Getting to GRIPS with Chronic Pain in Scotland
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.
Published Date: 10 December 2007
