Chronic Pain Services

– in the Scottish Parliament at on 17 March 2011.

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Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

The next item of business is a members’ business debate on motion S3M-7853, in the name of Mary Scanlon, on chronic pain services in Scotland. The debate will be concluded without any question being put.

Motion debated,

That the Parliament is concerned that some Scottish patients with chronic pain are being forced to travel to England for treatment, with eight of Scotland’s NHS boards sending patients with chronic pain for treatment at the Royal National Hospital for Rheumatic Diseases in Bath at a cost of £206,685 in the first six months of 2010-11; understands that since 2008-09 it has cost the NHS over £620,000 to send patients to one hospital in Bath for treatment for chronic pain; understands the difficulties that this extra travel will cause for patients in terms of their own pain through travelling long distances, particularly from the north of Scotland, and also being separated from friends and families, and acknowledges the plight of people with chronic pain in Scotland, where the service across NHS boards is very patchy.

Photo of Mary Scanlon Mary Scanlon Conservative

The previous debate on chronic pain in the Parliament was secured by Dorothy-Grace Elder in February 2002. Nine years on, now is a good time to take stock of what is a serious issue in our national health service. I welcome Dorothy-Grace Elder to the public gallery. In her inimitable style as an excellent campaigner, she asked that chronic pain be moved up the political agenda. In 2002, she stated:

“‘The Highlands and Islands are a disgrace to the NHS’ for lack of specialised services.”—[Official Report, 27 February 2002; c 6746.]

In the motion for that debate, she highlighted

“the wreckage of many lives through lost jobs, and the loss of millions of pounds to the economy”.

It is estimated that 770,800 people in Scotland are affected by chronic pain. Now, nine years later, it is only right to mark the progress that has been made and to highlight how much more can be done.

Chronic pain is now acknowledged as a condition in its own right, and not just as a symptom of other problems. In 2009, the first lead clinician in chronic pain, Pete MacKenzie, was appointed. The GRIPS report—“Getting to GRIPS with Chronic Pain in Scotland: Getting Relevant Information on Pain Services”—was published, and a managed clinical network was established in Glasgow. The Royal College of General Practitioners has now appointed Dr Martin Johnson as the clinical lead for chronic pain, starting from 1 April this year. The Scottish pain research community will be launched on 31 March in Dundee, led by Professor Blair Smith, and I understand that more than 100 delegates have already registered for the launch. A chronic pain community website, led by NHS Quality Improvement Scotland, will be an information resource both for health professionals and for the public. Finally, there has been a submission for a guideline from the Scottish intercollegiate guidelines network this year.

People might therefore ask why we need this debate to highlight issues relating to chronic pain, and might ask why, if there has been so much progress, so many people, including adolescents, are being sent to Bath for residential treatment. Why is pain treatment in the national health service still such an issue?

The briefing paper provided by the Royal College of General Practitioners for the debate confirms that chronic pain affects around 20 per cent of the population, with about 7 per cent having chronic pain that is severe and disabling. People with chronic pain consult their general practitioner around five times more frequently than those without chronic pain, and chronic pain is a presenting condition in around 22 per cent of GP consultations. A total of 50 per cent of GP visits are for either pain or mental health issues.

A study in 2006 found that 25 per cent of people with chronic pain had to give up their jobs, 34 per cent had to change their jobs, and 24 per cent suffered from depression as a result of their pain. A total of 68 per cent of those people said that there were times when their medicines were not adequate to control their pain.

Tracking studies in Grampian have shown that the prevalence of chronic pain is increasing year on year, while 78 per cent of patients continued to report pain after four years.

I was surprised to learn that, in the United Kingdom, more than twice as many people are affected by chronic pain as are affected by heart disease. That leads to long-term absence from work, costing the UK economy nearly £4 billion and accounting for 180 million lost working days. A rough calculation shows that the cost for Scotland is £370 million, with 18 million lost working days. There can be no better case for a spend-to-save policy than the case for investing in services for chronic pain—with early diagnosis and early intervention.

The chronic pain managed clinical network in Glasgow is undoubtedly the best that we have; what we now need is a similar service throughout Scotland—with clear referral pathways from primary care to secondary care pain services, and with access to tertiary services such as spinal-cord stimulators, where those are considered appropriate. I understand that health board funding for referral to secondary and tertiary care is available only in two or three areas.

Last week, the cross-party group on chronic pain, of which I am convener, heard from Fiona Townsley—I have permission to use her name—who had an accident in 1997, which was followed by several orthopaedic operations. She was told that nothing else could be done and that she should go home and get on with her life. She could not use her arm; she lived on benefits and she lived on painkillers. In her words, she was

“trying to get through life but wishing it was all over.”

She eventually got referred to Dr Pete MacKenzie, who changed her life. The spinal-cord stimulator was used in 2007, and Fiona is now not only back in full-time employment but in a management position.

I accept that spinal-cord stimulators may not be the answer for everyone, but I am concerned that the number of those procedures available is limited both at Ninewells in Dundee and in Glasgow. How can patients across Scotland be referred for this procedure and other procedures when we do not have a clear referral pathway and we have a capped service?

If economic growth is our number 1 priority, surely we need to ensure that patients suffering pain are treated appropriately and given the opportunity to stay in work or return to work. Scotland has a reputation for parking people on methadone, antidepressants and, now, painkillers when other options could be tried if patients only got the chance.

We need equity of provision. Given the cost of sending people for residential treatment in Bath, my question to the Minister for Public Health and Sport or the equivalent minister who is appointed in May is whether an audit can be done across Scotland to identify how many people could benefit from residential treatment, to determine whether it would be appropriate to have such a service in Scotland.

Although I have only skimmed the surface of this important issue, I hope that others will recognise that progress has been made but we still have a patchy, postcode lottery service across Scotland.

Photo of Christine Grahame Christine Grahame Scottish National Party

I acknowledge the commitment to the issue of both Dorothy-Grace Elder and my colleague Mary Scanlon. As a pre-emptive strike, I beg a little flexibility from the Presiding Officer, because I may digress a little. He is indicating to me no, but I shall try.

My speech concerns a 53-year-old constituent of mine who has recently been in touch with me and who has been a bricklayer most of his life. He was hospitalised for abdominal pain about 18 months ago and has recently been diagnosed with type 1 diabetes, for which he has at least four injections a day. His abdominal pain has increased and is now chronic. His medication comprises Pregabalin, Merbentyl, Tramadol, paracetamol and Omeprazole, which are to deal with nausea and constant pain. At least the medication will be free from 1 April.

My constituent has been unable to work since the first week in December and his doctor has signed him off from 3 March to 3 April, deeming him unfit for work. His consultant has said that he is unfit for work. However, the Department for Work and Pensions claims that he is fit for work. He completed the employment and support allowance questionnaire and then was sent, as people are, for an assessment with a private company called Atos Healthcare.

The test that is given is not only for people with chronic pain but for everybody. The information about it states:

“The assessment is likely to be different from what you would expect from your own doctor. The approved healthcare professional’s assessment is not to diagnose or discuss treatment of your illness or disability; it is to assess how it affects you and your ability to work. To find this out, the approved healthcare professional may not need to carry out a physical examination.”

In the case of my constituent, there was no physical examination. The problem for people with chronic pain and, indeed, other illnesses is that how they feel can vary from day to day. However, the questionnaire asks:

“Can you go up or down two steps without help from another person, if there is a rail to hold on to? ... Can you move from one seat to another right next to it without help from someone else? ... Can you stay in one place, either standing or sitting, for at least an hour without help from another person?”

My constituent tells me that, on a good day, the pain is similar to a bad stitch in his side but that, on a bad day, he simply does not get out of bed. He states that there are more bad days than good and that they occur randomly, and that he sleeps only a little through the night. None of that kind of information is exposed in the test for the DWP. To compound the problem, even the assessor told my constituent that the system is unfair. He also said that his claim would be rejected—it was and he was awarded no points—but that his appeal would be successful. I wait to see whether it will be.

In the meantime, my constituent is worn out and disgusted and upset that, after all his years of working and now having pain that gives him little respite, he is being rubber-stamped as—I think that the term is apposite today—a benefit scrounger, when he is anything but.

I thought that it was important to bring that issue to the chamber because, although it is adjacent to the issue of the treatment of chronic pain, it is another unfairness for people who have chronic pain.

Photo of Cathie Craigie Cathie Craigie Labour

I am grateful for the opportunity to speak in the debate. I thank Mary Scanlon for bringing the subject to the chamber and I acknowledge her long involvement in the issue, which dates back to the first parliamentary session. I am grateful to her for reminding us of Dorothy-Grace Elder’s work on chronic pain. I thank both of them for their work.

A great many people in Scotland suffer from chronic pain. It is worrying that some patients are being forced to cross the border to receive care that should be available here in Scotland. Sending patients to England for care not only puts pressure on the public purse but can be painful and inconvenient for patients, for whom travelling such a great distance is stressful.

In the first six months of 2010-11—the motion contains some of this information—21 Scots were treated in the centre near Bristol. Eight of the 14 Scottish health boards referred patients to the royal national hospital for rheumatic diseases, which cost almost £207,000. That is a lot of money. There is no doubt that the facility in Bath is highly specialised, but the Scottish Government and we as a Parliament should do all that we can to invest in services in Scotland, so that our constituents do not have to travel such a great distance.

In its briefing for the debate, the Long Term Conditions Alliance Scotland reminds us that chronic pain is a long-term condition. As well as suffering chronic pain, people suffer the effects of other long-term conditions. It is a concern that patients are not treated nearer home.

I know that I need not tell members about the debilitating effects that people who live with chronic pain suffer. It affects families as a whole. Christine Grahame mentioned her constituent who has sleepless nights. If someone who has sleepless nights lives as part of a family, it is not only that person who suffers from walking the floorboards, because the rest of the family will be up, too. As Mary Scanlon said, people lose their jobs and cannot work because of chronic pain, which means that they lose the confidence and self-respect that work can provide.

Chronic pain is a serious matter. As Mary Scanlon said, 20 per cent—one in five—of the population suffer from chronic pain. The number of people who go to their GP for support and advice is eye opening.

Various projects across Scotland offer patients support but, when we take account of the figures, more needs to be done. Mary Scanlon’s point about spending to save is important. If we invest in local community pain-management services and support groups closer to patients’ homes, that will pay dividends not only for individuals but for taxpayers in the future.

I very much support the work that is being done and which Mary Scanlon and the cross-party group on chronic pain have done to highlight this serious issue. We should improve the services in Scotland and deliver them here, where patients want them.

Photo of Jamie Stone Jamie Stone Liberal Democrat

It is a pleasure to join the debate. I congratulate Mary Scanlon on her motion and I salute the work that she has done with her cross-party group on chronic pain. It is great that Dorothy-Grace Elder is in the gallery today. I remember well that, when I was a much younger and less grey MSP, she tackled me about chronic pain. Being tackled by her is an experience that is not forgotten for a very long time. I thank her for making me aware of the issue and making me think about it.

It will come as no surprise to members that, when I hear Mary Scanlon speak of the trips to Bath and their cost, I cannot help but reflect on what such trips would mean for my constituents and those of Mary Scanlon. They are faced with trips that are bad enough as it is from the north coast of Sutherland or Caithness to Raigmore hospital or, for some treatments, Aberdeen royal infirmary at Foresterhill. The thought of chronic pain sufferers having to endure a four-hour or seven-hour vehicle journey each way is almost unthinkable. The journey itself and the discomfort of sitting in a vehicle for that length of time can only make the condition worse. On long journeys, young children ask repeatedly, “Are we there yet?” and we all get uncomfortable if we have to sit in the same position.

My plea is this: let us support absolutely Mary Scanlon by looking to see what more we can do locally. As the minister has heard me say on previous occasions, the potential of telemedicine is important. I think that the minister agrees that telemedicine enables us to do things differently and more cleverly. It could get rid of the necessity for people to travel to Inverness, never mind the dreadful prospect of having to go as far as Bath. I have pushed for us to use our existing NHS infrastructure to deliver telemedicine as and where we can, and I make no apology for raising again the issue of the Dunbar hospital in Thurso, whose future is, alas, somewhat uncertain. We do not quite know what NHS Highland is saying on the matter. Mary Scanlon, Rhoda Grant and I have raised the issue repeatedly, as has the Thurso and Wick Trades Council. The name John Deighan will not be unknown to any of the three of us. The trades council is voicing a very real concern.

By delivering advice and treatment for chronic pain at least partly via telemedicine, we could kill two birds with one stone, to use my surname. We could do something locally and we could help people. There is a great opportunity in using telemedicine to do that.

Photo of Mary Scanlon Mary Scanlon Conservative

I should bring some balance to the debate. Having quoted Dorothy-Grace Elder saying that NHS Highland was a disgrace in 2002, I should also say that we now have a pain service, albeit that it is not as good as it should be. Dr John Macleod, who is based at Caithness general hospital, is showing excellent leadership in developing the service.

Photo of Jamie Stone Jamie Stone Liberal Democrat

The intervention is fair and I accept the point entirely. I do not wish to denigrate NHS Highland; I simply wish to question its policy decision on the future of the Dunbar. I want to know how we can support Dr Macleod and do similar things to his work all over the Highlands via our existing infrastructure. There is an opportunity in all of this, which we should seize with both hands. There will, of course, be cost implications, but there will also be tremendous savings on the cost of sending people all the way to Bath and back.

I congratulate the member on bringing the motion before the chamber.

Photo of Nanette Milne Nanette Milne Conservative

I apologise to you, Presiding Officer, and to colleagues for not being able to stay for the whole debate. I have commitments elsewhere in the building.

Mary Scanlon has brought a very important issue to the chamber, and I congratulate her on securing the debate. I realise that a number of people in my age group and above suffer significant aches and pains from wear and tear and that arthritis of various kinds affects many people of all ages in Scotland. Before I started on my preparations for the debate, I confess that I was unaware of just how many people’s lives are adversely affected by chronic pain and how many are severely disabled by it. Any condition that affects nearly 20 per cent of the population must be taken seriously. It came as something of a surprise that, even today, chronic pain remains poorly recognized and often poorly managed and that progress is only now beginning to be made in developing chronic pain services in Scotland.

The recognition of chronic pain as a long-term condition in its own right and not just a symptom of other problems has been a major step forward. The development of a national policy to cope with it puts us ahead of England, but it is clear that the policy is not yet implemented consistently across Scotland. Chronic pain is yet another condition where adequacy of care is a postcode lottery.

There are, however, encouraging developments and there is a growing momentum to recognise chronic pain as worthy of clinical and academic investment. The acceptance by the Royal College of General Practitioners that it has a major role to play and its decision to make chronic pain one of its clinical priorities for the next two years is very encouraging. The appointment of the first lead clinician in chronic pain will, I hope, add to the momentum to develop good practice across the country.

I was heartened to read the aspirations of the RCGP, notably to develop enhanced chronic pain education and training for professional staff and to work with the third sector on developing public awareness of the condition, tapping into the rich pool of patient information and resources that is already in existence.

The drive to achieve an audit of the pain services that are currently available in the United Kingdom, to review existing models of good practice and assess existing evidence-based data, plus the intention to press for a National Institute for Health and Clinical Excellence guideline on a quality standard for treating chronic pain, are important developments that should bring together the important work that is already being done in a piecemeal fashion by many organisations, mostly in the voluntary and charitable sectors.

It makes sense that every health board should have a pain group or managed clinical network to develop specialist pain services, but that is not yet the case. It also makes sense to increase GPs’ understanding of pain and its management. Surely it does not make sense to spend more than £600,000 in two years to send patients with chronic pain to the south of England to access pain management programmes, yet that is happening to patients in more than half of Scotland’s health board areas. Surely proper investment in local services would be far more cost effective.

Progress is undoubtedly being made, but it is evident that much more needs to be done. The cross-party group is to be congratulated on putting chronic pain on the political agenda, as is Mary Scanlon for highlighting the issue today. I hope that, next time such a debate takes place in the chamber, we will hear that good practice in the management of chronic pain has been replicated across Scotland and that sufferers have access to appropriate services regardless of where they live. Now that the will is there, I hope that more rapid progress towards that goal will be made.

Photo of Ian McKee Ian McKee Scottish National Party

I congratulate Mary Scanlon on obtaining this members’ business debate. It is, perhaps, the last time that I will be able to contribute to parliamentary proceedings. It is no secret that I have sometimes disagreed with Mary Scanlon’s views, but no one can doubt her record as a doughty campaigner for the causes that are dear to her heart. The treatment—often, alas, lack of treatment—of chronic pain ranks high in that category, and rightly so. Along with other members, I acknowledge the contribution that Dorothy-Grace Elder has made to the cause.

We are becoming familiar with statistics that highlight how many people in our population have their lives affected by chronic pain. As Mary Scanlon and others have said, 20 per cent of people are affected and 7 per cent need intensive treatment, as their condition is so disabling. In the past, the condition received little attention, but I am glad to say that there are signs that that is changing. For example, the Royal College of General Practitioners has made chronic pain one of its priorities for 2011 to 2013. As just about everyone who is affected presents first in primary care, that is a great step forward.

One lesson that we have learned from the past is that there is much more chance of a successful outcome with early and appropriately targeted intervention than if the condition is left until it has become almost embedded as a permanent feature of someone’s life, affecting every aspect of what they do and feel and how they relate to others. Pain is disabling, both physically and mentally. It follows that chronic pain is not an easy condition to treat, and those affected usually need a combined approach, involving not just medication but many other interventions.

Mary Scanlon’s motion highlights the fact that some Scottish patients experiencing chronic pain have to travel to England—even as far afield as Bath—for the treatment that they need, and implies that that is automatically a bad thing. I quite understand that sentiment, but I advise a degree of caution. Although it is easy to see the adverse consequences—some of which are listed in the motion—of having to travel far for medical treatment of any kind, it is now accepted that, for some conditions, travelling to a centre of expertise is preferable to accepting what may be a lower standard of service nearer home. The treatment of certain types of cancer is a case in point.

Photo of Mary Scanlon Mary Scanlon Conservative

I asked for an audit to be carried out across Scotland to see whether we could justify having here in Scotland a specialised service similar to that which exists in Bath.

Photo of Ian McKee Ian McKee Scottish National Party

Knowledge of the problem that faces us can never be ignored. Therefore, an audit of chronic pain and other conditions is desirable.

Although I do not know offhand the number of Scottish patients involved, the figures in the motion regarding costs and so on imply that they constitute a tiny percentage of the 20 per cent who experience severe chronic pain in Scotland. If that is so, the establishment in Scotland of a similar centre to the one in Bath would be a very expensive way to deal with the problem—an argument that holds little water with people who are in severe pain, as I can perfectly understand—and, which is much more important, it almost certainly would not deal with enough referrals a year for its staff to maintain the expertise that is needed for such a centre to be successful.

Cross-border traffic goes two ways: English patients come to Glasgow for paediatric extracorporeal membrane oxygenation—ECMO treatment. I would have hoped that a good unionist such as Mary Scanlon would see the benefits of that sort of co-operation.

Once more, Presiding Officer, I congratulate Mary Scanlon on obtaining this important debate, and I give you, your officials and others in the chamber my very best wishes for the future. Thank you for helping me to make my short parliamentary career so enjoyable. [Applause.]

Photo of Rhoda Grant Rhoda Grant Labour

I congratulate Mary Scanlon on securing the debate. She was right to pay tribute to Dorothy-Grace Elder, but Mary has taken up the role of being an advocate for chronic pain services and has kept the subject very much within the view of the whole Parliament and the Health and Sport Committee. I am sure that the Minister for Public Health and Sport will agree with that—she probably does not get much peace from Mary Scanlon on this subject.

Mary Scanlon’s motion mentions the centre of excellence in Bath. Those who access that centre will testify to the good work that is done there. It makes a huge difference to people’s lives if they get the right treatment, not just for chronic pain but for hugely painful conditions such as rheumatic diseases and ME.

The figure of £620,000 of costs since 2008-09 shows that only a very small number of people get to access that service. I have a fair amount of sympathy with what Mary Scanlon said about looking at the numbers and determining whether or not we need our own centre of excellence in Scotland. Given the changes that are taking place with the health service in England, it may be that the costs of using the centre of excellence in Bath will rise. This could be the time to carry out an audit to ascertain whether we can provide our own centre of excellence in Scotland.

In a way, however, that does not deal with the problem of the distances that people must travel. Even if there were a centre of excellence in the central belt, it would be difficult for people in the Highlands and Islands, which I cover, to access it. It would be a good thing to build a centre of excellence, with specialists in the community who are much closer to patients and who could give them the help that they require.

I note that referral rates are low. I have some sympathy with GPs who are not referring and who might instead be handing out painkillers. If the required services are not there and if there are long waiting times, GPs must feel frustrated in trying to deal with that. We need a good pathway, but the services need to be in place to help people. The costs of keeping people out of the workforce are huge and we need to factor them in, too.

Jamie Stone mentioned telemedicine and Dunbar hospital. The issue is close to our hearts. Jamie, Mary Scanlon, David Thompson and I fought to keep open the rheumatology unit in Dingwall and we had a successful cross-party campaign. People saw the good of that service and the difference that it made to people’s lives. Luckily, that unit has been saved.

The hospice service provides good advice and assistance to people who suffer chronic pain. It deals more with people with cancer, but there are times when hospice staff have gone out and helped people suffering from chronic pain for other reasons. That has been a huge boost for the people who have needed its services. Perhaps we should get those services to work together so that people in that situation can go to their GP and find a solution that allows them to live their lives and to be productive members of society in the long term.

Photo of Shona Robison Shona Robison Scottish National Party

I congratulate Mary Scanlon on securing a debate on such an important topic as chronic pain. The issue has interested her since the establishment of the Parliament. Like other members, I acknowledge Dorothy-Grace Elder’s role in putting chronic pain on the map.

Ian McKee’s final speech in the Parliament was worth listening to. He always has something intelligent and useful to add to a debate, whatever the subject, and I thank him.

Mary Scanlon was right to start by acknowledging the progress that has been made. Of course, there is always more to be done. Christine Grahame mentioned important issues to do with DWP assessments and tests not recognising chronic pain as an issue.

The motion focuses on Scottish patients with chronic pain who travel to Bath for treatment. The crux of the matter is that Scottish clinicians who are responsible for pain management take the view that a small number of patients, mainly adolescents, can benefit from the service at Bath. In some cases, the whole family needs help in understanding how to manage the young person’s pain.

Referrals to Bath are managed by the national services division of NHS National Services Scotland, which has put in place robust processes to govern referrals but is not in a position to countermand a clear decision by a consultant that a patient needs the treatment that is offered in Bath.

It might be worth noting that referrals reached a peak of 34 in 2005-06 and that there were only 18 referrals in 2009-10. Overall, fewer patients are being referred to Bath than used to be the case. I wonder whether that is a reflection of the ability of chronic pain services in Scotland to manage patients. I hope that as services in Scotland improve, fewer referrals to Bath will be required. Ultimately, however, if a clinician thinks that Bath is the most appropriate place for treatment, we must accept that judgment.

Photo of Mary Scanlon Mary Scanlon Conservative

The royal college and others have said that there is no clear referral pathway in Scotland, apart from through the managed clinical network in Glasgow. Consultants are not likely to know all the patients outwith Glasgow who need secondary or tertiary specialised treatment.

Photo of Shona Robison Shona Robison Scottish National Party

Mary Scanlon’s point about the patient pathway is important. The solution is a managed clinical network. Good evidence is emerging from Glasgow on the benefits of the approach, which I want to be taken forward.

There is no doubt that pain management services in Scotland remain patchy, as the GRIPS report made clear. Our response to the recommendations in the report has been concentrated on the development of a Scottish service model for chronic pain, about which I will say a little.

First, the model is based on the provision of pain education for the Scottish population, which includes promoting people’s ability to self-manage and promoting the information that is available from the NHS inform website about lower-back pain, to help people to return to work. If a person had experienced pain for more than 12 weeks, they would be encouraged to refer themselves to a voluntary sector organisation-run self-management course or to their primary care team. They would then be referred to what the model calls a level 1, or outpatient, pain-management service. If necessary, they could be referred on to a level 2, or more specialist, in-patient, service. The model includes level 3, highly-specialised interventions, such as spinal-cord stimulation and residential pain-management programmes.

Mary Scanlon made an important point about spinal-cord stimulation. Access to what can be a life-transforming treatment, as she acknowledged, is provided for in the chronic pain service model that is under development. The chronic pain steering group will oversee implementation, to ensure equity of access for everyone who might benefit from the treatment. Spinal-cord stimulation is very much on the group’s radar screen.

The model also underlines the importance of early access to emotional and psychological support. Its aims are, in summary, to improve the prevention and management of chronic pain, to improve services at all levels and to ensure that people get the earliest and most appropriate treatment, locally where possible, but with ready access to the more specialist tiers of the service.

Taking the model forward will be the top priority for our next lead clinician for chronic pain and the steering group that the previous lead set up to support him. Interviews for the post were held yesterday, so we will know the result very soon. The chronic pain steering group will then carry out a scoping exercise with NHS boards to assess the level of service that is available in each area and how it relates to the service model. That will allow for a comprehensive examination of the pain management services throughout Scotland and what Scotland needs, including the level of demand for a residential facility of the kind that Bath offers.

The experience of people living with chronic pain highlights the importance of good communication between primary and secondary care, as well as the need for a multidisciplinary approach. People also stress the crying need for good information and the healing effect that proper peer support can have. All those factors underline the importance of a managed clinical network approach to pain services.

I thank all those who have put so much work into the development of the chronic pain MCN in NHS Greater Glasgow and Clyde. It has promoted equity of access to services by making sure that the Clyde area is included in the network’s scope. It is also producing really helpful information for patients and for staff who work in primary care. I urge all other boards in Scotland to learn from that MCN’s achievements.

The chronic pain steering group has also focused on an analysis of the need for education on chronic pain for those who work in primary care. It recently considered the findings of a report, which was commissioned by NHS Education for Scotland, that helps us with the way ahead.

Other valuable work includes NHS Quality Improvement Scotland’s decision to support the development of a clinical guideline on non-malignant chronic pain. There is an opportunity for people to have their say about the key questions on which the guideline should focus. That will also be a topic at the launch of the Scottish pain research community at the end of this month.

The steering group has also been developing a community website to act as the basis of a chronic pain information resource. It is intended primarily for NHS Scotland, but it will also be accessible to the public. Each board will have its own page on which it will be able to describe the pain management services that it provides. I consider that to be a real driver for equity of service, as boards and the public will be able to compare the range of services that are available in each part of the country.

I do not for a moment deny that there is still a journey to travel, but it has been helpful to set out during the debate some of the progress that has been made. The debate was constructive, and I thank every member for their contribution to it.

13:12 Meeting suspended until 14:15.

14:15 On resuming—