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Pain Treatment

I congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) on securing this debate on what is, as he says, an extremely important topic. I listened carefully to him. He spoke with clarity and commitment not only about the position that his constituent finds herself in, but more generally about the issues faced by those suffering from pain, and particularly chronic pain. I take on board the issues that he raised about the treatment and management of pain in the NHS. In particular, I listened carefully to his comments about the treatment of complex regional pain syndrome, or reflex sympathetic dystrophy. He is right to say that pain can have a devastating effect on the quality of an individual’s life. It can take different forms and have different effects, depending on the individual. It is both a sensory and an emotional experience and is generally associated with tissue damage or inflammation. I, too, pay tribute to the hon. Gentleman’s constituent, Miss Lapinskis. I will look out for the proceedings and the conclusions of the conference that she is organising. I hope that he will pass on to her my best wishes for a successful conference. We will certainly want to see what progress the conference can make. We are not starting from scratch when it comes to managing pain. In recent years, a number of initiatives have focused on pain and its management. In 1999, the clinical standards advisory group issued a report on pain services—““Services for Patients with Pain””—which the Government welcomed. The researchers undertook in-depth interviews in 12 NHS trusts with pain service staff, ward staff, post-operative surgical patients, pain clinic patients and carers. They undertook site visits to interview hospital managers, health authority officials and others, and undertook a range of survey work with organisations and individuals with a relevant interest. The report concluded that pain services are highly cost-effective, producing savings for the national health service, but there is a ““but””, and perhaps here I will agree with the hon. Gentleman. The group found that there are variations in the commissioning arrangements for pain services and the resources dedicated to them. The group recommended that commissioners review local provision of pain services, looking particularly at the provision of more specialised treatments on a networked basis. The Royal College of Anaesthetists believes that the relief of pain should be a fundamental objective of any health service. Good practice should ensure provision of an evidence-based, high-quality, adequately resourced service dedicated to the care of patients and to the continuing education and development of staff. The hon. Gentleman was right to draw attention to that point, and in particular to the training component of courses for junior doctors. I am sure that his comments will have been heard by officials in my Department. Having considered what has gone before, I want to consider what is happening now and the plan for the future for the services that are available to deal with pain. As I said, pain can affect different people in different ways, so a range of different services and interventions will be needed to ensure that patients receive the care that is right for them. We are committed to ensuring that patients and their needs lie at the heart of all health and social services. As far as pain management is concerned, we need to ensure that patients receive help that is tailored specifically to their personal needs. That is why we have never centralised the management of pain services and why we believe that local flexibility is crucial to ensure that the NHS can and does respond effectively. Services are generally provided across a range of providers, such as community services, teaching hospitals, specialist units and so on, to ensure that patients get the care that they need. Treatments range from education to spinal cord stimulation and complex psychological treatments. One-to-one physiotherapy is often delivered to individuals in a pain management service oriented to rehabilitation rather than pain relief. Sometimes other health professionals, such as occupational therapists, offer one-to-one treatments, too. More than one treatment is often necessary, particularly in the treatment of complex pain. The treatment of long-term chronic pain is different from that of acute pain. We are talking about the ability not just to handle pain but to live with it in the long term. As the hon. Gentleman said, that is a different thing. Of course, it has an effect on a person’s quality of life, their sense of well-being and their mental health, and all those factors are relevant considerations. The hon. Gentleman might know that the Department has driven forward the expert patient programme, driven by the NHS, which provides opportunities for people who live with long-term chronic conditions to understand their condition in depth and to develop new skills to manage it better day to day. The number of course places on the expert patient programme will increase from 12,000 to 100,000 by 2012. The programme’s success and the response of individuals who have taken part have been such that the Government are committed to trebling investment in it. In 2006-07 its budget will be £13.4 million. We realise that commissioners may need additional support to set up specialist pain services, particularly in areas of the country where more provision is required, so we have issued guidelines to help. Those specialist national service definitions look specifically at specialised pain management services, which are for patients with chronic pain who require local specialist clinical expertise. In North-East Cambridgeshire, to use the hon. Gentleman’s constituency as an example, services are commissioned from a number of acute providers, including Peterborough, Addenbrookes, Hinchingbrooke, King’s Lynn and West Suffolk. More distant providers include the input centre at St. Thomas’s in London, the other major tertiary hospitals in London and the Queen’s medical centre in Nottingham. Those pain management services all treat patients with a wide range of conditions. Other local services include pain clinics. People with persistent pain may be able to attend a specialist pain clinic for assessment and possible pain management, together with advice on living a fuller life in spite of pain. Pain clinics vary in the treatments offered and not all hospitals have a specific pain clinic. Sometimes a consultant with an interest in pain will prescribe drugs or give injections to try to control it. Other clinics have teams of doctors, psychologists, nurses, physiotherapists, occupational therapists and others. The hon. Gentleman’s constituents can take advantage of other sources of pain management. For example, most physio services will offer treatment for RSD and multiple sclerosis, including pain relieving treatment techniques. This year, the primary care trust’s local delivery plan has identified the need for more general physio and musculoskeletal specialist posts—I hope that the hon. Gentleman will welcome that—which will in turn provide faster access to such treatment. I understand that funding has been allocated to support that development. I shall turn now from provision in the hon. Gentleman’s area to that offered nationally. The Department is developing a musculoskeletal services framework to sit alongside the expert patient programme and specialist services work. It is designed as a good practice guide to help NHS patients with musculoskeletal problems, and is a core pathway-based approach for all stages of musculoskeletal problems. The system relies heavily on referral to hospital for most conditions, but many patients with musculoskeletal problems do not need to be treated in hospital and could receive faster and more appropriate care in a community setting. People in such a position need and want treatment closer to home and I think that there will be no difference of opinion about it being right to move in that direction. The most common presenting symptom in people with musculoskeletal problems is pain. Qualitative studies have shown that what the group involved most wants from the NHS is pain control and help with improving functions. Providing services for prompt symptoms control through education, non-pharmacological and pharmacological treatment is pivotal to enabling an individual to maintain normal activities of daily living. Pain management is addressed throughout the framework. A patient booklet, co-sponsored by Arthritis Care and the Department of Health, has been developed alongside the framework. A number of other initiatives are in train, too, which I shall mention briefly. End-of-life pain needs specific handling, so in March 2004 the then National Institute for Clinical Excellence published guidance on supportive and palliative care services. That important document sets out services that help patients and carers cope with cancer and its treatment throughout the cancer journey, including through the management of pain. Although it is orientated towards cancer, many of the principles and recommendations in the guidance apply equally to other conditions. The NHS has been required to set out action plans to achieve compliance with the recommendations, and their implementation is being monitored by strategic health authorities. The implementation of the guidance will be incremental and will be supported through the increased funding provided to the NHS. The hon. Gentleman mentioned the need for better training for health professionals. As he will know, the Department of Health is not responsible for settling curricular matters for health professional training. However, we share a commitment with statutory and professional bodies that all health professionals are trained so that they have the skills and knowledge to deliver a high-quality health service to all groups of the population with which they deal, whatever their condition. We take on board his points and I am sure that they will be borne in mind. I want to say a brief word about the Government’s manifesto commitment on palliative care. We made this pledge:"““In order to increase choices for patients with cancer we will double the investment going into palliative care services, giving more people the choice to be treated at home””." That is why we set out a programme of action on end-of-life care in the White Paper, ““Our health, our care, our say””. As it is developed and implemented, it will provide the necessary support so that all people, regardless of age or condition, can, where appropriate, choose where they die. We have committed an additional £50 million a year to improve the provision of and access to specialist palliative care. Our latest information is that the allocation has funded a range of activity nationally, including the provision of an extra 44 palliative medicine consultants, 172 clinical nurse specialists and 46 specialist palliative care beds. In conclusion, we recognise the need to broaden the access that patients with a variety of conditions have to high-quality care and pain management services. We recognise that there is still some way to go to ensure that all people who need it have access to such care, but we have started to implement a number of initiatives to stress the importance of pain management. This has been a good debate. I am grateful and pleased that the hon. Gentleman has managed to secure it. He is right; it is the core business of the national health service to get the treatment and relief of pain right, and it is right that we consider it in the broad sense in which he has brought it to us. I wish his constituent well with her conference later this year and also congratulate her on the work that she is doing to draw attention to a condition that needs help and specialist support.