Chronic pain service delivery - draft framework: consultation

The impact of the COVID-19 pandemic

18. The COVID-19 pandemic continues to have an unprecedented impact on all NHS and care services. As with those in the rest of the UK, pain management services in Scotland were, and unfortunately continue to be significantly affected by the pandemic. ^[18]

19. Restarting chronic pain services remains a priority for the Scottish Government. This Framework will seek to build on the principles and priorities outlined in the NHS Recovery Plan published in August 2021 which sets out our plans for health and care over the next five years and is backed by more than £1 billion of investment over the next five years. We want this Framework to guide Health Boards and other providers as they continue to rebuild pain management support.

20. While most procedures and in-person appointments were paused in the early stages of the pandemic, NHS Scotland Health Boards began to resume these services during summer 2020. Many used this opportunity to explore new models of service delivery as part of their activities to safely resume services. Over the past 12 months, data for first outpatient appointments at pain clinics shows there have been increases in the number of people referred and a decrease in the number of people waiting longest as these services have remobilised. However, we know many people continue to face lengthy waits to be seen for pain management support, including those awaiting repeat appointments.

21. In line with the Scottish Government's overarching approach to NHS remobilisation, we sought feedback on the priorities for restarting pain management support from people with chronic pain and those providing pain services. This informed the development of a Framework for Recovery of NHS Pain Management Services which set out the Government's expectation that pain management services should be prioritised in Health Board remobilisation planning.

22. The Framework will also provide further support for existing activity already underway to support people experiencing chronic pain both as a direct, or indirect result of the pandemic. Pain has been recognised as a key factor in informing clinical decision-making, with Health Boards expected to take into account its impact and exacerbation when prioritising those awaiting treatment. Work was also carried out to provide information and support to those who may be experiencing issues such as pain while they were awaiting elective care during the pandemic.

23. The direct and indirect links between the pandemic and pain have also been recognised and reflected in the Government's priorities for COVID-19 rehabilitation, including those who have had the virus and are experiencing pain as a result, but also those with existing painful long-term conditions who may have been impacted as a result of pausing non-critical health services.

24. The impact of pain as a potential element of the longer-term effects of coronavirus (Long COVID) has also been identified, and is being addressed through UK-wide clinical guidelines and ongoing development of resources and research. In addition, the Long COVID Support Fund will help people impacted by the condition to access coordinated local support across existing health and social care services in their local area.

25. The mental health impact of the pandemic on those with long-term conditions, including chronic pain, has also been identified as part of the Government's Mental Health Transition and Recovery Plan and is part of a wider approach to ensure support is available for mental health and wellbeing.

How has the framework been developed?

26. As part of the 2020 Programme for Government, we announced we would publish a new Framework to better meet the needs of people living with chronic pain in Scotland.

27. During 2021 we worked with the National Advisory Committee for Chronic Pain (NACCP), relevant stakeholders and across the Scottish Government and its partners to shape the Framework aims and priorities.

28. We have worked to ensure people with lived experience, their families and carers are at the centre of this Framework's creation. The Scottish Government also funded the Health and Social Care Alliance to develop the Chronic Pain Patient Reference Group (CPPRG) which brought together people with chronic pain from across Scotland to share their experience in order to inform the development of the draft Framework.

29. We have also carried out a number of lived experience, carer and service surveys, literature reviews as well as reviewing work undertaken by Healthcare Improvement Scotland (HIS) and the Scottish Public Health Network (ScotPHN) about the health needs of people with chronic pain. We have also considered the Scottish Access Collaborative report developed in partnership with people with lived experience of chronic pain, and wider UK and international policy.

How the Framework should be used

30. Through the development of the Framework it has been apparent that while the expectations set out by the existing Scottish Service Model for Chronic Pain may be appropriate, and reflect best practice, people with chronic pain tell us they still do not experience consistent, high-quality care when seeking support for their condition.

31. The new Framework therefore aims to evolve this Model and set out, for the first time, a national vision for enabling people to manage chronic pain; to improve their well-being and quality of life. It will serve to improve standards of care and support and to inspire innovation.

32. Progress has already started locally in many areas to re-design services, building on what works well and to address gaps in provision. Through the Framework, we intend to continue our work with the NHS, charities and other organisations to support them to make this national vision a reality. We want people to be able to access the right care in the right place at the right time wherever they live in Scotland.

33. This Framework is being provided for consultation purposes at this stage. Once consultation feedback has been analysed and incorporated, the final Framework will be published with more information on how the commitments will be delivered.

34. When published in its final version, we will carry out a programme of active engagement with people with lived experience, health and care providers and other key stakeholders. This activity will support our ambition to deliver clear expectations for pain management care and support in Scotland and underpin implementation of the Framework aims and commitments.