Pain Management Task Force minutes: December 2023

Attendees and apologies

• Lynne Nicol, Chair, Scottish Government 
• Stuart Stephen, National Implementation Lead for Pain Management, Scottish Government
• Nicola Rhind, National Clinical Lead for Pain Management
• Rory Mackenzie, Associate Clinical Director, NHS Centre for Sustainable Delivery
• Martin Dunbar, Third Sector Network Lead and Lived Experience Representative
• Lyn Watson, Pain Nurse Network Lead
• Nicci Motiang, Clinical Priorities Unit Head, Scottish Government
• Moira Nelson, Chronic Pain Team Lead, Scottish Government
• Gayle McCann, Senior Policy Manager, Scottish Government
• David Craig, Psychology Network Lead 
• Anne Wallace, Professional Adviser (attending on behalf of Lois Lobban).
• Helen Moores-Poole, AHP Professions Officer, Scottish Government
• Stephen Martin, Realistic Medicine Team Lead, Scottish Government

Apologies 

• Sharon Robertson
• Lois Lobban
• Lars Williams
• Lynn Railston
• Tracy Robertson
• Aline Williams
• Deborah Stephen

Items and actions

Welcome and apologies

The Chair welcomed the group and introduced new members. Consent was given by members to publish task force minutes on the Scottish Government website. 

Apologies were noted. 

Previous minutes and matters arising

The minutes from September’s meeting were agreed subject to the update of acronyms relating to digital badges.

Updated Terms of Reference

The updated terms of reference (ToR) was previously circulated to the group. The Implementation Lead spoke through the changes. The group agreed the updates.

Implementation plan

To better manage the risks within each action a central risk register covering all actions was proposed. Reporting against each action will still be carried out with a more streamlined template. Reporting templates have been updated up to December 2023. The group agreed this to be a sensible approach. An updated risk register and new reporting templates will be sent out in the New Year. 

Implementation plan updates

Patient Centred Care Working Group (SLWGA)

NHS Inform updates have been completed. The group are now developing a best practice toolkit for lived experience engagement which is currently being drafted. This work will pull together existing patient information resources. SLWGA are also developing a framework to consider which resources are widely used and are liaising with the third sector for this work. 

Education Group 

Module 1 – Currently undergoing evaluation, the module has been tested by NHS Education for Scotland (NES) and is undergoing evaluation from health and social care staff at that level and lived experience volunteers. Evaluators will complete a knowledge, attitudes and confidence scale as well as a reflection exercise post module and will be followed up with in three months to assess the impact on clinical practice.

Module 2 – NES have begun work on module content. The education group are developing sections of the module. Module 2 will sit on knowledge hub which is expected to go live at the end of February 2024. Patient volunteers will give experience of interactions with healthcare professionals which will form part of the module. The animation video is being updated to reflect the recent statistics from the Scottish Health Survey (SHeS). 

Modules 3 and 4 – Work will begin after the completion of levels one and two. The modules have some tertiary education support from Edinburgh University who will share and develop resources with education group. 

The task force welcomed the update from the education group and suggested some learning may be able to be taken from dementia structured education and possibly used in undergraduate education. The education group are currently approaching undergraduate students to become volunteers. 

Remote Healthcare Pathway (RHCP)

NHS Ayrshire and Arran and Grampian are next to test within their own Health Board systems. A risk was raised: funding from Connect Health has been cut and chronic pain work will be impacted. Future of funding is unsure, but the greater the number of boards utilising or desiring pathway, the increased likelihood of funding. 

The group discussed what could be done to promote and highlight the value of RHCP to the Boards. 

Scottish Health Technologies Group (SHTG)

The request to SHTG to deliver a national approach to specialist interventions has been accepted. 

Psychology Network

Staffing issues discussed at most recent network meeting. This is causing issues for some services, including pain management programmes, in some boards. Psychology would like to be represented in workforce SLWG when it is established.

Third Sector Network (TSN)

Recently expanded numbers and now has representation from a fibromyalgia charity. Work is continuing with the audit of third sector resources, results will be collated and shared when complete. Group continues to ensure lived experience voices are heard in various pain groups. Agreement from Service Managers Network to have a liaison person from each Board for TSN members.

Nurses Network

Workforce planning and clinical nurse specialist (CNS) tool discussed at most recent meeting. Concerns raised that the workforce and workload planning tool for CNS’s does not meet the requirements of the role. The network will convene working groups to look at learning needs and career pathways, particularly for nurses moving from band 6 to band 7.

Data Group

Public Health Scotland (PHS) have put together new template for reporting data. There are some concerns around how psychology data is reported as this is hosted on a different system. Discussions with PHS are underway trying to work out what is the right information with most value in relation to return appointments. Work is required to explore ways this might be done but requires broader change, not just with pain services. 

Lived experience on task force

A paper was sent round to members of task force in advance of the meeting which outlines the method for recruiting an additional lived experience representative to the task force. The paper was drafted using learning from other policy areas across Scottish Government to utilise the best approach. The recommendation is to issue an expression of interest form to join the task force and/or inform policy development, which will be cascaded through our various stakeholder networks. Expressions of interest would be evaluated by a panel of both external and internal reviewers. The Scottish Government Participation Framework will be used to inform the lived experience inclusion to ensure we are involving people at the right time in the right way. The expression of interest will be shared once approved by the task force and will remain open until the end of January for the task force lived experience representative.

The group was unanimously supportive of this approach. The group discussed the importance of a fair and open process, and to include as many people as possible to be part of the panel. It was suggested further learning may be taken from other policy areas in Scottish Government, specifically national care service policy.

Chronic pain workforce challenges

A paper was sent round to members of task force in advance of the meeting outlining workforce challenges. 

Paediatrics 

Risk affects NHS Tayside. Clinicians are nearing retirement and concerns about succession planning. Task force suggested exploring the possibility of mutual aid in the first instance. Clinical Lead will meet with paediatric clinicians to develop action plan. 

Psychology 

Similar issues with work force, impacting pain programmes in some boards, risk for NHS Borders has been raised to the National Planning and Performance Oversight Group (NPPOG).

Action 14 in the updated Implementation Plan is to create SLWG for workforce to discuss issues like these. 

The group discussed the importance of considering short and long term solutions to workforce issues. In the short term a risk management approach considering inter-board solutions will be taken. 

Policy colleagues will liaise with workforce team colleagues in the Chief Operating Officer Directorate within Scottish Government to discuss service wide issues. 

The group discussed the following topics as a starting point for the workforce group:

• utilising existing networks regional planning groups to discuss issues
• long term workforce development
• raising profile of chronic pain service to undergraduates
• responsibility of Scottish Government and the boards

Scottish Government funding of third sector projects 

A paper was circulated with the group before the meeting highlighting issues for awareness on behalf of third sector. The paper outlines issues often faced by third sector in obtaining public funding, which can be a substantial amount of their funding. Requests for core funding to be made available, feedback on unsuccessful applications and a uniform funding process across health boards.

The group noted the issues raised and members noted work by NCS on ethical commissioning could provide possible learning. 

Finance and commissioning

Scottish National Pain Management Programme.  Policy colleagues have spoken to National Services Division (NSD) who reported no financial issues. Policy colleagues to meet with them again in February. Funding will move to 50% Board funded from next financial year. 

NHS Centre for Sustainable Delivery (CfSD). Possible underspend in current financial year. SG meeting with CfSD to discuss further. Current year to year funding is impacting how work can be delivered longer term.

Budget for Division and Directorate have still to be decided but task force will be updated when this information becomes available. 

Communications

The chronic pain page, hosted on the Scottish Government website has been updated. Task force minutes will be published on the Pain Management Task Force page going forward. 

The third edition of the newsletter has been drafted and is waiting to be approved. The focus is person centred and highlights how the updated implementation plan affects patients. This will be distributed shortly after the New Year. 

Any other competent business

The Scottish Health Survey was published on December 5 2023 and included questions on chronic pain for the first time. Incidence of chronic pain in the report was 38% amongst the adult population, and also included questions on how pain impacted life activities. 

Date of next meeting

Wednesday 14 February 2024 at 10.30 am via MS Teams.