Agenda item

Break 11:20 – 11:30

Dr Jon Norman (Lead Clinician Chronic Pain, Maidstone and Tunbridge Wells NHS Trust), Ashley Scarff (Head of Business and Corporate Planning, Maidstone and Tunbridge Wells NHS Trust), Patricia Davies (Director of Service Improvement, NHS West Kent), Zoe McMahon (Commissioning Pathways Improvement Manager, NHS West Kent), Alison Davis (Assistant Director of Commissioning, NHS Eastern and Coastal Kent), Jo Staddon (Lead Commissioner for Musculoskeletal Services and Adult Therapies, NHS Eastern and Coastal Kent), Val Conway (Clinical Lead-Consultant Nurse Community Chronic Pain Service, NHS Eastern and Coastal Kent), Hilary Birrell (Community Chronic Pain and Orthopaedic Service Manager, NHS Eastern and Coastal Kent), Sheila Pitt (Head of Cancer, Long Term Conditions and Therapies, NHS Eastern and Coastal Kent), Dr Claire Butler (Medical Director, Pilgrims Hospice), Dr Bruce Pollington (Medical Director, Heart of Kent Hospice), and John Ashelford were present for this item.

(1)       Representatives from NHS West Kent presented an overview of the situation for patients in their health economy and explained that large number of patients did require pain management services and these did need to be developed locally.  Specialist services were accessed at Guy’s Hospital and elsewhere, but there were concerns that now a service based in Medway had been withdrawn, this would be too far for some patients to travel.  Community Hospitals were being utilised, and they were looking at developing a more specialised service at Maidstone Hospital.

(2)       An overview from representatives of NHS Eastern and Coastal Kent followed.  A review had been carried out in 2005 as it was recognised that pain management services were not delivering and this was followed by a redesign across the eastern half of the county.  The system in place involved those with complex pain being referred to the acute sector for interventions and to community services for non-complex interventions.

(3)       One Member observed that services in the east of the county appeared to be better than in the west and specifically asked about the pain clinic which had been withdrawn from Maidstone Hospital five years ago.  Dr Norman was able to provide the broader context as he had moved to Maidstone and Tunbridge Wells NHS Trust (MTW) after the closure of this service.  The previous service had been a single-handed service and was unsustainable, but more staff were hired and the service rebuilt.  The 18 week waiting time target was now being reached and in January 2009 the MTW board had agreed to set up a hub and spoke model and Sevenoaks had just opened as the first spoke.  A clinic at Maidstone Hospital would not be possible until July 2011 following the move of some services to the new Pembury Hospital to make facilities available at Maidstone.  There was no guarantee of funding and there was a possibility of a different provider appearing.  Separately, a cancer pain service had been established at Maidstone in 2005 and this was performing well.

(4)       A number of Members had personal experience of pain and pain services and this lead to a discussion around the patient experience.  The view was expressed that the use of painkillers was not always advisable as it masked the pain and that training the patient to manage the pain was the better way.  Dr Norman explained that it was important to treat the patient as an individual and that the treatment, be it drugs or rehabilitation, had to suit the kind of patient.  In Eastern and Coastal Kent it was explained that self-management was the model.  Part of this was to hold Pain Roadshows to reach out to people who had yet to access pain services and overall an unmet need for the service had been found when the redesigned service was set up and there were now 300 referrals a month to the service.

(5)       The point was also made by clinical representatives present that education of medical professionals was also required and that clinicians often felt they needed to be seen to do something, such as prescribe drugs, when doing nothing was sometimes the better option.

(6)       In West Kent the development of GP services was being looked at and a pilot had been set up by the Invicta cluster concerned with back pain.  The skill mix for services in East Kent was different with less focus on consultants and more on nurses.  There were referrals between the two parts of the county.

(7)       Patients requiring pain services were a very diverse group and there was a need for specialist services were there was enough need for clinicians to gain the appropriate experience.  However, with Payment by Results, services were paid for piecemeal and the Market Forces Factor meant that each treatment cost more in London so there was a financial incentive to repatriate services, although patient choice has and would continue to play a part in patients going outside of Kent.  The pain involved in travelling was given as another reason for bringing services closer to home.  The repatriation of pain pump work from Basildon to Kent was provided as an example.  The establishment of a clinic in Sevenoaks was partly to enable patients who had previously accessed services at Bromley to access them locally.  Specialist spinal services were available at Guy’s and other services were available at University College London, the Royal National Orthopaedic Hospital and King’s.  Concerns were raised about communication following discharge from King’s.

(8)       Representatives of the Hospice sector were present and provided details of the large overlap between their services and regular pain management services.  Hospices had built up a good level of expertise in this area over the years, primarily in cancer pain though the number of conditions that the hospices managed was expanding.  The work of Dr Norman and the cancer pain services at MTW was highly praised by the clinical directors of the Hospices represented.  The amount of funding that hospices receive from Primary Care Trusts varied, with the Pilgrims Hospice receiving 30% from NHS Eastern and Coastal Kent.  The hospice at Home programme was being rolled out in East Kent and would cover the whole area from January 2011.

(9)       Hospices also played a role in training registrars and sharing knowledge with GPs was also seen as key with the money that could be saved through utilising pain management services rather than drugs given as an example.  There was potential for closer integration between the hospices and other sectors dealing with pain management.

(10)     The Chairman thanked all those who had participated in a very informative debate.