Pain management - service delivery framework: implementation plan

Governance of the Framework

We have set out our priority Actions where people with chronic pain have told us they wish to see rapid improvement. Many of these initial Actions are focused on improving the infrastructure underpinning the delivery of the information, services and support accessed by people with chronic pain. Other Actions begin the task of addressing more complex issues which are likely to be realised and implemented over a longer horizon. Our approach is also informed by feedback from NHS workers, service managers and Health Boards which are still in the process of rebuilding and redesigning care as we continue to emerge from the impact of the COVID-19 pandemic. We are therefore mindful of the pace of change which is realistically possible in the coming months and year ahead, and feel that this is reflected in Actions which are impactful but proportionate.

Since 2009, a number of advisory bodies or committees have evolved to advise Scottish Government Ministers on matters relating to chronic pain. The National Advisory Committee for Chronic Pain (NACCP) was established in 2017 and was reviewed in 2020 to increase representation of people with lived experience. In 2021 the Committee provided valuable engagement and input on key Government policies, most notably informing the draft Framework for Pain Management Service Delivery.

Going forward, implementation of the Framework for Pain Management Service Delivery in Scotland will be overseen by the Pain Management Task Force which will report directly to Scottish Government Ministers (see Annex B). This replaces the NACCP, as the role and remit of the Task Force will be focused on implementation of the Framework by utilising programme and risk management methodologies to ensure successful delivery of the aims and commitments whilst keeping all stakeholders involved and informed throughout the process. The Governance structure will see stronger links built between the existing Clinical Networks, working groups and the Task Force to increase communication and collaborative working.

The permanent membership of the Task Force will largely consist of Scottish Government Policy and Clinical Leads to provide clear lines of accountability and ensure rapid triaging, assessment and action against risks to delivery and implementation. Membership will include policy officials working in pain management, Realistic Medicine, Primary Care, Rehabilitation as well as our National Implementation Lead for Pain Management, the Centre for Sustainable Delivery and lived-experience representation.

We are investing in the leadership required to help us, and the wider pain community, to identify, prioritise and agree activities at the pace that people with chronic pain have told us is required. A key element of this is the shift to working groups aligned to the Aims of the Framework with a clear mandate and responsibility to ensure appropriate engagement, consideration and recommendation of activities to drive progress. These Short-Life Working Groups (SLWGs) will be tasked with delivering the Actions for each of the specific Aims. The Chairs of the Groups will also be co-opted onto the Task Force whilst their groups are operational. Recruitment of Chairs and Group membership will reflect the expertise, experience and diversity of skills required to deliver the Actions for each Aim set out in this Plan.

Leveraging clinical expertise

This Governance Structure recognises the existing work programmes of each of the National Clinical Networks, which will be further strengthened through establishing a Service Manager Network, exploring a third-sector network and a Pain Management National Network Leads meeting. Individual Network leads will be paramount to aligning their work programmes to the Short Life Working Groups. This will ensure multi-disciplinary input across all professional groups working in pain management services throughout Scotland.

Involving people with lived experience

The ethos of Realistic Medicine is that the person receiving care should be at the centre of decision making through meaningful conversations about what matters most to them, with a shared understanding of what healthcare might realistically contribute to this. It is therefore vitally important that we place people with lived experience of chronic pain at the very centre of this Plan.

Previous Governance models for Scottish Government chronic pain policy have involved people with lived experience in a variety of methods – including individual representation, a wider reference group of lived experience and elected representatives. Our Equality and Impact Assessment for this Framework has identified the need to amplify the voices of groups of people who may be impacted by persistent pain but typically overlooked when it comes to engagement. People from socioeconomic deprivation, older people, and certain ethnic minority backgrounds have been under represented to date. The Governance model for this implementation of the Framework will include a representative of people with lived experience on the Task Force, deliver a Pain Management Panel and a HIS convened Gathering Views exercise to ensure that diverse lived experience is utilised and informs each of the Aims' SLWGs.

Pain Management Panel: This will be a focused and targeted engagement exercise which is designed to help harness a broad range of voices to inform implementation of the Framework. We have commissioned an independent organisation to recruit, support and engage a diverse cross-section of people with chronic pain across Scotland. Participants in the panel will be invited to discuss and respond to key issues, proposals and questions arising from the work of the SLWGs as they deliver the Framework Actions. The SLWGs will have a responsibility to clearly articulate how they have listened and responded to the views of the Panel, and will be required to report back to participants how their input has been considered.

HIS Gathering Views: In order to secure the future success and sustainability of the Framework it is essential that we better understand the local barriers and opportunities to pain service improvement. HIS Gathering Views exercises work with local third sector organisations and community groups to reach people across Scotland, especially those who are often excluded from consultations. A range of methods are used including focus groups, interviews, questionnaires and events to gather people's views. People with chronic pain and carers will be invited to provide feedback on the key issues in their local area and these will be collated in order to give a national perspective. Outputs from this activity will help to inform national and local approaches to implementation that will help to increase the chances of successfully delivering meaningful improvement of local pain service delivery.

Reporting progress

Each of the SLWGs will produce an implementation plan based on the strategic aims and commitments of the Framework. The Task Force will agree these plans and oversee progress against them. An annual report on progress towards the strategic Aims and Actions identified in this plan, will be published, to allow ongoing oversight and reporting of progress. In addition, while this Implementation Plan includes an initial set of priorities, the SLWGs will be expected to identify and scope further potential Actions – at both the national and local level – to drive continued service improvement activity. This is intended to lead to a 'pipeline' of recommendations which will be considered by Ministers to guide future years' Implementation Plans for the Framework.

We are also committed to monitoring and reviewing the performance of the Governance structures as they are delivered. This includes ensuring we are appropriately involving and engaging the views of all stakeholders through the proposed Networks, Groups and Lived Experience structures. In addition, we will take a risk-based approach to delivery of the Framework, with clear processes to escalate emerging issues or concerns raised by stakeholders through our Governance structure and Task Force.

We will develop a comprehensive strategy to provide clear and accessible communication of the Framework, progress against our Aims, and opportunities to be involved in delivery of its Actions where appropriate. This will help to foster stronger relationships across the chronic pain community, and enable individuals and organisations at all levels to better co-design care and support in line with the needs and expectations of people with chronic pain in Scotland.