Draft framework for pain management service delivery

The Scottish Government set out an ambition to develop a new Framework for pain services to better meet the need of people living with chronic pain in Scotland.   Chronic pain is estimated to affect 30 – 50% of the adult UK population, with an estimated 5% of the Scottish population experiencing disabling, high-impact pain

The draft Framework set out a comprehensive summary of the evidence on the impact of chronic pain. It contained a series of proposed Aims and Commitments which were intended to drive discussion and engagement with stakeholders to inform our approach to service improvement.

The consultation was launched on 6 December 2021 and closed on 28 February 2022. The consultation paper can be found at: Draft framework for pain management service delivery - Scottish Government - Citizen Space (consult.gov.scot)

114 responses were received to the consultation, of which 88 were from individuals and 26 from organisations. Where consent has been given to publish the response it can be found on the Scottish Government’s Citizen Space public consultation portal Published responses for Draft framework for pain management service delivery - Scottish Government - Citizen Space (consult.gov.scot)

There was a very high level of support for the Aims and Commitments set out in the draft Framework from both individual and organisational respondents. We have published an independent analysis of all the response which can be found at Pain management - service delivery framework: consultation analysis - gov.scot (www.gov.scot)

A consistent theme which emerged from the feedback included a call for greater clarity and articulation of the specific actions that would be taken to deliver the Aims set out in the draft Framework.

It was highlighted that there is considerable variation in what information and advice is provided to people with chronic pain which should be addressed by the Framework. This included the importance of ensuring all health and care workers have an understanding of the challenges of living with persistent pain so that they provide informed and compassionate care. Feedback was provided on opportunities to improve referral and planning of care as well as suggestions for what services should be accessible for everyone with chronic pain to help them maintain their quality of life.

It was also indicated that greater clarity is required on the range of options that should be considered as part of care planning. Respondents also provided views on how to improve consistency in clinical practice, including a focus on updated clinical guidance, improved education and greater skill-sharing across professional groups.

It was felt that alongside ensuring more consistent advice was provided to patients, there is a need for improved education and training on pain management, and views were provided on what this should include, how it should be delivered and how best to engage both trainee and existing healthcare professionals on this issue. In relation to the data proposals in the draft Framework there were calls to ensuring continued progress to improve quality and transparency of the existing data that is reported.

Respondents to the consultation highlighted the importance of clear leadership and governance arrangements being in place in order to ensure the success of any service improvement initiatives in support of the Framework Aims.

Based on the findings of the independent analysis of your responses, we carried out work during 2022 to review, update and refine the Aims and Commitments which had been set out in the draft Framework. In doing so we have developed a ‘Framework for Pain Management Service Delivery – Implementation Plan’ in order to reflect the urgency for service improvement expressed in the responses to the consultation. This is available to view at: Pain management - service delivery framework: implementation plan - gov.scot (www.gov.scot)

In response to the feedback for greater clarity, the Implementation Plan sets out 18 specific Actions we intend to deliver in the next year to improve care, support and services for people with chronic pain. This will provide a clear ‘roadmap’ to guide both Government and stakeholder activity to address the priorities you have identified.

We have developed dedicated Actions to deliver new information resources on NHS Inform and other sources of information, which will be overseen by a dedicated expert working group. We will also work to increase the healthcare workers’ knowledge and skills in supporting people with chronic pain with Actions to establish a Chronic Pain Knowledge Hub supported by NHS Education for Scotland and to promote a ‘pain informed’ approach to care.

We have developed Actions on the challenges people with chronic pain face in accessing the care they need, when they need it. This includes establishing a new pain service managers Network to improve local coordination and planning of services for people with chronic pain. We will also identify, scale-up and roll out best-practice ways of working that have been developed in different Health Board areas to improve care across for people across all of Scotland.

We will deliver Actions to help reduce the unwarranted variation in services and care that people responding to the consultation highlighted. This includes Actions to update existing clinical guidance to drive more consistent and appropriate decisions about care and prescribing of medication for chronic pain.

Actions have also been developed in response to the feedback from the consultation on the need for increase healthcare professional skills on chronic pain, including establishing a new national pain education group. We are also acting to deliver new pain management training pathways. We will respond to calls to improve data collection and reporting through work with Public Health Scotland and delivering national data on pain and its impact through the Scottish Health Survey.

Finally, we have acknowledged the challenges raised in the consultation on ensuring all partners views are heard and involved in national policy and improvement activities. In response to this we have developed new Governance arrangements which are intended to increase coordination, engagement and the pace of action to improve care and services for people with chronic pain.