A consultation on the provision of specialist residential chronic pain services in Scotland

Chapter 1: Introduction and background

Introduction

This consultation focusses on those patients who may benefit from treatment provided by creating a specialist residential service in Scotland. This type of service is designed to improve quality of life, enable patients to better manage their chronic pain and reduce their disability.

We know that around 800,000 people in Scotland live with chronic pain to varying degrees. It is defined as pain that has lasted for over 12 weeks and continues beyond the time in which healing /recovery would normally take place. It can have a considerable impact on individuals and family members and can result in significant impairment, disability and sometimes depression. It is also a major clinical challenge for NHSScotland.

The quality of life, mood, ability to sleep, general wellbeing and mobility of people who experience chronic pain can be greatly improved by appropriate treatment. In some cases, this can be achieved through a specialist residential service.

Why does Scotland need a specialist residential service(s)?

In a debate in the Scottish Parliament a clear commitment was given by Mr Alex Neil, Cabinet Secretary for Health and Wellbeing, to provide the first specialist residential service in Scotland. He also stated that a public consultation would take place on how this could be provided so that a wide range of views could be established.

The service will fill a gap in current service provision in Scotland and will stop patients, who are clinically assessed as likely to benefit, from having to travel long distances outside Scotland, first for assessment and then for treatment.

Currently Scottish patients who require this intensive service are referred to the Bath Centre for Pain Services in Somerset. However, there are patients in Scotland suitable for this level of treatment who are unable to access or benefit from it. This is for a number of reasons, for example:

• inability to withstand travelling long distances to Bath or elsewhere in the UK, first for a 2-3 day assessment and then returning for 2-4 weeks of treatment;
• being away from family or carers for 2-4 weeks of intensive treatment;
• having few, if any, visitors as most of these will be in Scotland;
• for some, paying for travel costs upfront can be an additional barrier (although repaid to those on certain benefits or low income, upfront costs prevent some patients from accepting).

As such, these combined factors mean there is likely to be an unmet need for a specialist residential service. It is therefore anticipated that a Scottish service is likely to grow in the future.

What does a specialist residential service do?

The service is intended to increase an individual's self-confidence and their ability to self-manage and cope with their pain. Through understanding and coping better this makes day to day living easier and often reduces disability. This level of service is set out within the Scottish Service Model for Chronic Pain (Annex B).

Patients who are most likely to benefit will usually fall into the following groups:

• those with chronic complex pain and associated problems, such as depression.
• those patients with severe chronic pain in an area where geographical or other logistical factors make it practically impossible to attend a local service on a regular (usually weekly) basis.

While in many cases a total 'cure' is not likely the skills gained can greatly improve patient's general well-being, mood, mobility and sleep enabling them to have a better quality of life. The treatment is provided daily over a 2-4 week period, with nearby residential accommodation.

This type of service includes:

• one to one assessment by clinicians and other health care workers trained in chronic pain issues.
• guided one to one sessions which offer support and challenge at the same time as encouraging self-exploration of new activities or different ways of doing routine day to day things.
• assessment and management of medication to enable people to gain the greatest benefit from these.
• group sessions involving discussion and the sharing of experiences.
• programmes of exercise tailored to individual ability.

Such a service is not an alternative or a substitute for the provision of locally delivered chronic pain services, either in primary or secondary care.

What does a Scottish service need to include?

Following an assessment of the residential service in Bath it is anticipated that a Scottish service should include the following key components:

1. Staff trained and skilled in chronic pain who work as part of a specialist (multi-disciplinary) team. This would include medical specialists, clinical psychologists, specialist nurses, physiotherapists and occupational therapists. The actual number and mix of staff will be dependent on the service model adopted. The consultation response will help to inform this.

2. Fit for purpose accommodation - for both treatment and residential facilities.

Space will be needed so that individuals can take part in the treatment activity, whether working in groups or individually. This would require:

• Occupational therapy space, including kitchen/bathroom area(s).
• An accessible nearby physiotherapy gym.
• Rooms large enough to accommodate group activity work.
• Access to consultation rooms for one to one work.

In addition to the treatment space described residential accommodation would also need to be provided. Local accommodation would be offered to those who wish to stay. The treatment space and accommodation would need to comply with the Equalities Act (2010).

How will the new Scottish service be supported at a local level?

Regardless of the service model adopted, the new service will need to be supported by an improvement to local chronic pain services. All NHS Boards are already working towards improving care and access to their local services as set out in the Scottish Service Model for Chronic Pain. This includes provision of education and support for individual self-management, support from third sector organisations, access to pain services through primary care teams and referral to local specialist pain services in hospitals and other outpatient settings.

Care will need to be taken that the availability of the new service does not result in a lack of investment by NHS Boards to improve their local services.

What will happen until a Scottish service is in place?

From those who have participated we know that there is a high level of satisfaction with the service provided in Bath. This is also supported by evidence that positive outcomes are achieved. As such in the interim, up until a Scottish service is developed, patients who are clinically assessed as likely to benefit will continue to be referred to Bath.