The Department has asked the National Institute for Health and Care Excellence (NICE) to develop a quality standard on pain management for young people and adults as part of a library of approximately 180 NHS Quality Standards. NICE has not yet published a time scale for the development of this quality standard. NHS England is now responsible for the strategic direction of NHS quality standards.

The mandate to NHS England requires it to deliver continued improvements in relation to enhancing the quality of life for people with long-term conditions, which includes those with chronic pain.

I refer the hon. Member to the written ministerial statement I made on drug driving on 7 March 2013.

The recommendations of the UK Pain Proposal report are closely aligned with those in the chapter on chronic pain in the chief medical officer's annual report for 2008, and those agreed at the national pain summit of December 2011. A range of actions have been taken by the department, in partnership with other national organisations, to address these recommendations. From April 2013, the NHS Commissioning Board will be held to account for achieving improvements in domain 2 of the NHS Outcomes Framework, improving the quality of life of people with long term conditions, on which chronic pain has a significant impact.

Estimates of spending in the National Health Service in England on chronic pain are available from the programme budgeting collection, which requires primary care trusts (PCTs) to analyse their expenditure by specific healthcare conditions and, from 2010-11, by care setting. Chronic pain is treated in the programme budgeting framework as a subcategory within the main category “neurological conditions”. The following table provides estimated PCT expenditure on chronic pain in 2010-11, by care setting:

Notes:

1. Figures are aggregate PCT expenditure figures. This does not include any expenditure by the Department, strategic health authorities or special health authorities.

2. The figure for ‘GP, dental & ophthalmic figure’ does not include expenditure on standard contract primary care consultations.

3. The primary prescribing figure includes expenditure on analgesics estimated using information from the British National Formulary to split this expenditure between Chronic Pain and other categories.

4. Due to differences in the level of information available to PCTs on A&E attendances, a national split has been applied to PCT total A&E expenditure to apportion it across programme budgeting categories, based on A&E diagnosis codes

5. Analysing expenditure for the Programme Budgeting return is complex. Data for subcategories such as chronic pain are expected to be less robust than data on main categories such as neurological conditions.

6. The care setting level figures are experimental and caution should be used when interpreting these figures

Local commissioners are responsible for determining policies for spending on chronic pain, as for other conditions, informed by local needs and priorities and by available national guidance. Commissioners will wish to take into account the results of the recent national audit on secondary care pain management services, which shows wide local variations in the access to services.

Estimates of the number and proportion of people living with chronic pain for each strategic health authority (SHA) in England are given in the following table, based on the prevalence estimates from the 2011 Health Survey for England. Differences in prevalence between SHA populations are not statistically significant after adjusting for differences in age profile.

Chronic pain is defined as pain or discomfort which currently troubles an individual either all of the time or on and off, and which has lasted for more than three months.

Sources:

1. Mid-year 2011 population figures from ‘GP registered populations by SHA’, Health and Social Care Information Centre, derived from 2001 census data.

2. Prevalence estimates from the Health Survey for England 2011, Chapter 9 Table 9.2.

Under Any Qualified Provider, the commissioner is responsible for setting the local specification for the service. The criteria used to assess the suitability of potential providers for any service can vary between commissioners according to local quality requirements. East Riding of Yorkshire Primary Care Trust (PCT) and Hull Teaching PCT are currently the only two PCTs implementing Community Chronic Pain Management services. Both PCTs have chosen to use the same service specification for this service, a copy of which can be accessed via the NHS Supply2Health website at:

www.supply2health.nhs.uk/CPI/Lists/AQPOffers/DispForm.aspx?ID=7

We have asked the National Institute for Health and Clinical Excellence (NICE) to develop a Quality Standard on pain management for young people and adults as part of a library of approximately 180 NHS Quality Standards. NICE has not yet published a timescale for the development of this Quality Standard.

The NHS Commissioning Board, who will be responsible for the strategic direction of NHS Quality Standards from April 2013, have begun discussions with NICE to determine the most appropriate sequencing for NHS Quality Standards to assist the board in improving patient outcomes across the five domains of the NHS Outcomes Framework.

The Medicines and Healthcare products Regulatory Agency (MHRA) is the Government agency responsible for ensuring that medicines and medical devices work, and are acceptably safe. When assessing new medicines, including those for the management of chronic pain, the MHRA considers the benefits of administering the product for the proposed indications versus the potential adverse effects.

Departmental officials are working closely with the Department for Transport and other Government Departments to develop legislation aimed at reducing drug-impaired driving, while ensuring that people have access to the medicines that they need.

The aim of the new offence is to improve the law available for tackling the problem of drug driving, a behaviour which presents a significant road safety risk. The new offence contains a statutory defence for those drivers who have taken medicines containing specified controlled drugs in accordance with medical advice.

The Government have set up a panel of experts to work together to come up with recommendations for the controlled drugs to be covered by the new offence and a specified limit for each. The terms of reference for the panel include considering the evidence in relation to amphetamines, benzodiazepines and hypnotics, cannabinoids, cocaine, hallucinogens and opioids.

The expert panel is considering opioids, because some of the scientific issues need to be considered across this family of drugs, which includes both heroin and medicinally used drugs. However the prime targets for the new offence are those controlled drugs taken for non-medicinal reasons which represent a public safety problem on the roads. Heroin is one of the relatively prevalent controlled drugs taken non-medicinally and known to affect driving.

The members of the panel are medical and scientific experts. Their terms of reference include

“to consider in cases where such concentrations can be identified, for an average member of the adult population the degree of variability across the population, including for habitual users of these substances”.

Some controlled drugs available for medical use are often used as drugs of misuse and associated with increased road crash risks. These might be included in the new offence.

The existing offence (in section 4 of the 1988 Act), which covers driving whilst impaired due to drugs, would continue to be relevant to deal with those whose driving is impaired by prescribed drugs (including specified

controlled drugs taken in accordance with medical advice), where police will have to prove impairment on a case by case.

The list of specified controlled drugs and specified limits are not contained in the legislation itself, but the legislation creates the power to set these in regulations. This will be done taking account of the panel's recommendations, consultation and then through secondary legislation using the affirmative procedure. The consultation is a statutory requirement.

The previous administration had consulted various representatives from medical profession, pharmaceutical industry on new drug driving offence in 2008. There was also extensive evidence gathering for Sir Peter North for his report on the review of drink and drug driving law in 2010, commissioned by the Department for Transport.

The aim of the new offence is to improve the law available for tackling the problem of drug driving, a behaviour which presents a significant road safety risk. The new offence contains a statutory defence for those drivers who have taken medicines containing specified controlled drugs in accordance with medical advice.

The Government have set up a panel of experts to work together to come up with recommendations for the controlled drugs to be covered by the new offence and a specified limit for each. The terms of reference for the panel include considering the evidence in relation to amphetamines, benzodiazepines and hypnotics, cannabinoids, cocaine, hallucinogens and opioids.

The expert panel is considering opioids, because some of the scientific issues need to be considered across this family of drugs, which includes both heroin and medicinally used drugs. However the prime targets for the new offence are those controlled drugs taken for non-medicinal reasons which represent a public safety problem on the roads. Heroin is one of the relatively prevalent controlled drugs taken non-medicinally and known to affect driving.

The members of the panel are medical and scientific experts. Their terms of reference include

“to consider in cases where such concentrations can be identified, for an average member of the adult population the degree of variability across the population, including for habitual users of these substances”.

Some controlled drugs available for medical use are often used as drugs of misuse and associated with increased road crash risks. These might be included in the new offence.

The existing offence (in section 4 of the 1988 Act), which covers driving whilst impaired due to drugs, would continue to be relevant to deal with those whose driving is impaired by prescribed drugs (including specified

controlled drugs taken in accordance with medical advice), where police will have to prove impairment on a case by case.

The list of specified controlled drugs and specified limits are not contained in the legislation itself, but the legislation creates the power to set these in regulations. This will be done taking account of the panel's recommendations, consultation and then through secondary legislation using the affirmative procedure. The consultation is a statutory requirement.

The previous administration had consulted various representatives from medical profession, pharmaceutical industry on new drug driving offence in 2008. There was also extensive evidence gathering for Sir Peter North for his report on the review of drink and drug driving law in 2010, commissioned by the Department for Transport.

The aim of the new offence is to improve the law available for tackling the problem of drug driving, a behaviour which presents a significant road safety risk. The new offence contains a statutory defence for those drivers who have taken medicines containing specified controlled drugs in accordance with medical advice.

The Government have set up a panel of experts to work together to come up with recommendations for the controlled drugs to be covered by the new offence and a specified limit for each. The terms of reference for the panel include considering the evidence in relation to amphetamines, benzodiazepines and hypnotics, cannabinoids, cocaine, hallucinogens and opioids.

The expert panel is considering opioids, because some of the scientific issues need to be considered across this family of drugs, which includes both heroin and medicinally used drugs. However the prime targets for the new offence are those controlled drugs taken for non-medicinal reasons which represent a public safety problem on the roads. Heroin is one of the relatively prevalent controlled drugs taken non-medicinally and known to affect driving.

The members of the panel are medical and scientific experts. Their terms of reference include

“to consider in cases where such concentrations can be identified, for an average member of the adult population the degree of variability across the population, including for habitual users of these substances”.

Some controlled drugs available for medical use are often used as drugs of misuse and associated with increased road crash risks. These might be included in the new offence.

The existing offence (in section 4 of the 1988 Act), which covers driving whilst impaired due to drugs, would continue to be relevant to deal with those whose driving is impaired by prescribed drugs (including specified

controlled drugs taken in accordance with medical advice), where police will have to prove impairment on a case by case.

The list of specified controlled drugs and specified limits are not contained in the legislation itself, but the legislation creates the power to set these in regulations. This will be done taking account of the panel's recommendations, consultation and then through secondary legislation using the affirmative procedure. The consultation is a statutory requirement.

The previous administration had consulted various representatives from medical profession, pharmaceutical industry on new drug driving offence in 2008. There was also extensive evidence gathering for Sir Peter North for his report on the review of drink and drug driving law in 2010, commissioned by the Department for Transport.

The aim of the new offence is to improve the law available for tackling the problem of drug driving, a behaviour which presents a significant road safety risk. The new offence contains a statutory defence for those drivers who have taken medicines containing specified controlled drugs in accordance with medical advice.

The Government have set up a panel of experts to work together to come up with recommendations for the controlled drugs to be covered by the new offence and a specified limit for each. The terms of reference for the panel include considering the evidence in relation to amphetamines, benzodiazepines and hypnotics, cannabinoids, cocaine, hallucinogens and opioids.

The expert panel is considering opioids, because some of the scientific issues need to be considered across this family of drugs, which includes both heroin and medicinally used drugs. However the prime targets for the new offence are those controlled drugs taken for non-medicinal reasons which represent a public safety problem on the roads. Heroin is one of the relatively prevalent controlled drugs taken non-medicinally and known to affect driving.

The members of the panel are medical and scientific experts. Their terms of reference include

“to consider in cases where such concentrations can be identified, for an average member of the adult population the degree of variability across the population, including for habitual users of these substances”.

Some controlled drugs available for medical use are often used as drugs of misuse and associated with increased road crash risks. These might be included in the new offence.

The existing offence (in section 4 of the 1988 Act), which covers driving whilst impaired due to drugs, would continue to be relevant to deal with those whose driving is impaired by prescribed drugs (including specified

controlled drugs taken in accordance with medical advice), where police will have to prove impairment on a case by case.

The list of specified controlled drugs and specified limits are not contained in the legislation itself, but the legislation creates the power to set these in regulations. This will be done taking account of the panel's recommendations, consultation and then through secondary legislation using the affirmative procedure. The consultation is a statutory requirement.

The previous administration had consulted various representatives from medical profession, pharmaceutical industry on new drug driving offence in 2008. There was also extensive evidence gathering for Sir Peter North for his report on the review of drink and drug driving law in 2010, commissioned by the Department for Transport.

The National Institute for Health and Clinical Excellence (NICE) is an independent body and its clinical guidelines, developed through a rigorous and consultative process, are widely recognised as authoritative guidance for the national health service. Local commissioners are expected to take account of NICE and other professional guidance in determining the services they commission for their local populations in the light of local needs and priorities.

The information requested is not available centrally. Commissioners are responsible for using their available resources to secure the best possible care for their populations, taking into account national clinical guidance and standards and local needs and priorities. In future, front line clinicians in clinical commissioning groups will be taking the lead in making these judgments. Where a commissioner has decided, as a matter of general policy, not to provide funding for certain treatments, they should have in place a transparent and fair process for considering requests for exceptional treatment on their merits.

The information requested is not available centrally. Commissioners are responsible for using their available resources to secure the best possible care for their populations, taking into account national clinical guidance and standards and local needs and priorities. In future, front line clinicians in clinical commissioning groups will be taking the lead in making these judgments. Where a commissioner has decided, as a matter of general policy, not to provide funding for certain treatments, they should have in place a transparent and fair process for considering requests for exceptional treatment on their merits.

The information requested is not available nationally. Decisions on treatments should be made by clinicians based on what is most clinically appropriate for the patient and take the individual patient's needs into account. Local managers need to be able to demonstrate how they have taken account of the best available evidence, patients' health care needs and the views of health care professionals who understand patients’ needs when making decisions.

Marketing authorisation by the Medicines and Healthcare products Regulatory Agency, has only been sought for racemic methadone. Levo-methadone has not been authorised in the United Kingdom and data in support of its efficacy have not been submitted for evaluation.

The Department has no plans to specifically commission research into the efficacy of mindfulness-based therapies in the treatment of chronic pain and associated depression. However, the Department's National Institute for Health Research welcomes funding applications for research into any aspect of human health, including mindfulness-based therapies. These applications are subject to peer review and-judged in open competition, with awards being made on the basis of the scientific quality of the proposals made.

The Department has made no specific assessment of the efficacy of mindfulness-based therapies in the treatment of chronic pain or associated depression. The available literature suggests that such therapies are promising but that definitive evidence of their efficacy is currently lacking. The British Pain Society's draft pathways for the treatment of chronic pain refer to the use of a range of psychological therapies, which could include mindfulness-based therapies.