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Chronic Pain in Scotland: Just what have we achieved?. Dr Lesley Holdsworth Dr Steve Gilbert. Purpose of This Session. Share our story and key lessons learned; Scottish Service Model for Chronic Pain Our approach to implementation, the underpinning theory
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Chronic Pain in Scotland: Just what have we achieved? Dr Lesley Holdsworth Dr Steve Gilbert
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?
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
The ‘traditional’ chronic pain nightmare (pathway)
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
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?
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
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
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
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
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
@ www.chronicpainscotland.org @chronicpainscot
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
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?
Patient Reported Experience Measure – Must do with me programme • Involved • Listened to • Carers involved • Information and advice • Outcome of care • Overall satisfaction
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
Just what have we achieved? Engaged and Proactive Service Users Clinical teams Third sector Politicians Service Managers Specialist Interest Groups
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
Summary: Key learning • Hearts and minds • Creating the conditions for this to happen • Collective will • Sustainability