In 2008 we all blew out the candles on the NHS 60th birthday cake but in 2009 we have to close our eyes, make a wish and cut this cake into ever-thinning slices.
Cutting anything with your eyes closed isn’t exactly high on any health and safety ‘to do’ list, but here’s my 2009 NHS wish anyway.
A national service framework for pain will be published, focusing on chronic pain. Inequality of service provision will be at an end. In addition, the opportunity to develop and review quality and outcomes framework indicators by trusts will pave the way for the inclusion of pain management as a clinical indicator for 2009–2010. GPs are handsomely rewarded for managing pain in the community.
This is all wishful thinking. According to the Chronic Pain Policy Coalition, almost 7.8 million people in the UK have their days and nights blighted by unremitting pain.
Chronic pain isn’t glamorous. You won’t see TV medics yelling ‘Stand back! We need 60mg of codeine phosphate so that this patient can make it to the shops for a pint of milk.’ It’s simply not all that riveting to watch people in pain get through another hip-grinding or back-aching day.
As long ago as 1998, the then Clinical Standards Advisory Group was asked to look into the provision of specialist pain services. Professor Spence’s report makes unsettling reading. Has anything really changed? Well, yes. Both palliative care and post-operative pain management appear to have progressed significantly. Multidisciplinary expertise is out there.
So, why can’t we properly resource chronic pain management? Surely any resulting reduction in disability is likely to prove cost-effective. It is morally indefensible for a civilised society to fail to address this silent epidemic. And what message are we giving if we fail to develop joined-up pathways to manage chronic pain? That people should stop whingeing and pull themselves together?
Let’s start in incremental ways. We could incorporate pain assessment into routine new-patient health checks. We discuss neuropathic pain during diabetes reviews, so why not extend pain assessments during other long-term condition consultations? And if we act promptly on what patients tell us, wouldn’t that be the icing on the NHS cake?
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Jane Warner is a practice nurse in Devon
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