Pain management - service delivery framework: implementation plan

Aim A – Person centred care

We will improve the consistency and quality of the information and advice received by people with chronic pain, increase healthcare professionals' understanding of the condition and its impact, and deliver better access to a range of local options to support self-management and wellbeing.

You told us

Responses to the consultation reiterated the value in clear and consistent information for people with chronic pain, and the challenges that are currently experienced when seeking support. It was highlighted that there is considerable variation in what information and advice is provided to people with chronic pain. There was also substantial feedback on what information should be provided, how it should be accessed in order to address existing inequalities, and how to ensure that it is of sufficient quality. More broadly, it was felt that there are opportunities to raise awareness of pain and its impact at the national level through a public-health led approach, and at the local level through increased information on what NHS services and other community-based support is available and how it is accessed.

People with chronic pain have told us they feel that a challenge of living with the condition is a lack of recognition of its impact on their everyday life, including from health and care professionals. This was a clear point of focus in the responses which highlighted the importance of ensuring all health and care workers have an understanding of the challenges of living with persistent pain to ensure they provide informed and compassionate care. There was also a need expressed for greater consistency in the information individual healthcare professionals and local services provide to people with chronic pain, both in terms of how their condition could may be managed, and other appropriate support options that may be available in their local area.

Responses also highlighted a need to improve how people with chronic pain access support for non-NHS services or help to improve their wellbeing. There was also a focus on the role of the third-sector and it is clear that challenges need to be addressed around coordination and delivery of charity services by Health Boards. Action is also needed to ensure improved recognition of other issues that impact quality of life for people with chronic pain, such as employment, and improved referral and signposting to services provided by councils and local authorities, such as physical activity.

What we will do

Deliver improved information quality and access

Action 1: Establish a national expert working group to oversee coordination and development of chronic pain information and resources

We will establish a short-life working group drawn from the chronic pain community to drive and oversee delivery of this Aim. The insight and ideas already provided through our public consultation and engagement with stakeholders will inform this group's priorities, including input from people with lived-experience.

This group will provide a focus for evaluating existing resources at the local and national level and make recommendations to ensure a more coordinated, national approach to chronic pain information and self-management tools and resources. This would include consideration of digital, community and rehabilitation-based approaches which can help empower patients to feel more in control of their pain and to live well with their condition. This approach will reduce duplication and build a collaborative, cross-sectoral approach to information provision and advice. They will also have a focus on considering how to reduce existing inequalities in order to ensure wider promotion and easier access to the right information, at the right time, to enhance how people with chronic pain find and engage the support and services they need.

Action 2: Enhance quality and access to chronic pain information on NHS Inform.

In order to inform the activity of the Aim A working group, there is a need to comprehensively assess the information needs of people with chronic pain. We will commission NHS24 to carry out a user-needs assessment in order to improve and enhance chronic pain information hosted on NHS Inform.

This will provide an opportunity to consider additional content and information requirements, including multimedia, self-help guides and other resources. It will also provide an agreed and rigorous quality assurance process with input from people with lived experience, the clinical community and other stakeholders to design and deliver effective and engaging support and signposting for people with chronic pain. Outputs from this action will also benefit people with other conditions where pain is a common symptom, for example endometriosis, by improving the links between existing NHS Inform resources and ensuring more consistent and appropriate content on pain and how it is managed.

While this is being delivered, we will continue to identify opportunities to increase the accessibility of existing NHS Inform content, including translating information into other languages and formats, for example, British Sign Language. Through the needs assessment it is expected that the requirement for other, off-line or local resources will be identified, which will also be addressed as part of delivering this Aim.

More knowledgeable and compassionate health and care workforce

Action 3: Establish a Chronic Pain knowledge hub for healthcare professionals to promote understanding and learning on chronic pain

While it is expected that delivering improvements in patient-facing information on chronic pain will also support healthcare professional learning, there is a need to further promote awareness on chronic pain amongst the health and care workforce. In order to improve the consistency and quality of clinical care and advice provided to people with chronic pain, we will make it easier for healthcare professionals at all levels to access and navigate high-quality, up to date information and resources through a national Chronic Pain Knowledge Hub.

Underpinned by the work of the National Pain Education Group we will develop a 'one stop shop' national resource for healthcare professionals, service managers and other delivery partners. This will be based on the TURAS platform, NHS Education for Scotland's (NES) national platform which promotes health and social care professional learning and training, and provides tool that support collection and sharing of best practice. It will also offer service planners and national networks a platform to share information which will support improved collaboration and shared planning to drive down unwarranted variation in care and service delivery.

Action 4: Develop a Pain Informed Care toolkit for healthcare professionals to promote care in all settings

Given that chronic pain is often experienced alongside other health conditions, and that most people will access support from local, non-specialist health and care services, we will take action to increase awareness and understanding of pain and its impact amongst staff in all healthcare settings. We will build on the success of the Scottish Government's progress in trauma-informed care to deliver a package of measures to support a 'Pain-Informed' approach to the planning and development of health and care services.

There is evidence to indicate that there are links between adverse experiences and the incidence and impact of pain, which similarly demand an approach to care that prioritises empathy and kindness in order for it to be effective. To inform this approach we will draw on the expertise of people with lived experience of chronic pain, healthcare professionals working in specialist and community pain services, the third sector and other key stakeholders. Together, they will work towards identifying existing best practice already being delivered and establish how the principles of trauma-informed practice can be incorporated as part of pain management care and support services. Delivering this Action, initially through the new national Pain Education Group (see p.18) will lead to a better experience of health and care services, and more effective, person-centred care for people with chronic pain.

Improved access to community based support

Action 5: Enhance coordination of community and third-sector support for people with chronic pain

People with chronic pain are already experts in managing the impact of their condition on their everyday lives. However, we know that pain and its impact is often felt unequally across our society and there are many people who could benefit from additional support outwith public health and care services, to improve their quality of life. We will work with the third-sector, and other community-based partners, to make it easier for people with chronic pain to access a choice of person-centred support in their local area. We will ensure alignment to other work underway to improve cross-sector working in relation to improve access to rehabilitation support and services.

To support this action we will explore opportunities to develop a network-based approach to third-sector engagement to act as a forum to draw on the experience of charities already providing services and support to people with chronic pain. Together, and through participation in other working groups established to deliver the Framework, this Network will focus on the opportunities and challenges of delivering local person-centred care and working at the interface with Health Boards and local authorities. This work is intended to lead to a nationally shared approach to collaboration between public and third-sectors at the local level to ensure a more sustainable relationship around commissioning and coordinating community-based support for people with chronic pain as part of health and care pathways.

Increasing the impact of our actions

Earlier recognition and action on pain

Chronic pain is rarely experienced as a stand-alone condition, and is often the factor in other conditions which has the greatest impact on people's day to day wellbeing. As set out in the Actions for this Aim there is a clear opportunity to enhance recognition of chronic pain as part of routine health and wellbeing practice to ensure more timely and effective care.

These Actions will also improve healthcare professional knowledge of how to recognise, and act on, risk factors for developing chronic pain, including in patients presenting with acute pain. This approach includes population health strategies already being delivered by the Scottish Government which can directly and indirectly contribute to a reduction in pain-related risk factors. We will ensure that opportunities to raise knowledge of preventative approaches amongst both public and healthcare professional audiences are considered and integrated as part of the Actions for this Aim.

Support for the wider impact of pain

In supporting a prevention-based approach there is also a need to consider opportunities for earlier intervention to limit the progressive impact of chronic pain, across all aspects of life. Through each of the Actions outlined above we will also consider social and economic factors, such as work, housing, earnings and benefit uptake, in order to ensure more timely and effective coordination and signposting of relevant services and support for people with chronic pain.

This includes the impact of chronic pain on work and employment and we will continue to identify opportunities to ensure recognition of the impact of pain on work, and improve access to employment related support (e.g. through provision of reasonable adjustments and/or Access to Work). Delivery of Social Security Scotland also provides an opportunity to ensure that those who require additional support, including people with chronic pain, can access assistance in a dignified, fair and respectful way.

Next steps

We will establish a Short Life Working Group (SLWG) in summer 2022 in order to begin immediate delivery of these Actions. We will appoint a Chair and consider the resourcing needs of the Group to ensure effective engagement in the following months, with a view towards rapid delivery of recommendations and outputs in this financial year.

The SLWG will discuss and consider any requirement for further extension of their work, and identify further Actions to support delivery of this Aim. It is expected that one of these recommendations will include consideration of the aims, objectives and targets for a national public health-led approach to chronic pain in order to raise awareness of the condition.