People should expect the right support to help them manage their long-term conditions, including chronic pain, and through the Mandate we have asked NHS England to make

measurable progress towards making the National Health Service among the best in Europe at supporting people with ongoing health problems to live healthily and independently, with much better control over the care they receive.

NHS England and its partners are working towards the implementation of the House of Care model, which is designed to support the delivery of person-centred, coordinated care, which enables individuals to make informed decisions which are right for them, and empower them to self-care.

NHS England is working to produce with patients and carers a supported self-management guide for people with complex care needs and frailty by June 2014 and is developing practical tools and commissioning guidance to support the delivery of the Mandate commitment for everyone with a long term condition being offered a personalised care plan by April 2015.

The content and standard of medical training, including in regards to pain management, is the responsibility of the General Medical Council (GMC), which is an independent statutory body. It has the general function of promoting high standards of education and co-ordinating all stages of education to ensure that medical students and newly qualified doctors are equipped with the knowledge, skills and attitudes essential for professional practice.

Medical schools design curricula for undergraduate medical education. In doing so they must ensure that teaching meets the standards of the GMC in order to both gain and maintain GMC recognition of their course.

The Government has mandated Health Education England (HEE) to provide national leadership on education, training and workforce development in the national health service. HEE will work with stakeholders to influence training curricula as appropriate.

Health professionals are responsible for monitoring pain levels during and after a hysteroscopy procedure.

There is no standard national pain scoring system but there are a number of different pain assessment tools available to health professionals. This means that methodology may vary between providers.

NHS England allocates funding to clinical commissioning groups (CCGs), who commission health services on behalf of their local population.

It is for local CCGs to decide how to best use the funding allocated to them, underpinned by clinical insight and knowledge of local health care needs.

The National Institute of Health and Care Excellence (NICE) has published a range of guidance on pain and

pain management. This guidance represents evidence-based best practice and provides a clear description of what high-quality health and social care services look like, so that organisations can improve quality and achieve excellence.

The Department expects CCGs to take into account any relevant NICE guidance as they design services to meet the needs of patients.

Recently announced changes to the general practitioner (GP) contract aim to restore the link between family doctors and patients, giving GPs the opportunity to provide more proactive, personalised care for all. They also introduce a new requirement for named GPs for people over 75.

The named GP will proactively ensure that a personalised care plan is in place, working with a multi professional team to make sure people stay healthy and independent for longer.

GPs will need to work closely with other healthcare professionals, their patients and their carers to identify priorities for the care plan in a co-ordinated way.

The Care Quality Commission (CQC) is the independent regulator of health and adult social care providers in England. Under the Health and Social Care Act 2008 (the 2008 Act) all providers of regulated activities, including national health service and independent providers, have to register with the CQC and meet a set of requirements of safety and quality.

(a) Under the registration requirements, employers must ensure that their employees are adequately trained to perform their duties.

(b) In addition, care providers should encourage service users, or those acting on their behalf, to understand the care or treatment choices available and discuss the balance of risks and benefits involved in any particular course of care or treatment. CQC also requires the provider to encourage the service user to express their views on what is important to them in relation to their care or treatment.

It is an offence if a provider fails to comply with the requirements and under the 2008 Act, and CQC has a wide range of enforcement powers that it can use if the provider is not compliant.

It is CQC's responsibility to develop and consult on its methodology for assessing whether providers are meeting the registration requirements.

On 15 October 2013, CQC published ‘A Fresh Start for the Regulation and Inspection of Adult Social Care’. This document sets out CQC's proposed changes to the regulation and inspection of Adult Social Care. CQC will carry out a full public consultation of these proposals in spring 2014.

On 23 January 2014, the Department published a consultation on Fundamental Standards. The Francis Inquiry report recommended the introduction of new fundamental standards of safety and quality below which care should never fall. The Department committed to incorporate these into the requirements for registering with CQC.

The Fundamental Standards are intended to be common-sense statements that describe the basic requirements that providers should always meet, and

set out the outcomes that patients or care service users should always expect. All care providers registered with CQC will have to meet them. The consultation closes on 4 April.

Through the Mandate, the Department has asked NHS England to demonstrate progress towards making the national health service among the best in Europe at supporting people with ongoing health problems to live healthy and independent lives, with better control over the care they receive.

NHS England has also committed to increasing the dementia diagnosis rate, from the current 46%, to two-thirds by 2015. A diagnosis of dementia is vital for accessing advice, care, support and treatment and this is especially important for people with co-morbid conditions.

The Department's NHS Outcomes Framework contains the indicators that will be used to hold NHS England to account for making significant progress in supporting the earlier diagnosis of illness, ensuring people have access to the right treatment when they need it and making progress in enhancing the quality of life for people with long-term conditions, such as dementia.

The Prime Minister's Challenge on Dementia has enabled the National Council for Palliative Care (NCPC) to learn from partners about the kind of resources they need in supporting people affected by dementia.

On 4 December 2012, the NCPC published guidance on managing pain and distress for people with dementia approaching the end of life.

The National Cancer Experience Survey 2013 contained a range of questions relating to the provision of information and advice about cancer care. The results of the survey were published by NHS England on 30 August 2013. In response to the specific question about the provision of information to help those caring at home, 61% of patients said their family or someone close to them, such as carers, received all the information they needed to help care for them at home, an increase of 1% on the result of the 2011-12 survey.

Through the Mandate we have asked the NHS England to make measurable progress in supporting people with ongoing health problems, such as complex regional pain syndrome (CRPS) to live healthily and independently, with much better control over the care they receive.

Many patients with long term chronic pain, such as those with CRPS, can be successfully supported and managed through routine primary and secondary care pain management services. However, it is important that those with the most serious pain management issues receive specialist treatment.

NHS England is responsible for commissioning highly specialised pain management services for patients with CRPS and has recognised more can be done to identify those most seriously affected. NHS England's Specialised Pain Clinical Reference Group is working with the Royal Colleges and the British Pain Society's guidelines to ensure the needs of these patients are appropriately met.

The DWP does not hold information regarding how many people in receipt of benefits in 2012 suffer specifically from a chronic pain condition. This is because for benefits that are not linked to health conditions, such as jobseeker’s allowance, we would not hold records pertaining to specific conditions that claimants may have in a manner that would allow us to accurately capture the statistics; we record the underlying health condition for employment support allowance, (or those remaining on income benefit), those on personal independence payments, (or remaining on disability living allowance), or those on attendance allowance. However chronic pain may be associated with a wide range of medical conditions and we do not record chronic pain as a discrete entry.

The term chronic pain is a general one that refers to persistent pain lasting anywhere from 3-6 months. Therefore chronic pain can be a result of a large number of diagnoses that cause pain. The medical condition of incapacity benefit/severe disablement allowance claimants and employment support allowance is recorded using a grouped version of the International Classification of Diseases (ICD10), and the only codes that specifically indicate chronic pain are those for 'Chronic intractable pain' and 'Other chronic pain', both of which come under the general heading of 'Pain not elsewhere classified'.

Figures for 'Pain not elsewhere classified' are provided in the following table for incapacity benefit/severe disablement allowance and employment support allowance. However, this is unlikely to be an accurate reflection of those individuals with chronic pain.

The Shropshire and Staffordshire area team does not hold a budget for specialised commissioning.

NHS England is responsible for commissioning specialised services. The prime objective of NHS England is to drive improvement in the quality of the NHS services, and the Government will hold them to account for this through the NHS Mandate.

NHS England is implementing a single operating model for the commissioning of 143 specialised services. This replaces the previous arrangements whereby 10 regional organisations were responsible for commissioning specialised services and where there was wide variation in the range, quality and access to specialised services that were commissioned.

Single nationally agreed service specifications are being developed for each of the 143 services to ensure that patients have equitable access to high quality services, regardless of where they live in England.