Getting to GRIPS with Chronic Pain in Scotland (PDF, 244KB, 45secs)
Background
This is not the first report on Chronic Pain Services in Scotland. In 1994 the then Scottish Office published ‘The Management of Patients with Chronic Pain’; in 2000 the Clinical Standards Advisory Group published ‘Services for Patients with Pain; in 2002 a SPICE (Scottish Programme for Improving Clinical Effectiveness in Primary Care) report on pain services was published; and in 2004 the Scottish Executive published the ‘McEwen Report’ on Chronic Pain Services in Scotland. All four reports have three things in common: they provide comprehensive information on pain services in Scotland; they report on the enthusiasm and commitment of the staff providing these services; and they highlight that current provision is inadequate to meet the need, that services are unequal between and within boards and that few services achieve comprehensive and seamless care. Despite these reports, which include constructive recommendations, very little has changed since 1994 and if anything, the need for these services is greater.
NHS Quality Improvement Scotland (NHS QIS) was approached by representatives from the Royal College of Anaesthetists, the Cross-Party Group on Chronic Pain, the North British Pain Society and by a range of healthcare professionals and patients all asking whether we could together act as the catalyst that would bring about change. We have worked with all these groups and individuals, and with NHS Boards and we thank them sincerely for their openness and support during the preparation of this report. In particular we acknowledge the work of Janette Barrie who has co-ordinated this project from start to finish. Together we have delivered the most comprehensive stocktake of chronic pain services ever produced and we have reported from every perspective: that of the patients, that of the healthcare professionals providing services; and that of the NHS Boards responsible for strategic planning, funding and delivery of the services. The messages are stark and the actions are clear. We need to stop talking about what is not working and start improving these services as a matter of priority. With ‘Better Health, Better Care’ and the Scottish Government’s Long Term Conditions Alliance we have never had a better opportunity to make a difference and we hope this report will indeed light the touch paper of improvement and change.
Findings
- Despite four nationally commissioned reports in the last ten years and data from surveys indicating high prevalence (18% of Scottish population), chronic pain is not recognised as a ‘condition’ and is not currently included in the key long-term conditions to be addressed by the Long Term Conditions Alliance. As a result, it is not regarded as a priority by Scottish Government Health Directorates (SGHD) or by NHS Boards.
- The provision of chronic pain services within Scotland is patchy and fragmented particularly for core secondary services. Service provision and access to services varies considerably between and within NHS Boards and we found little evidence of needs assessment or strategic planning for chronic pain services. Very few NHS Boards have dedicated funding streams for these services. The quality and effectiveness of these services is rarely monitored.
- None of the NHS Boards could provide a complete or accurate description of the chronic pain services provided, or of the resources available to provide them.
- There are significant discrepancies between the descriptions of available services as reported by NHS Boards and services actually provided, as reported by healthcare professionals and service users. In the main, clinicians providing services did not recognise and could not reconcile actual service provision with the service provision reported by NHS Boards.
- Some information was available on services provided in the secondary care sector but very little feedback was
provided on primary and community healthcare services although we are aware that most patients are cared for in this setting. - Access to specialist services is limited, with GPs often reluctant to refer and waiting times are long.
- There is a general lack of knowledge about chronic pain and awareness of treatment options and services in NHSScotland.
- Very few Boards offer pain management programmes (PMP) and very few patients have access to these.