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Arriving home from my 55th cycle of chemotherapy I waded through the flyers for cheap broadband and 25% off pizza and found a letter from my hospital on the doormat. Usually, the only letters I receive from there are ones informing me when I have an MRI scan, but this one was in response to a question I'd posed at the hospital's annual general meeting back in September. Showing the wonder of the postal system over the Christmas period, the letter was dated December 19 and took 27 days to get to me from the hospital, 10 miles away from my home. I don't walk very far these days, but Google says I could have made it there and back in eight hours.

Anyhow, I digress. My question at the meeting was directed at the chief executive, and I asked her whether she thought the hospital did enough to look after the mental health needs of patients-the letter I received in reply details how a mental health assessment is completed at the Trust. Or, to be precise, it explains how a mental health assessment should be completed.

It says "one of the Trust's aims is for all our patients to have a holistic needs assessment". According to the letter, this should take place at diagnosis and the end of treatment, or at other times should a patient's needs change.

It states that after the assessment, referrals can be made to "appropriate services" within or beyond the hospital trust, including the psychological support service. And apparently, patients can also self-refer to psychological support.

It doesn't answer the question of why holistic needs assessments are not carried out. Someone somewhere has thought about the procedure staff should follow, but no one has thought to ask why staff aren't following it. Why aren't medical teams asking patients about their mental health?

The idea of self-referral is a good one, but how can people self-refer to a psychological service if they haven't been informed that such a service exists?

When I first saw the hospital's dermatologist nine months into my treatment, I was asked why I hadn't done a self-referral. I had to explain that my bowel cancer is my first cancer (and will probably be my last because it's incurable), so I wasn't aware that such a service existed because no one had told me about it.

It will be similar for patients who need mental health support. I learned about the psychological service eight months into my treatment after reading an article in the in-house magazine. If I hadn't picked up the magazine that day, I would have been none the wiser about the service. Surely they can't expect everyone being treated there to have read the spring 2024 issue of the magazine?

And I also have a question about the final line of the letter. It states: "For concerns about your cancer care or mental health, please reach out to your clinical nurse specialist."

I have absolutely no clue who that is, despite my being part of the furniture at my hospital. And, even if I did know, I wouldn't be allowed to contact them directly.

In warmer times, also known as early summer 2024, I emailed a woman in my medical team who I thought could be described as my clinical nurse specialist (even though I have never actually been assigned a specific person).

I got a reply from someone in my medical team saying that the clinical nurse specialists don't have the capacity to respond to the high volume of emails they receive. Instead, I was told to use the hospital's messaging system on the app.

The messages on that system can be read by almost everyone who is involved in my treatment. This is fine when I'm just messaging to ask whether an appointment time can be changed, but if I'm having a mental health crisis, I would not want that to be on a message for lots of the staff to see.

Instead, I would want the privacy of being able to email or call a named person, who would be my point of contact for mental health issues. This would have to be someone I trusted, as I feel trust and confidentiality are two of the most critical aspects of mental healthcare.

So though it's encouraging to know that my hospital does have a procedure for supporting patients with mental health issues, it's bitterly disappointing, as I understand that the process is not followed.

And since our campaign started last January, I've learned that this is the situation for many cancer patients across the country.

It's not good enough for hospital trusts to "aim" for cancer patients to have a holistic needs assessment. It needs to happen. And this needs to be the start, with medical teams regularly asking patients about their mental health issues.