It was discovered that 250 people should not have been on the waiting list and these were redirected to primary care services.

There has been progress, but in areas where the CAMHS waiting lists remain stubbornly high a different approach is needed, according to the Department of Health. Children and adolescents need to be assessed, treated and managed in as timely fashion as possible.

The other large cohort of children on the waiting list were referred to CAMHS via the National Educational Psychological Service (NEPS). This group typically had the longest waits because the resources they would need when they returned to education were a factor.

“GPs know the difficulty in trying to get kids seen,” Dr D’Alton said. “In some areas, the waiting time is utterly unacceptable. For young adults with mental health difficulties, waiting lists do not work. The situation gets worse. In Ireland, an ‘acceptable level of waits’ has emerged and that cannot be tolerated.”

Access to primary, secondary and third-level education are also priorities for the Seanad candidate.

A focus on well-being at the very early stage of life (the first 1,000 days, in particular) was also key, in his view.

“This is crucial to ending the cycle of poverty. Access to third level for people from disadvantaged communities too, has not greatly improved,” Dr D’Alton added.

Gary Culliton

Click here to view the full article which appeared in Irish Medical Times