Chronic Pain
The final item of business today is a members' business debate on motion S1M-2597, in the name of Dorothy-Grace Elder, on the plight of chronic pain patients.
Motion debated,
That the Parliament considers that the Scottish Executive and health boards should move the plight of chronic pain patients up the health agenda, chronic pain being regarded as the most neglected health issue in Scotland and possibly the biggest in terms of numbers as, according to the Pain Association Scotland, some 500,000 people suffer long-term pain through problems such as back pain and arthritic conditions, and agrees with health professionals who have appealed to the Parliament that the wreckage of many lives through lost jobs, and the loss of millions of pounds to the economy, could be relieved by ending the dire shortage of specialised pain clinics and staff in Scotland.
The large bundle of mail that I have with me is just this morning's responses from people who have taken part in the interactive discussion forum on the Parliament's website, which opened on Monday. I have not even properly printed them all out yet. The public's letters and postings, which have come showering in, must shock politicians into action.
What does chronic pain feel like? James MacDonald, a former soldier who lives in Glasgow, has severe and untreated back pain. He contacted Parliament to tell us pretty much the same story that we heard from all over:
"Pain has ruined me … All I've ever wanted in life was a home, a family of my own and a job. These I cannot have, all due to pain. I live as a virtual prisoner, out of my mind with pain and the loneliness that I have to put up with … at 2 a.m., sitting at the end of my bed, weeping with pain and unable to cope with pain, I feel so damned alone and frightened … We sufferers have no voice! We, the sufferers, feel impotent, neglected, invisible, third class citizens."
He says that he looks to Parliament to
"fight, fight and fight again for us, the invisible people who have no champions".
Surely we were all elected to be champions on just such immense human issues.
I welcome to the public gallery the people in pain who have made long journeys to come here today and the doctors, nurses, physiotherapists and others who back them. All those people wish to see the Scottish Parliament haul up chronic pain from the very bottom of the health agenda.
Thanks to the fact that the Scottish Parliament has the world's most advanced parliamentary website, this debate is being watched live all over the globe. I welcome watchers from everywhere. We have had postings on the Parliament website from as far afield as Europe, California and Detroit. Pain is an international issue. As the Scottish Parliament has the first parliamentary cross-party group on chronic pain—Westminster does not have one—perhaps people in other countries are getting the message that we are trying to take a lead.
Chronic pain is a monster that devours lives. It wastes £1,000 million a year in the Scottish economy by destroying jobs and preventing people from working. However, the Parliament can start to tame the monster by, for a start, expanding chronic pain services throughout the country.
Chronic pain is the biggest single health issue in the country. A multitude suffers: 550,000 people, according to the Pain Association Scotland, which has just updated its previous estimate after a three-year study. Those people mainly suffer at home from conditions that are often not terminal but can be agonising. Those conditions range from back pain, which is an epidemic in itself, to arthritic conditions, bowel problems, almost all degenerative diseases, multiple sclerosis and ME. The public have been hitting the website to mention other conditions, such as endometriosis and repetitive strain injury.
I ask members to imagine that, instead of suffering from those conditions, 550,000 Scots had broken their arms at about the same time. If that happened, the Parliament would panic. We would ask, "How will the health service cope?" We would say, "The economy is going to crash with all those 550,000 out of work." Broken arms mend eventually. Why are 550,000 people just written off because their pain is long term? No wonder the floodgates have opened since the debate was announced.
I am delighted that members of all parties—and, indeed, the enthusiastic staff of the Parliament—have shown good heart and banded together in the common cause of trying to help those patients. I give special thanks to my assistants Gordon Anderson and Evelyn McKechnie, whose utter dedication to the cross-party group on chronic pain is exemplary.
Everyone knows someone who is in pain. Only a fraction of the 550,000 are given modern relief at national health service pain clinics. Only an estimated 5,000 a year are treated by a doctor, nurse or physiotherapist who is trained in the subject. Even cancer patients do not get enough pain control or advice. People want action, not more sugar-coated, platitudinous pills.
Our pain services are few and patchy, but I pay tribute to the people who are making major advances, such as those at the Royal hospital for sick children in Glasgow, who cope with children in pain from all over Scotland. They want to improve services and to have local clinics for suffering children. Glasgow clinics for adults are so overworked that some Glasgow patients are sent to Edinburgh, which then overloads the Edinburgh service. In Dundee, waiting lists are up to six months. Aberdeen sometimes has to send patients to England. Some areas have nothing.
Last night, a heart-rending note was posted on the website from a 20-year-old woman in Nairn, Kerry McEwan. She is not a terminal patient, but she has been referred to a doctor in a hospice because there is no one else in her area to treat her pain. She writes:
"The Highlands and Islands are a disgrace to the NHS"
for lack of specialised services.
"I developed chronic pain because my pain was untreated for many years."
Dr Denis Martin of the Scottish network for chronic pain research, who is in the gallery, estimates that only 5 per cent of long-term pain sufferers get back into a job because they are caught early enough. The vast majority could have a life.
I pay tribute to those people from Lochaber who are in the gallery and who are fighting for a hydrotherapy pool in their area. They are not getting much backing from their health board.
Rheumatology is kicked to the bottom of the pile, but we appeal to the Executive to deal with other things, too. Dr Charles Martin of Crosshouse hospital and Dr Penelope Fraser posted messages on the website and named two major studies that have been conducted in the past few years showing how chronic pain could be better treated in Scotland. Neither of those reports has been implemented; they are gathering dust while people suffer.
I implore the Deputy Minister for Health and Community Care to take five steps. First, will she please promise to study those two reports, and then consider how we might begin to implement them? Secondly, we ask her to request every health board in Scotland to tell Parliament where chronic pain is on their agendas. Some of them do not mention it. Thirdly, will she please ask our few pain clinics to report on waiting lists and on what services they offer? Fourthly, will she please consider cancelling fees? Does she know that nurses and physiotherapists who want to help patients in pain often have to raise the money needed for that themselves, paying up to £5,000 from their own pockets? Fifthly and finally, the Pain Association Scotland needs the funds that it receives from the Executive to be renewed this year and an extra £20,000 so that it can spread its vital work throughout Scotland. We are setting up a citizens monitoring group within the cross-party group on chronic pain in order to watch what progress is made.
Let us—from every party—bond together in the noble cause of alleviating pain. Let us be the first Parliament in the world to declare that long-term pain is a priority. Thank you. [Interruption.]
I say to the public in the gallery that our standing orders do not allow applause—this is not a public meeting. I do not mean to be rude, but if we have applause, we will get criticism later. I ask them please to restrain themselves.
I congratulate Dorothy-Grace Elder on securing this important debate and on her initiative in setting up the cross-party group on chronic pain. I also congratulate her on the website to which she has referred, which has given a voice to those who are in pain, and on the elaborate arrangements for the web broadcast of the debate. If she is not careful, she will be called a moderniser, which she would not necessarily welcome.
This is an important and serious debate. The motion refers to
"the plight of chronic pain patients".
In the many briefings on the subject that most members have received from various organisations over the past week, reference has been made to a hidden epidemic of chronic pain in Scotland. Chronic pain is certainly suffered in epidemic proportions. The briefings that I have read indicate that a large number of Scots are affected. Dorothy-Grace Elder said that 550,000 people—about 10 per cent of the entire population of Scotland—are affected. Each one is an individual who has to live with serious pain, which simply does not go away, whatever its cause or source—cancer, arthritis, back pain, multiple sclerosis, ME or any of the other conditions that could contribute to it. The fact that chronic pain arises from so many different sources is partly why the health service is not approaching the problem in a unified, coherent manner. Long-term pain caused by ME—although ME is not treated properly—or cancer, for example, are treated separately. The approach is divided.
The plight of chronic pain sufferers is costing the country dearly in jobs lost, unpaid taxes and the benefits that have to be claimed. Many individuals have lost their independence through chronic pain; chronic pain generates dependence. The issue should be placed high on the political agenda and on the NHS Scotland agenda. Tragically, as we know, it has not been and we must ask why.
Pain management is not a new idea. The first pain management clinics in Scotland were set up about 30 years ago. A proper network across Scotland for pain management is perfectly feasible. However, the will does not yet exist to make it happen. That is why the debate is important.
Current provision of hospital-based services is patchy. Whether sufferers can get access to pain management depends on the part of the country in which they happen to live. There are a limited number of pain management programmes in Scotland, of which only half have a specialist nurse attached to them. Almost all the clinics that assist in treating chronic pain have poor managerial and secretarial support and the waiting lists are, of course, far too long. Dorothy-Grace Elder referred to the waiting list in Dundee, which is unacceptably long. That is because the resources that have been allocated to pain management in the NHS are simply nowhere near enough.
As the motion says, more resources require to be allocated and pain management and chronic pain must be moved up the NHS agenda. However, we have to ask ourselves seriously whether that will happen. The NHS is becoming one of the biggest businesses in this country—and I am not referring to private sector involvement. The year after next, it will have a revenue budget of almost £7,000 million. It has a building programme that is worth another £0.5 billion. It employs thousands of nurses and doctors. The service is delivered through 15 health boards that deal with an even larger number of trusts. There is management at every level and politicians are screaming in from every direction about their priorities for it.
We know that the NHS is meant to be patient centred and driven by patients' experiences, but increasingly in the political din that surrounds the issue it is difficult for patients' voices to be heard. That is why this debate is so important. It is also why cross-party groups are so important, as they give a voice not just to MSPs, but to people who are not MSPs, who can then engage with the Parliament.
I congratulate Dorothy-Grace Elder and tell her that I will certainly support her in everything that she does in respect of chronic pain for the rest of the session.
I, too, thank Dorothy-Grace Elder for securing the debate. She is one of Scotland's seasoned campaigning journalists and, when she gets the bit between her teeth, she does not let go. That is the case with chronic pain. We all congratulate her on the consistency and persistency with which she has pursued the topic.
I travelled down from Inverness today, having been in recess last week. When I arrived back at the Parliament, I discovered that, like other members, I had received loads of mail and e-mail. I am afraid that I cannot do justice to the number of people who have written to me and other members. However, I will go through the mail and respond to it in time.
We often talk in the Parliament about joined-up talking and thinking. Surely pain management is an excellent example of a service that could span the NHS and the independent sector as well as complementary medicines and techniques in order to address all the conditions that John McAllion and Dorothy-Grace Elder mentioned.
I was surprised to find that, although there is a Scottish intercollegiate guidelines network document called "Control of Pain in Patients with Cancer", there are no guidelines for the many other conditions that cause enormous pain. I hope that the minister will consider that at the close of the debate.
Greater integration between the health care professions, particularly the huge untapped potential of osteopaths, physiotherapists and other professionals, could do much to help people with chronic pain to lead fairly normal lives.
The alleviation of pain would not only help the individual and their family to have a better quality of life; it would help many to get back to work and to gain independence, self-esteem, dignity and confidence.
Like others, I was shocked to find out that 10 per cent of the population of Scotland suffer from chronic pain. I have spoken in many members' business debates and I can think of none that has covered an issue that affects such an enormous number of people.
I commend the Pain Association Scotland for the measures that it is taking and for its emphasis on medical and social welfare problems relating to chronic pain. I hope that the emergence and establishment of local health care co-operatives will be another opportunity for general practitioners to specialise in pain management.
I was shocked and pleased to hear that the Scottish Executive health department currently funds six projects on chronic pain and that a further 229 projects are continuing or have recently been completed. I hope that, as a result of our call today, there will be joined-up thinking and a bringing together of research and expertise to help us to arrive at conclusions and recommendations in order to address many of the points that Dorothy-Grace Elder's researcher, Gordon Anderson, made.
I will give some of the statistics. Nearly two thirds of adults in the UK have had experience of back pain—that figure is enormous. Back pain is cited by 15 per cent of jobless people as a reason for not working. I refer to the points that John McAllion made: we need to bring people back into the world of work, away from loneliness and isolation. In the UK, back pain accounts for 119 million days of certified incapacity annually.
There is no doubt that physiotherapists have an enormous role to play. I hope that the minister will examine the vacancy rate of 7.8 per cent in physiotherapy, a profession that can be of great help to people in pain.
Finally, I thank Dorothy-Grace Elder once again for raising awareness of the issue. I look forward to a positive response from the minister.
On a point of order, Presiding Officer. In light of the number of members still to speak and the great interest in the public gallery, I would like to move a motion to extend the business.
We should just about fit everyone in. However, if the minister is agreed, I would be minded to extend the debate to 6 o'clock to give us a bit of leeway.
Motion moved,
That, under Rule 2.2.6(d), the debate be extended until 6.00 pm.—[Alex Neil.]
Motion agreed to.
The applause from the gallery earlier was no accident—Dorothy-Grace Elder is to be congratulated on securing the debate. It has been mentioned that she is a great crusading journalist. I remember when the name of Dorothy-Grace Elder would strike fear into the hearts of colleagues of mine and John Farquhar Munro on Highland Council. By way of a change, it is good to be on the same side as Dorothy-Grace today.
Today, I was re-elected as vice-convener of the cross-party group on chronic pain. That is a great pleasure and I extend my thanks to those who voted. When Dorothy-Grace Elder asked me to join the group almost a year ago, I accepted with alacrity. As John McAllion said, cross-party groups such as the group on chronic pain are an example of what the Scottish Parliament does so well. The fact that we having today's debate, and that the gallery is as full as it is, is a feather in our cap. Getting into detail on such a topic and doing it the justice that we do it today would never happen at Westminster.
I have some personal experience of chronic pain and therefore speak with a certain amount of knowledge. As has been said, pain can be a very lonely and personal thing. When we help people who are in pain—with care, support and kindness—it can make an enormous difference. We all remember from when we were wee kids that it helped, when we banged our shins, if someone said "There, there," acknowledging our pain. I shall return to that important point.
We are on this planet for only a short time—three score years and 10 if we are lucky. That is not a long time; it is just one grain of sand in the desert of eternity. It is a basic right that we should enjoy the best possible quality of life while we are here. Anyone who is in pain is very far from that ideal. Those of us who are not in pain and who are fit owe it to our fellow human beings to do everything that we can to alleviate their suffering.
If we were to hand out medals for bravery, those who are in permanent pain and know that there is no end to it—they will wake up with the same pain tomorrow and the day after and the day after that—would deserve recognition. That is true bravery in the face of impossible and endless odds. We should remember that when we see people who are suffering.
Reference has been made to 550,000 sufferers in this country; that figure represents nearly one in 10 of the population. We Scots—indeed human beings wherever they are in the world—have a stoical nature. Many people do not like to grumble. It is not done to grumble about being in pain, and people think that they should just get on with life, saying, "Och, I'll cope." I would bet that the real figures are a wee bit higher than the statistics suggest. We shall see.
I will pack up speaking in a minute. I know that John Farquhar Munro would like to touch on the specific Highland aspects of the problem, which—given the constituency that I represent—are dear to my heart.
When the minister replies, perhaps she will remember that we have an enormous resource of experts out there who could and should be co-ordinated in their approach to chronic pain. There are also people like me and others—for example, the lady who comes to bath a person, the home help or even just the mum—who know a little bit about helping with pain. I suggest to the minister that those people, if they were co-ordinated and directed, would amount to a huge resource—spread throughout Scotland, from John o' Groats to the Borders—that could be unleashed to help her and our fellow human beings.
I congratulate Dorothy-Grace Elder. Well done. If she has done one great thing in her time as a member of the Scottish Parliament, today's debate is it.
We have time in hand. If members could aim for three minutes, or a little more, that would be helpful. Adam Ingram will be followed by Elaine Smith. I am sorry, that was wrong—the next speaker is Gil Paterson.
Adam Ingram is a lot better looking than me, Presiding Officer.
I thank Dorothy-Grace Elder. I will explain why my thanks are personal. Some years ago, I had an accident. Although I thought nothing much of it, I woke up one morning to find that when I raised my neck from the pillow, I blanked out because of the pain. For two days, I was unable to raise my head above the pillow. I was in pain lying on the pillow and every time that I raised my neck, the pain was so great that I literally flaked out. I went to hospital and had all the usual tests, but the doctors could find nothing wrong with me. I ended up being braced and strapped—that was the only way that I could proceed through life for seven weeks.
As a result of my being braced, some of the muscles in my neck were wasted and I had to stay off work. One or two politicians who are present will appreciate what I am going to say. Having worked a lifetime in the Scottish National Party, I had eventually got on to the national executive and had been elected to an executive vice-convener's post. Giving up that post was probably the hardest aspect. Members will understand that the pain that I went through was double-sided.
I feel particularly lucky now, because I get pain only every so often. In fact, last week I was in the mountains for a whole week's snowboarding. Being able to get round the pain certainly allows one to do things.
I will spell out the real problem by talking about a constituent who lives with severe pain. She worked until 15 years ago, when the illness struck. There has been continual deterioration. The pain has been so severe that for nine years she has been on a high morphine dosage, which has resulted in morphine poisoning. She is wheelchair bound and is fed through a tube. She suffers from depression because of the constant pain and her difficulty in coping with it. In her words, there is a perception that it is mainly the elderly who suffer constant chronic pain, but that is not so. There are many young sufferers. The disabled housebound are continually cold and need the heating on all the time. If they are not eligible for income support, they get no help with their heating bills. As a group, such people would benefit from inclusion in the heating allowance scheme for senior citizens.
Pain management is needed desperately, especially by those who have difficulty in getting about. If my constituent lived in England, she would have been admitted to a pain management unit for a month to have the pain level monitored and to receive the appropriate treatment. Some health boards in Scotland seem to be making progress in the field, but in Lanarkshire in particular, where the lady in question lives, thousands of patients are living each day with chronic pain.
To the minister, I say that we need action and we need it swiftly. We also need resources, but most of all we need action that alleviates the pain, so that chronic sufferers get help and some respite from the pain.
I join others in congratulating Dorothy-Grace Elder on securing the debate on this important subject. I know that she has been trying for some time to have the plight of chronic pain patients debated in the chamber.
The most common type of severe pain, which is experienced by nearly everyone at some time, is toothache, which is
"the hell o' a' diseases".
Strong painkillers might alleviate the suffering, but as the effects wear off, the pain returns. We should imagine suffering that pain every day with no prospect of relief.
In Scotland, as we have heard, about 550,000 people experience long-term pain. John McAllion described it as a hidden epidemic. Chronic pain can result in job loss, family relationship breakdown, despair and even suicide. In terms of numbers, chronic pain is one of the country's biggest health and social welfare issues, but it tends to be seen as a symptom rather than a condition. That point must be made this evening.
As we have heard, there is considerable variation in the health service in the provision of services for the treatment and management of chronic pain. For example, many general practitioners are unaware of the existence of chronic pain services in some of our hospitals. Many health professionals are committed to the principle of effective pain management and treatment, but some medical practitioners do not provide patients with information on the varied range of medication and other treatments, such as alternative therapies and hydrotherapy, which was mentioned by Dorothy-Grace Elder; nor do they give information on self-help or support groups.
In my area, there was until recently a Monklands group of the Pain Association Scotland, but unfortunately the group has temporarily disbanded, primarily as a result of accommodation problems. The individuals involved are still members of the Pain Association Scotland, and I hope that the group will soon be operational again. Monklands hospital has kindly offered to make a room available, but there are access difficulties for those people who have mobility problems, which we have to overcome.
There is no doubt that more funding and better support mechanisms are needed for such groups and other voluntary organisations that work in this field. We should recognise and congratulate people such as my constituent Joan Woods, who is with us in the gallery this evening, who suffer themselves but who are motivated to help others by undertaking invaluable voluntary work in their communities.
It should be remembered that children also suffer from chronic pain, and their families can experience the social and emotional consequences of their child's suffering. Pain in childhood, if untreated, can develop into adult chronic pain. The American Pain Society suggests that education of the public would increase community awareness of, and encourage support for, children who are suffering from chronic pain, alongside helping to influence public policy. The society recommends that chronic pain in children should be highlighted in the media. The Executive has funded for one year a children's pain clinic at the Royal hospital for sick children at Yorkhill, with on-going funding to be provided by the national health service. However, will the minister comment on the possibility of establishing a Scottish child pain centre, which could network with communities throughout Scotland? Public awareness is vital in pushing the issue of chronic pain up the health agenda. The use of the media is logical in raising awareness about all chronic pain sufferers.
Pain management and appropriate and effective prescribing could help to reduce the prescription bill; that point has not been touched on this evening so far. For example, in Lanarkshire in 1999-2000, about £7.3 million was spent on analgesics.
The minister might wish to comment on the possibility of having a high-profile awareness-raising media campaign, similar to other campaigns that have been run by the Scottish Executive. She may also wish to consider organising a citizens jury on this matter.
Chronic pain is a hidden epidemic, so let us expose it. Let the public know of its prevalence. Let them see those who until now have suffered in silence, and let them know the cost of this condition in monetary and human terms. Chronic pain should be a high-priority area for the Scottish Executive and the health service. I am pleased to associate myself with Dorothy-Grace Elder's motion this evening.
First, I thank everyone, headed up by Dorothy-Grace Elder, who has taken part in the debate on this issue in the three years since the Parliament was set up.
I apologise to everyone as I will have to leave early, just after my speech.
I am not an expert in the field, but I have listened to Dorothy-Grace Elder as she has persevered over the past couple of years, as Mary Scanlon said. I have learned with horror about the prevalence of chronic pain and about its many causes. From speaking to other people, I have learned that the cost of chronic pain to the national health service cannot be measured only in hard cash terms, because physical and sometimes emotional and mental illnesses can result from suffering chronic pain.
The social cost was mentioned by Elaine Smith and many others. I wonder whether we should take a much wider view of chronic pain, its causes—of course—and its effects. We should consider other ways of dealing with and managing it. For example, the Chartered Society of Physiotherapy is keen for workplace physiotherapy to be put in place. That could help people to manage their pain and remain in the employment market, which is what they want to do. It must be awful to have the will to carry on with life normally, as everyone else does, but to suffer chronic pain and be unable to do that.
I am keen that we take a step back and take a holistic approach. We should think about a bit of innovation. We should look at alternative therapy, complementary medicine and preventive strategies. Throughout the health service, we do not take enough account of the prevention of illness and place too much emphasis on curing illness.
Pain management programmes and a national framework and guidelines for the management of pain, whether in specialist pain clinics or existing resources, have been discussed. As I said, I am not an expert, but I contend that bodies such as the Chartered Society of Physiotherapy and the Pain Association Scotland, which Dorothy-Grace Elder mentioned, are experts. They are strong on considering such measures, which could have added benefits for the NHS in general, because no one talks about many conditions that cause chronic pain.
Many people suffer chronic pain from various illnesses that are never talked about and on which records are not held centrally, for example. I have asked the Executive about a condition called scleroderma, which is sometimes called systemic sclerosis. The Executive told me that it did not hold figures centrally on various aspects of the illness and that the illness is very rare. Many such illnesses might be rare, but to the people who suffer the illness and its resultant pain, it does not matter that the illness is rare. What matters is that no resources exist to help them. I feel strongly that a national pain strategy and centres could help to unearth some of the hidden illnesses and suffering in our society.
I pay tribute to the voluntary sector, which does a wonderful job all over our country in assisting the national health service and helping people to manage their day-to-day lives while they suffer chronic pain.
One or two additional speakers have come on board. The minister must start to speak by 17:50, so I am afraid that speeches must be three minutes long from now on.
I am glad to participate in the debate. I had prepared an extended speech, and if it is cut to three minutes, that will be unfortunate.
In your case, we will manage the extra minute, but other members will have three minutes.
Thank you. I am sure that we all accept that there should be no barrier to the treatment and relief of pain, particularly chronic and persistent pain. Many patients are not given sufficient information about pain control, and many more are not involved or encouraged to become involved in making decisions on how their pain problem should and could be managed. It is unfortunate that patients lack information about pain relief and the options that are available to them. As we enter the 21st century, it must be possible to ensure that medicinal support and treatments are available and are applied, and that all pain sufferers are happy and comfortable, and understand their pain-free treatment.
Many patients throughout Scotland are disadvantaged by living in some of our remote rural areas where support and services are limited or—worse—non-existent. Treatment for such people often involves lengthy and uncomfortable journeys to distant hospitals or clinics. Return journeys of some 200 miles are quite common. As members will appreciate, such journeys quickly erode any treatment that the patients might have had.
In south Skye and Lochalsh, a self-help group of multiple sclerosis sufferers and their carers have raised funds and established a hyperbaric chamber that is attached to the Strathcare medical centre at Broadford. That has helped those pain sufferers and has eliminated hundreds of miles of travel. I understand that the community of Lochaber is attempting to establish a hydrotherapy pool to provide a useful facility for regular exercise and therapy, which would aid sufferers in that area. That group has been campaigning actively for several years and has raised the magnificent sum of £150,000 in the community. That money will go towards the total cost of £500,000. The group has a site and the support of general practitioners and the local community but, so far, it has failed to secure the support of Highland NHS Board for its project, which, if completed, would serve a wide area of south-west Inverness-shire and would eliminate unnecessary expense and travel for many patients.
It appears that visible wounds are sympathetically and quickly treated, but that when people complain of invisible pain, it is regarded with some scepticism—like backache and the sore-head syndrome. That culture must change.
The aims and objectives of the Pain Association Scotland must receive wider recognition. We in the Scottish Parliament must encourage all shades of the medical profession and the health boards to be far more considerate and proactive in relation to the many and varied needs of chronic and persistent pain sufferers.
I congratulate Dorothy-Grace Elder on her persistence and determination in bringing such a worthwhile debate to the Parliament.
As John McAllion suggests, if we consider the numbers that have been mentioned, chronic pain would appear to be an epidemic. I cannot recall any other health debate in which so many people were mentioned as suffering from the same symptoms or condition. It is self-evident that we must have a much-improved strategy for the self-management and self-help of pain sufferers.
However, although a great many people are involved, I would like to make a special plea for one particular group of people—those who have multiple sclerosis and who use cannabis to alleviate their pain. There has been much discussion over whether using cannabis is desirable or, indeed, efficacious. I will not go into that discussion. All I know is that I am impressed by the number of people who for a number of years have been helping themselves to manage pain that in some cases is intolerable. Those people have been subjected to the full rigours of the law because of their use of cannabis.
I ask how we can help those cannabis users to alleviate their pain. Their present behaviour should be decriminalised. They should be able to help themselves—as they have been doing—with more security. And while we determine the best way in which to use cannabis or cannabinoids to help MS sufferers, can we please not be judgmental or punitive in our approach? If by smoking cannabis, or by having it baked in cookies, people gain just a bit of pleasure or just a bit of relief from the dreadful drudgery of the pain that is imposed on them, let them do so. How many of us here would deprive someone of a glass of red wine if that would take the edge off their pain when they were desperate to get some sleep at night? As well as being sensible in our approach to a strategy for pain management, can we be humane in the way in which we apply it?
I also congratulate Dorothy-Grace Elder on securing this excellent debate and thank the people who have turned up to listen to it. I cannot think of anything worse than being in constant pain day after day and sometimes year after year. I pay tribute to the many people who, although they suffer, still have plenty of time to get involved in voluntary work and other issues. In fact, there is a lady in the gallery whom I took home from Faslane after she had been demonstrating for a few hours. I do not know whether my driving or my car was to blame, but I think that she was in worse pain when she got out of the car than she was when she arrived at Faslane. As I said, it is marvellous that, although those people suffer pain, they still involve themselves in so many other issues.
As Elaine Smith pointed out, the fact that chronic pain is debilitating is well documented. She also mentioned that other long-term acute illnesses are associated with chronic pain. That issue is not so well publicised, and it would be an excellent idea to publicise it more. Of course, chronic pain also leads to relationship break-ups, which are terrible, and to long-term unemployment, which can be debilitating not just to one's health but to one's state of mind. We must recognise and publicise the impact that long-term pain can have on the country's economy and on people's well-being.
Dorothy-Grace Elder's motion suggests that the Executive should get together with health boards and push chronic pain patients to the top of the agenda, and also highlights the dire shortage of pain clinics and staff. I urge the minister to take those serious points on board. The Beatson clinic was mentioned earlier; Malcolm Chisholm intervened on that situation. I hope that, in her summing-up, the minister can give some hope to the many people in the gallery that she might take the same action. Health boards and trusts have been running the agenda for too long, and people have been suffering. I ask the minister to give us something positive and to tell us that she will push the issue up the health boards' agenda. I also hope that she will tell us that the Parliament, not the health boards, will run that agenda.
I had a very dear brother who died of motor neurone disease, which causes great pain and results in a terrible lack of dignity for sufferers. Indeed, the whole family suffered with him. That dreadful disease has not yet been mentioned in the debate; however, as I am involved with the Scottish Motor Neurone Disease Association, I thought that I would bring it up.
Obviously, MS comes to mind. I have visited and talked to a Morayshire group of MS sufferers, all of whom want the drug interferon. Some of them get it; some do not, and I do not find the explanations given to those people satisfactory. There has been some economising in the way in which the drug is awarded. Interferon is definitely very palliative; in some cases, it completely arrested the disease for some time. It worries me that we are economising on available palliative drugs.
As for the hyperbaric pool that was mentioned, I attended a meeting of Highland NHS Board and complained about its attitude on that very matter. When I was told that the pool was not curative, I said, "Well, I know that it's not curative, but it is palliative. It makes people feel better. Are they not entitled to feel better?" There is a pool in Wick; the Lochaber people have made a wonderful effort and should be encouraged. I have criticised Highland NHS Board's attitude in writing.
I agree completely with Margo MacDonald. Cannabis should be available on prescription to alleviate the pain that people suffer.
Finally, Gil Paterson mentioned young people. We tend to think that chronic pain affects older people, and very often it does. However, after I lost my first seat, I got involved with the issue of the dreadful rheumatic pain suffered by very young people, who can be crippled by it. Let us remember that all ages can suffer from chronic pain. I thank Dorothy-Grace Elder for securing the debate.
I join in congratulating Dorothy-Grace Elder on her success in securing the debate. It is the reward of several years' perseverance. Dorothy-Grace has been lodging questions and motions on chronic pain at regular intervals since the Scottish Parliament came into being, and was instrumental in getting started the cross-party group on chronic pain. I acknowledge also the number of people in the gallery this evening. That just goes to show how important the issue is to many people.
I need hardly say that the Executive and the NHS in Scotland recognise the misery that constant pain can cause, and the importance of effective pain relief and management. As the motion recognises, there are also economic implications for sufferers and the economy generally, when chronic pain prevents attendance at work or inhibits people's ability to work at all. It would be disingenuous, however, to suggest that there is a quick or easy solution that can help everyone who suffers from chronic pain. However, we must consider some options.
Chronic pain is a symptom that is present in a wide and varied range of conditions. There are literally hundreds of chronic conditions that can lead to severe pain. The most common of those are arthritis and back problems, but there are many others, some of which have been mentioned. The conditions have different causes—although we do not know the cause of some—and bring with them different kinds of pain. They all have other symptoms, some common to more than one condition and others unique. Controlling pain is only one part of the treatment for such illnesses and it is suggested that that would best be handled as part of an holistic approach, in which the whole condition is tackled.
As part of its response to a petition by Dr Steve Gilbert, the Scottish Executive health department carried out a survey of NHS boards to find out how they handled chronic pain. As expected, the department found that every board was conscious of the need for pain management. All except Highland NHS Board, which has arrangements for referral to other areas, provide some form of chronic pain management service. There are many means of delivering that service, of which analgesia and physiotherapy are the most common. I am more than happy to take away Mary Scanlon's query about physiotherapist vacancies. However, boards also provide other means of pain management, such as transcutaneous electrical nerve stimulation—or TENS—relaxation therapy and, in some areas, complementary therapies such as acupuncture and homeopathy.
I note the survey to which the minister referred. Will she also read the messages that have been pouring into the Parliament's website on the matter and, where appropriate, pass on the comments to health boards so that they become fully aware of the intensity of public feeling on the issue?
I am happy to do that. We await health plans from the health boards and we hope that within those plans there will be further indications on how each board will address the issue. I should also add that the boards' responses to the health department's informal survey would have focused on pain management only where it was possible to identify that as a separate service. We will use the health plans to consider that in more detail.
The motion calls for more specialised pain clinics and staff and I can understand why; however, a specialised clinic does not exist in isolation but must be led by a suitably qualified clinician. Pain management is not a recognised medical specialty and cannot be turned into one by any action on the part of the Executive. The establishment of any new specialty must be led by clinicians—usually by the appropriate royal college—because the first step is the creation of a suitable curriculum for training new specialists.
The identification of a lead clinician is only a first step. All operational matters are best handled by the NHS boards, which are funded by the Executive to plan and prioritise services in their areas. I remind members that, in the coming financial year, NHS boards will receive an average increase of 7.2 per cent over their 2001-02 allocations.
In "Our National Health: A plan for action, a plan for change", the Executive promised that we and the NHS would work closely with patient support groups to ensure that the needs of those who suffer from chronic conditions are met. An important part of implementing that promise is the continuing development of managed clinical networks—a concept that emerged from the acute services review that was published in June 1998 and which has been well received throughout the NHS. MCNs are a means of designing services so that all points at which patient care is delivered are linked. MCNs cross the traditional boundaries between primary, secondary and tertiary care and put patients' needs at the heart of the service that we are trying to deliver.
In time, a number of the conditions that cause chronic pain might become candidates for the development of managed clinical networks, under which the control of pain would be included as part of the treatment. Because of its diffuse nature, chronic pain is not itself a likely candidate for an MCN, but the related field of palliative care was one of the first to be developed.
As Mary Scanlon mentioned, a considerable amount of research into various aspects of chronic pain is being carried out. I am glad to say that some of the funds that are directly controlled by the Executive through the health department's chief scientist office are supporting such research. The national research register contains details of 99 current research projects, of which nine are in Scotland. That does not include the two projects that are financed by the CSO in Scotland. It will be of considerable interest to medical researchers, not least those in Scotland, that such work is being carried out.
Before I conclude, I will pick up some of the points that Dorothy-Grace Elder made, but which I have not dealt with so far. The Pain Association Scotland is at liberty to make grant applications at any time under section 16(b) of the National Health Service (Scotland) Act 1978. It is not only the Pain Association Scotland that receives such grants; I could list 12 or 15 other organisations.
Dorothy-Grace Elder also asked for additional pain clinics throughout Scotland, but that decision must be left to individual health boards. However, I would like to look more at examples of good practice throughout Scotland, especially of pain clinics that have been developed and operate successfully.
I am happy to consider what can be gained from examining the reports that Dorothy-Grace Elder mentioned. I will clear up with her later to which two reports she referred.
The management of pain is a huge issue, as the figures that have been quoted prove. We need to see the management of pain being part of a package of care that is delivered to people throughout Scotland. I congratulate Dorothy-Grace Elder again on securing the debate, which has sought to raise the profile of chronic pain in Scotland. Judging by the number of e-mails and letters that she has received, the debate has already started to do that.
That concludes the debate on chronic pain. The debate has been followed not only by the public in the gallery but by people throughout Scotland, the UK, Europe and the wider world via webcast and via the interactive bulletin board. The opportunity to contribute to and comment on the debate remains open for at least another week. Access can be obtained via www.scottish.parliament.uk.
The address is www.scottishparliamentlive.com.
As Dorothy-Grace Elder has pointed out, access can also be obtained through that secondary address. The bulletin board is available through both web addresses. Have a look. If members want to contribute, they, too, can respond.
Meeting closed at 18:00.