Gino Kenny: Urgent Care Failures for Terminal Cancer Patients

Good morning everybody and happy St. Bridges Day, the first day of the Irish Spring, a very positive day of the year, just my first questions in relation to those that have a terminal cancer diagnosis that present themselves in ED departments, what is the kind of the international practice for those that present themselves in ED departments with their condition deteriorating and so forth, because I just had first-hand experience as of late as a person in my family that have gone to the ED department and spent an enormous amount of time there, which was just rigorous belief, but where, you know, the system has to be better than somebody who's staying two days in Australia that is terribly ill, it's quite incredible, but is there international practice where actually that doesn't happen? Because it's just, it's just unacceptable that, you know, somebody could be in that situation waiting two days in the ED department. Is there another system that, you know, that has been done elsewhere where people wear terrible illness and are not, you know, and not, you know, allowed to stay in the ED department for that long? Thank you. And I'm so sorry to hear that you had that experience. It's a horrific, like, as I mentioned, like, it's awful going through cancer at all, but having to go through an ED department, particularly at the minute, is just crazy and it just adds to the distress. I mean, best practices, you wouldn't be going to an ED at all. Cancer would have separate pathway and people wouldn't have to go to an ED to try to, be triage to be seen by somebody from the cancer services. They'd have a separate pathway to that care. We understand, so the NCCP have said that there are acute oncology triage services are ensuring that patients can be assessed without attending ED. But we often hear from patients who do have to go to emergency departments to access care, so I think that would be a good one to raise with the representatives from the NCCP when they are in. We hear as well of healthcare professionals telling us that they have to, particularly over the weekends, that that is the only way that their patients, including those with a terminal diagnosis, can actually get into the system is to have to go through emergency departments at weekends and overnight. It's intolerable. It's not the practice internationally where you have proper, separate cancer pathways. Yeah. And what would that practice be? Sorry, can I cut across you there? Just saying on the same issue, it would make more sense if, say, you're attending St. Luke's and James', that you go to the A&E in St. James', where their files are on. Would that be advice you would give people that, if they're attending a particular hospital, if you're going to have to go to an A&E, that you should go to where your files are? It would probably help the staff in the A&E, and maybe would you like to think that would speed the process in relation to that? Sorry for cutting across you, Chino. Well, I think part of the challenge is people may not necessarily be getting their cancer treatment in the nearest hospital, right? So they may be, for good reasons, as I mentioned, it makes sense. Like, it's better that they're going to a centre of excellence that they're going to one of the cancer centres. But then if you have an emergency, you know, the ED, you'd normally go to the local hospital. But as I said, in other countries, there will be separate pathways for that. And say, for example, even if you were getting your cancer treatment in James', and then you have an emergency, or if you're in extreme pain, yes, going to James' means that they have your files, but you shouldn't be going to an ED department to get that. It'd be better if you were going through a cancer pathway in James'. I am an out of hours service for cancer patients. Rather than sitting in a crowded waiting room, like even things for people who are on cancer treatment, I am, I'm, I know you all know from COVID as well that like the infection risk is so much greater. So like, like it's terrifying to think that you have to go through an overcrowded A&E and put yourself at that risk to get access to urgent care. So it's just not acceptable really that the ED that for many people in particular out of hours, it's the only route into the hospital. It shouldn't be that way. And does, you know that pathway we're talking about, that better pathway by the kind of, kind of, going not via the ED departments? Does that exist anywhere in Ireland? That other kind of alternative? I think, Deputy Kenny, just in relation to like what's happening elsewhere, I think that everybody agrees that it's not the ideal pathway and that other countries are doing it, are doing it, are doing it better than, than we are in Ireland. But I do know that there were 26 oncology nurse appointments that were made by the NCCP to try and avoid patients going through emergency departments. However, like Avril said, we are hearing that, you know, people still do, do have to do that. And there is, again, to refer back to the NCCP strategy and to underline the fact how important this strategy is, there is a target there to reduce the number of people who go through emergency departments to fewer than 20% if they're on active treatment. But, sadly, that metric or that KPI expired in 2018. So, it just goes to demonstrate the fact that the National Cancer Strategy, I think, really is the blueprint for what we need to do in cancer services. And when it's not implemented, there's a sad experience that you describe in your own personal situation. They continue to happen. And somebody said to us recently, you know, we're talking a lot about statistics today. And, you know, these, these high percentages of people who aren't getting the care that they need. And a medical oncologist said to us that statistics are people with the tears wiped away. And I think that that's something that we reflect on a lot, that when we do talk about these 20% or 40%, whatever it is, there's high, high numbers of people who are having an inferior experience in the Irish health system today. Just my final question. I know April has alluded to the report that's out in the National Cancer Registry, Ireland, the report about inequalities in relation to cancer care. And I think Gabriel has generally answered it. And I think as long as you have inequalities in our health system, you're going to have this kind of, you know, inequality shown in relation to particularly diagnostic care. Because, you know, if somebody has more kind of access to better health care in relation to a financial kind of sort of setting, they will get, you know, diagnosed quicker than somebody that has less resources. And obviously, this is quite a complicated field. There's no doubt about it. It's not going to be, it can be simply answered. But it's quite alarming that 28% of people will, in the less affluent area, will have a higher risk of cancer. And there is a number of factors involved. But, you know, I think one of the main factors is access, accessibility. Because it makes sense if you, you know, if you get a test or diagnosis or an MRI, whatever it is, months and some way, sometimes years before somebody that's on the public health system, it will save, it will save their life. There's no doubt about that. And so just, yeah, if you could comment on the report today by the National Cancer Registry or Ireland. Thanks. I mean, sadly, look, today's report, it's not news to us because, you know, it's long been established that there are those inequalities. We know, Rachel mentioned, for example, that, like, cancer is being picked up in the ED departments. That's much more likely for somebody from a disadvantaged area. Particularly, I mentioned as well, say, like, higher rates of smoke in disadvantaged areas. 25% of lung cancers are picked up in the ED departments. And, again, that's often people from poorer backgrounds who are being diagnosed then with a hard-to-treat stage 3 or 4 lung cancer. And that will almost certainly take their life, or at least, you know, the prognosis isn't good when it's picked up that late. So, like, it's, you know, I just think, like, it's, again, again, Rachel said we can be desensitized things. But it's absolutely just horrifying to think that, you know, in Ireland in 2023, we're one of the, you know, one of the best, one of the most well-off countries in the world, that people are dying of cancer just because they're poor. You know, that, like, and we've seen statistics published before as well, for example, where they've shown that you're three times more likely to get and to die of cancer in Mullhudder than you are in Castlenock. Like, two areas that are side by side, but where people have radically different outcomes, primarily because of their income and, as you said, access to diagnostics. And it's just, it's not good enough. And it's like, we're like, we're also really deeply worried that today's figures are for 2018. And like that, like having such a differential, you said 28% higher mortality rate in 2018. We have no doubt, Deputy, that it is a lot higher than that now. Because of what we've picked up about what's been happening, the impact that COVID has had, the widening inequality because of COVID. Our health services are much more difficult to access right now for everybody, but particularly for those from disadvantaged communities and lower outcomes. So, like, we're really worried that it's actually a lot worse than the picture that's been painted in that report today. And the frustration, I think, well, one of the frustrations on our part is that we've been highlighting this for as long as I remember, and I know that members of this committee have as well about the inequity in healthcare and specifically in cancer and cancer outcomes. So, when you look back on the last decade and you see health inequalities that are highlighted in this report, that the reporters are saying that there has been no difference in terms of the gap between those who are best off and those who are least well off. And that that's, I think, the most startling finding for us in the Cancer Society, that despite everything we know about health inequalities, that there has been no progress. That is really, really disheartening and extremely worrying.