Overview of the National Audit of Pain Services

Pain Clinics treat patients with chronic pain, for whom traditional disease centred therapies have failed, with the emphasis on regaining quality of life. However, many services are poorly resourced and practitioners isolated. Not enough is currently known about activity levels of these pain services, or about their clinical performance.

Two government reports have called for better assessment practices. In response The National Audit of Pain Services has been initiated to collect detailed data on pain services. The three year study aims to improve NHS services for people affected by chronic pain and will establish a national data collection system which will enable services to monitor performance, share data, feedback and consensus of interested parties. Areas of data collection will include, patient case mix, demographics, diagnosis, treatments, assessment of condition severity and patient outcomes.

The audit was commissioned by the Health Improvement Partnership (HQIP) and is being carried out by a partnership of the British Pain Society and Dr Foster Research Ltd.

Aims

The National Audit of Pain Services aims:

  • To improve the quality and effectiveness of care by measuring services against established national standards.
  • To improve access to specialist pain services for patients and services users.
  • To improve awareness of specialist pain services within the NHS amongst patients, commissioners and clinicians.
  • To help close the gap in the variation of care
  • To accelerate the rate of improvement and development in both the organisation and delivery of care for people with chronic pain.
  • To establish the new standards relating to the delivery of a high quality pain service.

Our Approach

In order that we can establish a detailed picture of the current delivery of specialist pain services the audit will be conducted in three distinct phases.

Phase one of the audit will focus on the provision and distribution of NHS pain services, within both primary and secondary care, across England and Wales. Data will be collected on the staffing levels, level of multi disciplinary care provided, facilities, treatments and waiting times for new patients at each individual clinic. Where possible the information requested will be based upon guidelines produced by the Royal College of Anaesthetists and the Department of Health1. The completion of this phase will establish a national data-base of pain services with all individual clinics mapped to their parent NHS Trusts and Strategic Health Authorities. This data-set will allow us to conduct a proper analysis of the pain services currently available to patients and look at the variation between different providers and regions.

Phase two of the audit will then concentrate on the collection of case mix and patient reported outcome measures (PROMS) from participating clinics. Case mix data will be supplied directly by clinicians via a web interface and will include the following patient details: age, sex, diagnosis, treatments, type, severity and duration of the pain. Participating patients will also be asked to complete a PROMS questionnaire before their initial consultation and then a follow up questionnaire 6 months later. The PROMS questionnaires will include the Brief Pain Inventory (BPI) short form, the EuroQol 5d questionnaire and a set of bespoke questions developed for the audit. The bespoke questions will examine a number of important areas: access to specialist services, patient satisfaction and experience, healthcare usage and the ability to work or seek employment. During this phase we will be collecting data from clinics for a three month period with all new patients at each clinic being requested to participate.

Phase three of the audit will bring together all of the initial work. We will be carefully analysing the organisational, case mix and PROMS data collected from both clinicians and patients in order that we can provide a clear picture of the current provision specialist Chronic Pain Services in England and Wales. Where possible we will be looking to establish standards, benchmarks and indicators for a high quality pain service. At the end of this process will publish a full report and make all of audit available data available.