The Department’s required Standard Operating Procedures, which all independent abortion providers must comply with, set out that all providers should have protocols in place covering the support that should be in place for women following an abortion procedure.

Abortion providers will discuss possible complications with the woman during the consultation and women will be provided with written advice and information about possible symptoms, including those which would necessitate urgent review. Women have access to a 24 hour telephone helpline should they have any concerns. Follow up calls regarding pain management are a matter for individual providers.

The Department does not hold the information requested.

No specific assessment has been made.

The Department does not set clinical practice. To support clinical practice, the Royal College of Obstetricians and Gynaecologists has considered the issue of fetal pain and awareness in its guidelines on ‘The Care of Women Requesting Induced Abortion’ and ‘Fetal Awareness: Review of Research and Recommendations for Practice’, which are available at the following links:

https://www.rcog.org.uk/globalassets/documents/guidelines/abortion-guideline_web_1.pdf

https://www.rcog.org.uk/globalassets/documents/guidelines/rcogfetalawarenesswpr0610.pdf

Access to defined healthcare is not restricted either under the previous Tier 4 arrangements or the current national lockdown. Where services are commissioned by the National Health Service, any decisions on changes to provision is a matter for the local NHS. Where health services are privately provided, such decisions are a matter for the individual practitioner or the organisation they are employed by.

The Complementary and Natural Healthcare Council has set out advice for its members on the circumstances in which it understands massage therapy would meet the definition of healthcare set out in the legislation. It is however for individual practitioners and their employers to ensure that practice is within the current legislation.

The Department does not set clinical practice. To support clinical practice, the Royal College of Obstetricians and Gynaecologists has considered the issue of fetal pain and awareness in its guidelines on ‘The Care of Women Requesting Induced Abortion’ and ‘Fetal Awareness: Review of Research and Recommendations for Practice’, which are available at the following links:

https://www.rcog.org.uk/globalassets/documents/guidelines/abortion-guideline_web_1.pdf

https://www.rcog.org.uk/globalassets/documents/guidelines/rcogfetalawarenesswpr0610.pdf

The Department does not set clinical practice. To support clinical practice, the Royal College of Obstetricians and Gynaecologists has considered the issue of fetal pain and awareness in its guideline on Fetal Awareness: Review of Research and Recommendations for Practice, published in March 2010.

The Department has brought the article to the attention of the Royal College of Obstetricians and Gynaecologists. It is for the Royal College to consider whether to revise the guidelines, having looked at the available evidence.

Agmatine is a substance that is classified as a novel food in the European Union. The Medicines and Healthcare products Regulatory Agency (MHRA) can confirm Agmatine is not present in any licensed medicines in the United Kingdom and there have been no clinical trials using agmatine either.

In order for the MHRA to authorise a medicine for use in the UK, a manufacturer has to apply to obtain a marketing authorisation. The MHRA makes its decision to approve a licence for a product based on demonstration of safety, quality and efficacy. Thus far, the MHRA has not received any application for Agmatine to be used for medical purposes.

The Women’s Health Agenda is not a formal group and there are no meetings of the Women’s Health Agenda planned.

However, we are committed to considering the issue of painful hysteroscopies as part of our ongoing work on women’s health and the Royal College of Obstetricians and Gynaecologists is currently reviewing the guideline regarding out-patient hysteroscopy, which has an explicit focus on minimising pain and optimising the woman’s experience.

The Department does not set clinical practice. To support clinical practice, the Royal College of Obstetricians and Gynaecologists (RCOG) has considered the issue of fetal pain and awareness in its guideline on ‘Fetal Awareness: Review of Research and Recommendations for Practice’, published in March 2010.

The Department has brought the article by Dr Stuart W G Derbyshire and John C Bockmann to the attention of the RCOG. It is for the RCOG to consider whether to revise the guidelines, having looked at the available evidence.

There are currently no plans to create a separate holistic pain management service as part of the proposed National Health Service mesh specialist centres.

Women who are referred to the mesh specialist centres will be discuss their treatment with the Mesh Service’s Multi-Disciplinary Team. The team will include a specialist in pain management with an expertise in pelvic pain who will support patients in managing their pain.

Departmental officials have been working with NHS England and NHS Improvement to establish means of specialist support for those women requiring it. While NHS England and NHS Improvement complete the process of commissioning mesh removal centres, there are hospitals in England where this type of treatment is available. Both the British Association of Urological Surgeons and the British Society of Urogynaecology have information on their respective websites about the hospitals and surgeons that will provide the specialist support required.

On managing chronic pain, the National Institute for Health and Care Excellence (NICE) advises that the draft guideline is still out for consultation in line with their standard processes. This will close on Monday 14 September after which their guideline committee will meet to consider comments received.

On pain specifically experienced as a result of mesh insertion, NICE advises that its specific guideline is ‘Urinary incontinence and pelvic organ prolapse in in women: management’, which includes advice on managing complications.

On the use of mesh to treat hernias (abdominal wall reinforcement), the Medicines and Healthcare products Regulatory Agency has not had any evidence which would lead it to change its position on use of surgical mesh for hernia repairs.

In the NHS Long Term Plan, published 7 January 2019, NHS England set out the expansion of online access to support for people with musculoskeletal problems. This included programmes such as a digital version of the well-established face-to-face ESCAPE-pain group programme, which enables self-management and coping with arthritic pain through exercise.

The online version of the ESCAPE-pain programme is currently freely available in both a web-based form, which can be accessed by a computer or a variety of mobile devices, and an application available on Android smartphones. The ESCAPE-pain website is available at the following link:

www.escape-pain.org/

Outcome data on user engagement the ESCAPE-Pain programme is expected in August, which will enable an assessment of usage.

We continue to work closely with the National Health Service and partners and guidance has already been issued to the NHS on the process of starting to restore urgent non-COVID-19 services in a safe way, with excellence in infection prevention and control as a key principle.

The approach to the reset of services, including pain clinics, will be flexed at local level according to capacity and demand in different parts of the country and will be a gradual process.

No specific assessment of soft tissue therapy for patients in pain, when no other solution is available, has been made. However, the National Institute for Health and Care Excellence guideline ‘Low back pain and sciatica in over 16s: assessment and management’, published in 2016, sets out that clinicians should consider “manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy”.

The commissioning of spinal cord stimulation (SCS) is the responsibility of clinical commissioning groups. The National Institute for Health and Care Excellence Technology Appraisal ‘Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin’ reviewed in 2014, recommends SCS as a treatment option for adults with chronic pain of neuropathic of ischaemic origin. The guidance is available at the following link:

www.nice.org.uk/guidance/ta159

There are a wide range of SCS devices available, and centres can choose which type of device to implant. The Evoke device is available through the NHS Supply Chain.

In the NHS Long Term plan, published on 7 January 2019, NHS England set out the expansion of online access to support for people with musculoskeletal problems. This included programmes such as a digital version of the well-established face-to-face ESCAPE-pain group programme, which enables self-management and coping with arthritic pain through exercise.

The online version of the ESCAPE-pain programme is currently freely available in both a web-based form, which can be accessed by a computer or a variety of mobile devices, and an application available on Android smartphones. The ESCAPE-pain website is at the following link:

www.escape-pain.org/

Outcome data on user engagement the ESCAPE-Pain programme is expected in August.

Clinical commissioning groups (CCGs) are responsible for commissioning care and prevention services for patients with multiple sclerosis, cancer and strokes. In doing so, CCGs need to ensure that the services they provide, including those in non-clinical and therapeutic settings are fit for purpose, reflect the needs of the local population and are based on the available evidence and take into account national guidelines

In addition to CCG funding of NHS services, on 22 May, the Government announced £22 million of funding for health and social care charities, many of whom provide non-clinical and therapeutic support services to patients with these conditions. The Department is engaging with the relevant charities directly to ensure the money goes out to the charities as quickly as possible.

There is currently no plan for the Department to review the guidelines on foetal pain.

The Department does not set clinical practice. It is for clinicians to determine whether it is appropriate to provide fetal pain relief. To support clinical practice, the Royal College of Obstetricians and Gynaecologists has considered the issue of fetal pain and awareness in its guidelines on ‘The Care of Women Requesting Induced Abortion and Fetal Awareness: Review of Research and Recommendations for Practice’, which can be viewed online at the following link:

https://www.rcog.org.uk/globalassets/documents/guidelines/abortion-guideline_web_1.pdf

https://www.rcog.org.uk/globalassets/documents/guidelines/rcogfetalawarenesswpr0610.pdf