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Older People: Pain

Volume 706: debated on Monday 15 December 2008


Asked By

To ask Her Majesty’s Government what is their response to the Help the Aged survey and report, Pain in Older People: Reflections and experiences from an older person’s perspective.

My Lords, as a clinician, I agree that the assessment and management of pain should be at the heart of all good clinical practice. I therefore welcome this report, which sets out the important issues relating to pain in later life and reflects older people’s experiences. It will raise awareness of important issues among those responsible for meeting effectively the healthcare needs of their local population.

My Lords, I thank the Minister for his reply. Given that estimates by Help the Aged and others suggest that 5 million older people in the population—possibly including some of us—are experiencing chronic and severe pain, and given that ageist attitudes predominate, as expressed by such statements as, “What do you expect at your age?”, will the Minister assure us that the Government plan to bring forward the timetable for introducing legislation on age discrimination in health and social care to within the lifetime of this Parliament?

My Lords, before I address the noble Baroness’s second question, I must say that it is imperative to understand that no one, irrespective of age, should tolerate pain. I appreciate that awareness in this area is extremely important, because we are living in a century when all of us are getting older and, at the same time, there is a suggestion that pain is a symptom of ageing, which it is not. As far as concerns age discrimination, older people deserve to be treated with dignity and respect in all care settings. That is why the Government are bringing forward the equality Bill that includes a commitment to end unfair discrimination in the NHS.

My Lords, among the valuable comments in the document, one is highly relevant:

“Doctors sometimes see us as an illness rather than a whole person”.

Does the Minister agree that although we have wonderful specialist services, we still need to have general physicians because, as in this case, it is sometimes difficult to determine someone’s problem? Is he aware of the wonderful work done by the Chronic Pain Policy Coalition?

My Lords, obviously I support what the noble Baroness said in relation to pain management. This important document will increase awareness among the public and patients. At the same time, it will remind clinicians that they should give higher regard to chronic pain. I take most of the recommendations and could not agree more with some of the other work that has been done in this field.

My Lords, a 2007 report by the Picker Institute referred to pain as a hidden problem. Does the Minister agree that people being left in harmful, unnecessary and sometimes excruciating pain is intolerable? Will he immediately give guidance to the Care Quality Commission to prioritise addressing this issue while we wait for the single equality Bill?

My Lords, the recommendations in this report highlight a number of things, and I should summarise some of them. Pain management in older people is highly relevant and is often regarded as a normal part of ageing, which is not the case. Clinicians should give high regard to the management of chronic pain. We are aware that self-reporting of pain by older citizens is an issue. We need to identify better ways of assessing pain in older people and in patients with dementia. The management of pain should be looked at in a different way. We all know that there is an altered physiology and that that may impact on the effectiveness of therapy. I could not agree more about the role of the regulator. We have set the standards, the National Institute for Health and Clinical Excellence has clear standards, and the CQC has the role of ensuring that they are met.

My Lords, in March 2007, the British Pain Society and the British Geriatrics Society produced a comprehensive evidence-based assessment framework for pain in older people. What is the department doing to encourage take-up of that valuable tool by GPs and secondary care staff?

My Lords, the commissioning guidance for PCTs has taken on board those recommendations. The 18-week chronic pain pathway is part of the commissioning tool. We are strengthening commissioning, and we have an assurance system to ensure that PCTs are working with their providers not just to address acute pain problems in hospitals, but, more importantly, chronic pain management in primary and community settings.

My Lords, in the light of what the Minister said and implied about the patchiness of services in this area, does he consider that any future review of the national service framework for older people should include a standard to address persistent pain in older people?

My Lords, the noble Earl raises the NSF for older people, which was published in 2001. We need to be much more proactive in the evidence base, and I hope that the national quality boards, which will be created under the health Bill that will be discussed in Parliament in the new year, will address the standards and their updating, including for chronic pain management.

My Lords, my noble friend mentioned self-reporting. Would he agree that older people are notoriously bad at reporting pain and think that they have to put up with it? What role does he see for patients’ organisations in this regard?

My Lords, the noble Baroness has raised an important fact. Self-reporting is a challenge in older patients. Working with patients groups, we need to identify assessment and other tools, such as visual analogue scales or even a visual language scale, by which patients who may find it difficult to communicate will be able to express their pain symptoms.

My Lords, my noble friend mentioned the 18-week pathway for chronic pain. I was seen within that period. Three or four months afterwards, I saw the consultant and we established that the procedure had not worked. I am now advised that it will be 52 weeks before I can have further treatment because of the new system of allowing patients to be seen in one or two places and the particular expertise of the consultant. Is this right?

My Lords, as I said earlier, we need to develop a network of pain provision between the acute sector—where I understand my noble friend had his visit—and the community sector. In other words, there should be a proper handover of patients after their visit to the acute pain clinic, or the pain clinic within a hospital setting, back to their primary care physician.