Chronic Pain in Scotland: Just what have we achieved?

1. Chronic Pain in Scotland: Just what have we achieved? Dr Lesley Holdsworth Dr Steve Gilbert

2. Purpose of This Session • Share our story and key lessons learned; • Scottish Service Model for Chronic Pain • Our approach to implementation, the underpinning theory • The challenges and ways we’ve tried to overcome these • What have we achieved?

4. Chronic Pain in Scotland What • Pain that persist for more than 12 weeks despite treatment/medication When • 2012-2014 2,300 800,000 Based on adult prevalence of 5.6%, CPG 4 Smith BH et al 2001

5. Treatment Guidelines

7. The ‘traditional’ chronic pain nightmare (pathway)

9. 1' representing no problem through to '5' representing the most severe category (All domains) 1 equates to ‘full health’ and death equates to 0 (EQ5D score). National median 0.3181 Normal population of same age = 0.80

10. Transformational Change • the organisation and the vision NHS in Scotland • the peoplewho are part of that organisation Service users, the public, third sector, clinicians, managers: collectivism • the services which the organisation delivers Chronic pain • the processes which are involved in the delivery of the services Implementing the model for chronic pain Could we create the conditions?

11. Creating a ‘social movement’ – the WILL • “a group of people with a common ideology who try together to achieve certain general goals ” oxford dictionary • to successfully mobilize individuals, need an injustice frame - ideas and symbols that illustrate both how significant the problem is as well as what the movement can do to alleviate it

12. https://www.youtube.com/watch?v=V74AxCqOTvg

13. Our Approach: the IDEAS Create the conditions, drive & support the agenda • Establish the vision, gain recognition – all levels • Involve and empower stakeholders, the movement, • Set a clear direction, expectations, what, by who and when • Provide resources • Enable and provide feedback • Engender local ownership encourage the leadership of followers

14. The Chronic Pain ‘Execution’ • Steering group – right membership, transparency • Local groups a/a • Government recognition, support & involvement • Three agreed aims: 1. Develop a quality improvement infrastructure to support NHS Boards: key aims/plans, education, research, practice 2. Provide leadership, all levels and opportunity 3. Implement the model

16. National and Local Networks National and local learning days and other ongoing communications to: • Create, share and nurture the vision • Opportunity to contribute, to be part, to own the change, enthuse others • Exposure to examples of best practice • Head room to develop and plan local solutions • Be involved in national work groups

17. Example 1: Level 1 • Information/communication - Confusing landscape • Variable quality of information for • Service users • The public • Clinicians • Local improvement groups • Sub group – provided solution: with QA processes

18. @ www.chronicpainscotland.org @chronicpainscot

19. Example 2: Level 2 • Some areas had programmes for upskilling GPs and AHPs including third sector • Shared at national event • Local interest generated • Resources and experience shared • Wider roll out – shared on website and primary care networks

20. Example 3: Level 3 • Access and reducing waits • Triage approach adopted in one area • Experience shared at national meeting • Other solutions being shared • What users think of Level 3 services?

21. Patient Reported Experience Measure – Must do with me programme • Involved • Listened to • Carers involved • Information and advice • Outcome of care • Overall satisfaction

23. Example 4: Highly specialist services • Issue: Variable referral rates of patients for interventions e.g. SPS • Working group - all referral centres established • National criteria agree • Implemented • Peer group

24. Just what have we achieved? Engaged and Proactive Service Users Clinical teams Third sector Politicians Service Managers Specialist Interest Groups

25. Just what have we achieved? • Transparent, local and national chronic pain improvement groups • Plans with clear and transparent accountability • Working groups, resources, communications and sharing networks • National leadership, coordination • Sustainability, but more work

26. Summary: Key learning • Hearts and minds • Creating the conditions for this to happen • Collective will • Sustainability

27. Leaders and critically, followers