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Specialist services exist in most hospitals in the United Kingdom, but their services are stretched, and some hospital services, such as at Oxford, have been withdrawn. In Southampton, the service closed and has been relocated in primary care, and at other hospitalsfor example, East Sussexthere are threats of closure. Relocating a pain service in primary care should be achieved with adequate funding and planning, not by a sudden decision to close existing
services or to dispense with the appropriately trained personnel. Primary care has many priorities, and pain services are unlikely to be near the top of the list. Pain management is generally known as a Cinderella service.
There have been schemes to link pain management with rehabilitation and back-to-work programmes, crossing the boundaries between the NHS, social services and the Department for Work and Pensions, but those have been sporadic, although the results have been encouraging. One scheme whereby patients with back pain were allowed to return to work part-time but retained benefits for a period proved very successful. Why are such schemes not more readily available? An individual approach is necessary; one size does not fit all.
It has been estimated that 10 specialist sessions in pain management are needed for every 100,000 of population, but nowhere in the United Kingdom achieves that, and services are scarcer in the midlands and Wales. Education is needed at all levels of the health service, and many more specialist nurses, doctors, psychologists and physiotherapists are required to support properly sufferers of the most severe pain. Proper pain management is not easy and presumably does not come cheaply.
Inadequate assessment and treatment of pain should be replaced by early recognition of the problem; listening to the real needs of the patient; education and more education at all levels of the health service; funding for high-quality clinical and scientific research; and adequate provision of specialist services in both primary and secondary care.
This was not a specialist area of mine, although I did spend two and a half magical years as the Minister for Health in Northern Ireland. The issue crossed my desk, but I have to admit that, given all the other priorities, I never spent the time on it that I should have. Perhaps it requires a constituent with this particular problem to bring the issue to the attention of an MP before these things are brought into the wider domain.
I welcome the opportunity to have the debate and to put these ideas on the table for debate. I hope that the Minister will presently answer the points that I have made. I end by paying tribute to a constituent of mine who suffers immense pain with stoicism and great bravery. She is planning a huge conference at the Methodist Central Hall in London in December and has attracted prominent speakers in this field from all parts of the world. I hope that her courage will begin to open the doors to knowledge about this condition for other pain sufferers.
The Minister of State, Department of Health (Andy Burnham):
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 individuals 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. Gentlemans 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 servicesServices for Patients with Painwhich 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 persons 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 programmes 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. Gentlemans constituency as an example, services are commissioned from a number of acute providers, including Peterborough, Addenbrookes, Hinchingbrooke, Kings Lynn and West Suffolk. More distant providers include the input centre at St. Thomas in London, the other major tertiary hospitals in London and the Queens 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. Gentlemans 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 trusts local delivery plan has identified the need for more general physio and musculoskeletal specialist postsI hope that the hon. Gentleman will welcome thatwhich 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. Gentlemans 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.
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.
Mrs. Madeleine Moon (Bridgend) (Lab): I am sure that you, Mr. Williams, are well aware of the fact that this is Wales biodiversity week. Interest in and support for biodiversity is manifest in the increasing number of people who are becoming members of wildlife organisations such as the Royal Society for the Protection of Birds, Butterfly Conservation, local wildlife trusts, recording groups for bats, badgers, fungi, insects, plants, invertebrates and arachnids, and the National Trust.
People want to get involved and do what they can to help biodiversity. They join wildlife groups, watch wildlife programmes on television, read the myriad press articles, and attend events in large numbers, even in the inner cities, including events like the excellent sustainability week in London. Why? They do it because biodiversity impacts on our whole life. It provides the support systems that sustain human existence, from our health to the fertility of our crops. The many species of plants, insects and animals that live in a diverse range of habitats gives us that sense of the place where we live, and can act as an incentive to visit other places.
The world is losing biodiversity at an ever-increasing rate as the result of human activity. In the United Kingdom, 71 moths are recognised to be endangered or vulnerable, mirroring parallel declines in common bird species such as the ptarmigan, the skylark, the grey partridge and, in some areas, even the common sparrow. Summers are not the same without our butterflies; the high brown and marsh fritillaries and the wood white and white-letter butterflies are all in decline. When farmers need to import bees to pollinate their crops, we know that we have a serious problem. Sadly, the list of decreasing species in the Joint Nature Conservation Committee barometer is at about 45 per cent., with insufficient data on a further 15 or 20 per cent. of species.
In preparing for the debate, I communicated with a number of organisations and they raised the same concerns. There is tremendous recognition of the Governments commitment to biodiversity, through the Countryside and Rights of Way Act 2000, the Natural Environment and Rural Communities Act 2006, the Commons Bill and the Clean Neighbourhoods and Environment Act 2005. However, it was felt that we urgently need statutory reporting responsibilities to be built into legislation to take forward the Governments commitment and to record progress.
There is a need for increased species and habitat prioritisation, data collection and research, so that policy making can be evidence-based. Finally, dare I say it, we need increased financial resources for UK BAPbiodiversity action planning. Clear commitments have already been given, and I stress that biodiversity and wildlife groups recognise how much the Government have done.
The Government, with European Environment Ministers, set a target in a Commission communication entitled Halting the loss of biodiversity by 2010and beyond, yet in Wales, where the natural environment runs deep within the soul, the Welsh environment strategy has a different target. By 2015, 95 per cent. of
Welsh sites of special scientific interest are to be in a favourable condition, and by 2026 all sites of international, Welsh and local importance are to be in a favourable condition.
Although I recognise that setting such targets is a devolved matter, wildlife groups are concerned that the disparate nature of those lower targets will have a major impact on the UKs ability to meet its target. The environment does not recognise man-made borders, and Offas dyke will not hold back the tide of biodiversity loss.
RSPB members have called for increased funding for management agreements and the species monitoring of agri-environment schemes in Wales. However, with the Countryside Council for Wales losing more than 30 staff in the past year, meeting common targets has become almost impossible. If we in Wales are to play our part in meeting the UK target, the Department for Environment, Food and Rural Affairs must help by ensuring that additional funding and support is available.
Section 40 of the 2006 Act replaces section 74 of the 2000 Act, so that from October 2006 Departments must allocate a Minister with a duty to conserve biological diversity and to monitor how public bodies working with the Department are conserving biodiversity. To see how this was working, I asked questions of all Departments on the allocation of ministerial responsibility, which revealed that although most Departments had assigned Ministers, they were awaiting guidance from DEFRAguidance that will also be followed by local authoritieson how they should undertake their monitoring role. I give credit to the Department for International Development. It sent the most comprehensive reply and demonstrated a clear commitment to the task, which stood out against the replies of other Departments
The need for a statutory responsibility to report progress in meeting biodiversity duties was raised by all the wildlife organisations to which I spoke. I am aware that DEFRA commissioned Entec to look at the subject some time ago, and there is universal hope that that will lead to targets being set as part of the comprehensive performance assessment and to best value performance indicators, with biodiversity integrated into performance assessment systems, especially in local government. Yet again, it will fall to DEFRA to urge the Audit Commission and the Department for Communities and Local Government to take that forward.
Indeed, local, regional and national Government could follow the excellent example of Hampshire county council, which has a corporate biodiversity management plan in place for all its directoratesthey must all demonstrate how they will meet biodiversity targets. It would be good, would it not, if Departments, and local and regional government, had such plans in place by the 2010 deadline?
Targets need to be integrated for the purposes of recording, monitoring, mapping and tracking habitat, species loss and the growth of invasive species at local, regional and national levels. I urge that butterflies are recognised as indicators of both a healthy environment and the effectiveness of the Governments land use policies.
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