To ask the Scottish Government on what date the Clinical Priorities Unit began issuing the most recent guidance provided by the Faculty of Pain Medicine, the changes of which came into effect on 29 July 2020.
I appreciate how difficult postponement of treatment has been for people with chronic pain. This includes those who may have had their normal treatment paused, including injections to manage acute pain, owing to clinical concerns related to an increased risk of COVID-19 infection or severity during the pandemic. We have taken a number of steps to provide advice and support to people with chronic pain during the pandemic, and remain committed to ensuring that Health Boards resume a full range of specialist pain services as quickly as it is safe to do so.
Last summer we published a national resource for people with chronic pain to provide information which was developed in partnership with a range of stakeholders including clinical advisors and third sector partners and is regularly reviewed. This guidance referenced advice on the safety of steroid injections from the Faculty for Pain Medicine (FPM) which clearly highlighted the potential risk to providing these interventions during the pandemic and states: ‘As with all pain management procedures a risk benefit balance has to be reached in discussion with the patient. Each case is unique and no guidance will cover all eventualities.’
It is important to understand that it is not appropriate, nor is it the case, that Scottish Government officials or Ministers make or influence treatment or prescribing decisions, such as those related to the provision of pain procedures, as these are entirely for clinicians in charge of a patient’s care to make. When taking these decisions we expect clinicians to be aware of relevant guidance and to take into account the impact of pain on people’s quality of life and any safety considerations.
In order to ensure Health Boards prioritised remobilisation of their pain services, in September 2020 we published the COVID-19 Recovery Framework for NHS Pain Management Services to support them in this process. As set out in the Framework, we recognise that pain has a significant impact on people’s quality of life, and Health Boards are expected to triage cases locally based on clinical need and in line with advice from organisations, including the FPM and the British Pain Society. The Framework also stated the Government’s expectation that people awaiting treatment should be contacted to advise them about their support options should the services they attend be disrupted.
Evidence-based caution is at the forefront of our decision-making, and we will continue to work with Health Boards to remobilise the NHS in the safest possible way, while also supporting Boards to prioritise elective activity on the basis of clinical urgency. As set out in the Framework for Clinical Prioritisation, people awaiting treatment who are experiencing worsening or existing pain should be considered for prioritisation in line with the principles of active waiting list management. However, the number of patients who can be seen, diagnosed and treated may be reduced by the continuing and necessary infection prevention and control measures. Any decisions to scale back elective activity will be taken on an evidence basis and where the need to support COVID-19 patients exceeds capacity for elective care.
The Scottish Government takes seriously the impact of the pandemic on the mental health of all individuals, including those experiencing chronic pain. That is why we have published the Mental Health Transition and Recovery Plan which outlines our response to the mental health impacts of COVID-19.
The Scottish Government has made a commitment within the Transition and Recovery Plan to ensure that those who need mental health support as a result of delayed treatment of their physical health services are identified and directed to the appropriate support and care. This is part of our wider approach to ensure that people with a long term condition are also given support for their mental health and wellbeing and are involved in decisions affecting all aspects of their care.