Future provision of specialist residential chronic pain management services in Scotland: consultation report

Executive Summary

Overview

This report responds to the findings of the consultation as set out in the independent report 'The Provision of Residential Chronic Pain Services in Scotland: Analysis of Consultation Responses' and sets out the Scottish Government's proposals for taking forward the development of these services.

Detailed analysis of the consultation was conducted independently and the results published on 23 January 2014. A full report is available on the Scottish Government website at http://www.scotland.gov.uk/Publications/2014/01/7685. In addition, a separate analysis summary has also been published - http://www.scotland.gov.uk/Publications/2014/01/9795 - along with the consultation responses for which consent to publish had been given.

The consultation focused on people who may benefit from treatment provided by the establishment of 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.

Responses

A total of 228 responses were received to the consultation. Where respondents consented to publication of their response, these are available in full on the Scottish Government website at: http://www.scotland.gov.uk/Publications/2013/11/9145/0.

The aim of the consultation was to reach a wide audience and the range of responses received suggests that this has been achieved. It is also noteworthy that just under half of the responses received were from people directly affected by chronic pain, as the individual or a carer or family member. When adding to this the responses received from organisations representing people with chronic pain, we can be confident that the result of the consultation fully reflects the experiences and views for whom the service is for.

Preferred option

A total of 89% of respondents selected a single option. Of those respondents who answered Question 2 (see Annex C, page 30), 75% indicated a preference solely for Option 1 (A centre of excellence in a single location).

Respondents noted a number of reasons for their preference including views that Option 1 offered the potential: for providing a high quality service; for bringing together an expert multidisciplinary team in one place (which would be easier to monitor, inspect and audit); for attracting and retaining staff; for promoting peer support; and offering the most sustainable solution.

In addition, it was considered that a centre of excellence has the potential to foster research and to develop clinical guidelines for use across Scotland to support further improvement in chronic pain services at a local level.

Following the publication of the Analysis of Consultation Responses, the Cabinet Secretary confirmed on 23 January 2014 that work will now progress to establish the service at a single location.

Barriers to service provision

Most respondents identified travel and costs as the main barriers, in particular the need to pay for travel in advance. Many respondents also noted barriers to gaining access to services such as the reluctance of GPs and other health and social care staff to refer them, and the lack of recognition and understanding of pain levels and associated conditions.

The views submitted in this area have provided some particularly useful insights into how we can shape future improvements in service delivery and access to services.

Components of service provision

Respondents provided a wide range of ideas and suggestions about the scope and content of the proposed service including pain assessment, the role of carers, follow-up arrangements, education and information, the needs of specific groups (such as deaf and deaf-blind people, veterans, children), and specific facilities (such as access to a gym or pool).

These ideas provide a useful steer on what respondents feel are priorities and will help to inform the future development of the work. All of the core elements identified have been endorsed by the findings of the consultation, and have been included as requirements for the new service.

Retention of access to current services in Bath or elsewhere

A total of 205 respondents expressed a view at Question 7 (see Annex C, page 31), 48% of which agreed that existing referral arrangements (such as to the Bath Centre for Pain Services) should be retained for occasional use. Some of these respondents further qualified their answer by adding that this should only be in cases where this is the patient's wish or is most appropriate to their situation, or only in exceptional or emergency circumstances.

The Scottish Government is absolutely clear that the Scottish National Chronic Pain Management Programme will be the primary service provider and the use of alternative providers would be considered only in very exceptional circumstances, based on clinical need, in consultation with the patient, family, carer, referring clinician and the national service.

Next steps

National Specialist and Screening Services Directorate (NSD) has a role on behalf of all NHS Boards in Scotland and the people of Scotland to commission specialist services as per need. This is taken forward following agreement by Scottish Government based on the recommendation of National Specialist Services Committee (NSSC) and the NHS Board Chief Executives group.

In line with the Cabinet Secretary's commitment that a specialist service would be provided in Scotland, the short life expert group, with full involvement of patients and service users, formed by NSSC developed a specification for a national specialist residential chronic pain management programme.

The resulting service specification was approved by NSSC at its meeting on 5 March 2014. NSD has subsequently written to all NHS Boards in Scotland inviting proposals from them, by 30 April 2014, to deliver the residential Chronic Pain Management Programme for Scotland. NSSC has identified a small group to work with NSD to assess the proposals and to make recommendation as to which NHS Board will be invited to host the programme.

NSSC expects to report to the Scottish Government in May 2014 to advise on the results of this exercise.

NSD will then work with the identified clinical team, local service management and the NHS Board to agree a Service Agreement which will ensure that the Scottish National Chronic Pain Management Programme will be provided in a safe, effective and person centred way, beginning as soon as possible.