Hansard

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.

12:41