EDITORIAL: August 2010

We hear much about "quality of life" which is a vital ingredient for those living with chronic pain. To receive a treatment that achieves this is a mighty relief not only to the individual but also their friends and family. So the news that The North Yorkshire & York Primary Care Trust(PCT) has decided to withdraw pain relieving spinal injections for all patients regardless of need is beyond belief. It would appear that a liberal interpretation of the National Institute for Health and Clinical Excellence(NICE) guidelines is behind this bizarre decision. These guidelines for the treatment of low back pain are in themselves soaked in controversy causing wide divisions amongst healthcare professionals working in pain management. Indeed the President of the British Pain Society who had been involved in developing these guidelines did not survive a "vote of confidence" being forced to resign. The members of the York and District Pain Management Support Group are some of the people who stand to be affected by this decision if it does get implemented. They provide strong and compelling evidence of just how effective spinal injections can be for somebody with chronic pain- a view that calls to the Action on Pain helpline endorse.

The PCT would do well to fully understand the guidelines before they take this step. Quoting from the NICE  guidelines " Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However the guidance does not overide the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient   and/or guardian or carer" Simply put this means that one size does not fit all which the PCT does appear to find hard to understand. It is difficult to steer away from the conclusion that the "beancounters" within the PCT have seen this an opportunity to save money without either understanding or indeed fully considering the wider implications.

Following their meeting with the Medical Director of the PCT the members decided to seek a meeting with the Chief Executive of the PCT being deeply unhappy with the position taken by the Medical Director. This second meeting was a little more positive yet the proposals put by the Chief Executive were both long winded and almost unworkable. It is hard to understand the logic of these proposals when the Chief Executive of the PCT actually admitted that in the long term their position would probably cost them more. The cynic would say with some justification that in the "long term" the existing Senior Managers of the PCT would have moved on leaving the problems to their successors. In the meantime those people who rely on these injections remain in limbo.

Action on Pain has since become aware of the same problems surfacing in other PCTs so will continue to develop a dossier which can be submitted to the Healthcare Commission and the Health Secretary. If this is happening in your area we would like to know if you are affected by it either as a patient or healthcare professional.   

Now in August we have been made aware of a number of PCTs who are not following the NICE guidelines not only for the above treatment but for other treatments which have been approved for use. Financial restraints are given as the reason yet the PCT has an obligation to fund such treatments. Given this scenario it cannot be that far way when a legal challenge is made against a PCT that is witholding treatment. Such a move has been made in other cases which have met with either a degree of success or in some cases the PCT "caving in" before the matter gets to court. That it should have to come to such measures is wholly unacceptable in a modern caring society yet the PCTs still think they can get away with it through a series of delaying tactics which impact greatly on the people affected by such prevarication.