The Provision of Specialist Residential Chronic Pain Services in Scotland: Analysis of Consultation Responses

Executive Summary

This report presents the findings of a Scottish Government consultation on "The Provision of Specialist Residential Chronic Pain Services in Scotland". The written consultation took place between 2^nd September 2013 and 27^th October 2013. Additionally, four stakeholder meetings were held. The consultation document described three options:

Option 1: A Centre of Excellence in a single location.

Option 2: A service delivered by local chronic pain clinicians supported by other clinical advisors in another part of the country.

Option 3: A service delivered in different locations by a team of chronic pain specialists (an outreach or roving service).

A total of 228 submissions were received to the written consultation and 77 participants took part in four events (including people experiencing chronic pain and other stakeholders). Respondents to the written consultation, by self-selected category, were as follows:

Respondent Category	No.	%
An individual who experiences chronic pain	79	35
Other stakeholder	43	19
A family member or carer of someone who experiences chronic pain	33	14
A health professional	30	13
An organisation representing people who experience chronic pain	18	8
Respondent selected more than one category	14	6
Undetermined	11	5
Total	228

Overall views of the options

There was a clear preference overall for Option 1 - a Centre of Excellence in a single location. Among those who ticked a box in the written consultation to indicate their preference, the findings were as follows:

Option ticked	Number	%
1	154	75
2	28	14
3	12	6
1,2	4	2
1,2,3	4	2
1,3	1	<1
2,3	1	<1
Total	204

Over two thirds of respondents in each of the categories (see table above) expressed a preference for Option 1 suggesting broad support for this.

A small proportion of respondents to the written consultation (5%) ticked more than one option. Participants in all of the stakeholder meetings also favoured a mix of elements, and some other respondents referred to the benefits of including aspects of other options (whether or not they expressed support for a specific option). Over a fifth of all respondents to the written consultation made some comments to suggest the need for, or value of, including elements of more than one of the options.

A small number of respondents suggested other alternatives (see Section 2 of the main report), or suggested that none of the options would be beneficial, or stated that they did not support the need for a residential service.

Perceived benefits of Option 1 related to: the overall high quality of the service and nature of provision; opportunities for staff development and recruitment; ease of delivery and management; the range of provision that could be made; and the positive impact on meeting service users' needs. There were also seen to be benefits in provision being closer to home and addressing some existing travel and access issues, as well as the option being tried and tested, and supported by evidence. Several respondents also identified benefits relating to cost-effectiveness and opportunities for attracting funding.

The most common benefits of the other options (identified by much smaller numbers of respondents than with Option 1) related to the opportunity to offer a service close to home and the lack of need to travel, as well as (with Option 2), the opportunity to use existing knowledge and develop local skills.

A low proportion of respondents expressed concerns with Option 1, but the most common related to travel issues and the single location. Common concerns with the other options focused on delivery and management issues such as their practicality, feasibility and sustainability. There were also concerns about the nature and types of provision possible, and the potential for a lower quality service. Other concerns included the impact on service users through perceived fragmentation, long waiting times, isolation and access difficulties, as well as concerns about staffing difficulties, cost-effectiveness, and the lack of experience and evidence for these options.

Among those who expressed disagreement with one or more of the Options, around 65% identified Option 3 (including both those identifying Option 3 alone and in conjunction with another option). Similarly, around half (51%) identified that they disagreed with Option 2. A smaller proportion (around 10%) identified that they disagreed with Option 1.

Barriers

Barriers to accessing a residential pain management service were seen to include:

• Costs.
• Location and distance.
• Transport and travel issues.
• Family commitments and access to personal support.
• Gaining access to the service.
• Education and employment commitments.
• Physical and mental health issues and personal perceptions of provision.
• The nature of the treatment and the environment.
• Limited funding or staff support for provision.
• Issues for specific groups.

Components of service provision

In terms of aspects of residential pain management services which respondents considered should be included in a Scottish service, the proportions of respondents who ticked boxes to support the inclusion of each of those suggested were as follows:

Aspect of service	No.	%[1]
A chronic pain assessment	195	97
Supported one to one sessions to teach coping skills	182	91
Residential accommodation	183	91
Medication assessment	182	91
Tailored exercise programme	174	87
Group sessions	168	84
Opportunity for carer / support provider to accompany patient	168	84
Peer support	157	78

Additional suggestions for components of Scottish service provision were:

• Particular types of treatment and therapies.
• Follow-up and review.
• Information, advice and other support to patients, carers and family members.
• Services to meet the needs of specific groups.
• Particular facilities.
• Provision in other settings.
• Planning.
• Social opportunities.
• Research.

Nearly half (48%) of those who expressed a view about the retention of the option of a referral to Bath believed that access should be retained.

Other issues

Many additional comments were made in the consultation about issues such as:

• The current context and nature of services (e.g. the nature of chronic pain; the likely level of demand or need for provision; problems with, and positive aspects of current service provision).
• The consultation itself (e.g. the consultation overall; the processes; questions and issues for clarification; and the role and nature of respondents).
• The way forward (e.g. strategic issues; pattern of provision; staff education and training; location of a Centre of Excellence; the timing of developments; funding and resources; and the evidence base).

Overview

The consultation identified three options. Of these, there was a clear preference for Option 1 (a Centre of Excellence in a single location), in some cases in conjunction with another option. A significant number of benefits, as well as a few disadvantages, were suggested for Option 1. Most respondents supported the provision of a wide range of services in such a Centre of Excellence. Option 3 (an outreach or roving service), however, was identified most often by respondents as one they disagreed with. Nearly half of those who expressed a view suggested that access to the residential service at Bath should be retained either on the same basis as at present, or in a modified form.

Respondents identified a wide range of barriers to accessing a residential pain management service, including cost, location, logistical and personal issues.