Health CommitteeWritten evidence from Napp Pharmaceutical Group (LTC 70)

Introduction

The Napp Pharmaceutical Group is a UK group of companies that is part of a worldwide network of independently associated pharmaceutical companies. The Napp Pharmaceutical Group manufactures and supplies medicines to the UK healthcare market, and exports medicines to our independently associated companies worldwide. We have a long heritage in the field of pain management, and have been supporting healthcare professionals to understand and manage chronic pain for over 30 years. In addition to the significant impact on individuals’ quality of life, poorly managed chronic pain places a financial burden on the NHS and the wider economy, which is why we continue to work towards better understanding and treatment. Our commitment to pain management extends beyond the provision of innovative medicines to include research into the impact of chronic pain on patients’ lives and further education for healthcare professionals in the management of pain.

1. Chronic Pain

We believe that given the scope of the Health Committee inquiry, chronic pain should be specifically included as it has been recognised as a Long Term Condition by Her Majesty’s Government, significantly impacts not only on individuals’ quality of life, but also their ability to function, work and is a central part of most of the key areas the Committee has already determined that they wish to examine.

1.1 Background

The 150th Chief Medical Officer’s report (2008)1 highlighted that:

Each year over five million people in the United Kingdom develop chronic pain, but only two-thirds will recover.

Chronic pain is the second most common reason for claiming incapacity benefit.

25% of sufferers lose their jobs.

49% of patients with chronic pain experience depression.

Much more needs to be done to improve outcomes for patients. the significant numbers of people (7.8 million in the UK) living with chronic pain, the low pain specialist to patient ratio 1 to 32,000 and the poor resolution rates for pain in the UK.

It has been estimated that back pain alone costs the economy £12.3 billion per year. The cost of pain from all causes is far higher.

Chronic pain and its consequences are not as well controlled as they could be. Early intervention may stop pain becoming persistent.

The limited number of specialist pain clinics around the country are inundated with referrals, and only 14% of people with pain have seen a pain specialist. Systems and infrastructure are not adequate to meet need or demand.

Better coordination of services and services designed around the patient’s needs are essential.

Chronic pain may be neglected at both ends of the age spectrum. In a study of United Kingdom nursing homes, most residents experienced constant or frequent moderate to severe pain, despite the fact that 99% were on pain medication.

16% of sufferers feel their chronic pain is so bad that they sometimes want to die.

Each patient requires an early assessment.

Each patient should have a tailored plan to suit individual needs.

That all healthcare professionals training should include professional training in chronic pain.

Consideration should be given to the assessment of pain in primary care and that pain should be part of the Quality and Outcomes framework (QOF).

1.2 Pain frequently co-exists with other diseases or long term conditions such as diabetes and dementia (LTCs) and is sometimes mentioned as an element of care within disease management guidelines such as the NICE Cancer guidance or dementia quality standards (QS).

Chronic pain has been the subject of two recent House of Commons questions.

In a statement in response to a question asked in the House of Commons on the 1st February 2012 by Linda Riordan MP, to ask the Secretary of State for Health whether it is his policy that chronic pain is a long-term condition that requires the preparation of care plans2

Chair Paul Burstow MP responded:

The Department recognises chronic pain as a long-term condition, either in its own right or as a component of other long-term conditions. Everyone who suffers persistent pain should have a timely assessment in order to determine the cause of the pain—if a cause can be determined—and to advise on options for treatment, including self-help. Patients with refractory chronic pain will benefit from the care planning approach, but decisions should be taken on an individual basis depending on the severity of symptoms and any co-morbidities.

1.3 Further on the 24th April 2013, Huw Irranca-Davies: to ask the Secretary of State for Health pursuant to the contribution by the Minister of State for Care and Support on 25 February 2013, Official Report, columns 147–150, what plans he has to introduce a quality standard for chronic pain management.3

Norman Lamb: 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.

1.4 The mandate to NHS England4 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.

1.5 On the 4th July 2012, “Putting pain on the Agenda”,5 the report of the first English Pain Summit was launched in the House of Commons. Four key recommendations were agreed:

1.Clear standards and criteria must be agreed and implemented nationally for the identification, assessment, and initial management of problematic pain

2.An awareness campaign should be run to explain the nature, extent, impact, prevention and treatment of chronic pain to the wider general and NHS community

3.Nationally-agreed commissioning guidance must be developed and agreed, describing best value care in chronic pain to reduce unwarranted variation

4.A data strategy for chronic pain should be agreed through creation of an epidemiology of chronic pain working group

1.6 However despite there being recognition by the Government that chronic pain should be considered as a LTC in its own right during 2012, and significant recognition regarding the appropriate management of chronic pain in the United Kingdom, there has been little activity to develop a specific Quality Standard, include it within the Quality Outcomes Framework or within the clinical domains of the NHS outcomes framework.

There is also variance of pain status across the devolved nations eg Scotland recognising it as a specific condition in its own right with SIGN guidelines currently being developed.

Pain is also poorly recognised, diagnosed and under managed in vulnerable patients with conditions such as dementia. Improvements here would clearly demonstrate “compassionate care”.

9 May 2013

1 http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/AnnualReports/DH_096206

2 http://www.publications.parliament.uk/pa/cm201212/cmhansrd/cm120201/text/120201w0002.htm#120201850

3 http://www.publications.parliament.uk/pa/cm201213/cmhansrd/cm130424/text/130424w0005.htm#130424w0005.htm_wqn3

4 http://mandate.dh.gov.uk/2012/11/13/nhs-mandate-published/

5 http://www.policyconnect.org.uk/sites/default/files/Putting%20Pain%20on%20the%20Agenda.pdf

Prepared 3rd July 2014