Service Improvement Groups
Introduction text
As of August 2013, all Health Boards in Scotland have Service Improvement Groups (SIGs) either in place
or under active development and directly supported by the Scottish Government for two years. The SIGs
are leading on the implementation of the Scottish Chronic Pain Model and have developed action plans
to support this.
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Service Improvement Group Resource Pack – September 2013
This section aims to share the key learning from some of the ‘pioneer’ Boards. Here you will find
information about local structure, organisation, patient and healthcare professional advice,
measurement and key contacts throughout Scotland. It also contains a section that allows local SIGs to
upload information about what’s happening in their area for wider sharing.
After intro above, the button choice is:

Organising your Service Improvement Group
 FAQs about SIGs
 Getting help to develop your SIG
 Patient Advice and Information
 Healthcare Professionals Advice and Educational resources
 Measurement and Reporting
With downloadable pdf copies of:
 EQ5D calculator
o EQ5D Guidance
o Data Collection Sheet
o Consent Form
 Key National Contacts
o This is a pdf table
 What’s happening in my SIG?
Will need tab for each NHS Board and also National Chronic Pain Steering group to be
able to upload information about their own area – files and text
Service Improvement Group (SIG) Membership and Organisation
Suggested membership; all members to play an active part in implementing the Scottish Chronic Pain
Service Model:
Clinical Representation
 Representatives from Primary Care; GP, Pharmacy, Nursing, AHP
 Representatives from Secondary Care; Medic, Nursing, Pharmacy, AHP.
Patients and patient representatives
 Patients with experience of chronic pain
 Representatives from the third/voluntary sector; Pain Association Scotland, Pain Concern, The
Alliance, ARMA etc.
SIGs are advised to ensure they have input from local Service Improvement Support i.e.
 Service Improvement / Local Improvement Advisor
 Organisational development
 Health Board representative/planning.
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Service Improvement Group Resource Pack – September 2013
Role and Responsibilities
1. To implement the Scottish Service Model for Chronic Pain (SSMCP) in line with the aims stated in
local Service Improvement funding bid.
Each SIG will have identified priority areas for change in their Service Improvement Bid and it is
understood that these priority areas will vary for each SIG depending on the existing organisation of
Primary and Secondary Care services, additional existing resources and needs of local service users.
These will include however:
 Pathways
 Patient Information and Health Care Professionals’ communications and approach to supporting
education
 Standards
 Measurement and reporting.
2.
To ensure that changes and local improvements associated with the SSMCP are person-centred
and have taken direct cognisance of local patient need and experience.
3.
To monitor and report the progress of the SIG locally and to the Scottish Government Health
Directorate (SGHD).
In addition to monitoring progress to inform ongoing improvement locally, there will be a requirement
for each SIG to report on progress to the Scottish Government each year. Advice and reporting tools will
be provided and relate to:
 Service level data
 Patient level data.
Information about other validated measures that services may wish to use will be provided as well as an
SSMCP tracker that allows SIGs to monitor their approach on a day to day basis.
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Service Improvement Group Resource Pack – September 2013
Organising Your SIG
In addition to the overarching Executive Group and to support the development of required areas of
priority, sub groups of the main SIG may be developed. An example of this could look like:
SIG Executive
Group
Pathways
CPD/Education
Standards
Measurement
& Reporting
It is advised that in line with local policy, each SIG develops appropriate project management
governance arrangements and supporting documentation e.g:
 Timescaled formal action plan
 Risk register
 Communications plan.
Frequently Asked Questions and Answers
We have compiled some key questions and answers that have commonly been asked over the last
few months that might be of use to you.
Service Improvement Groups (SIGs)
Q. What should the membership of the SIG look like?
A. It will be important be ensure you have representation from primary and secondary Care; GP,
Pharmacy, Nursing, AHP. Also, patients with experience of chronic pain, representatives from Third
Sector (previously called the voluntary sector); Pain Association Scotland, Pain Concern, The Alliance,
ARMA etc.
Having the input from your local Service Improvement / Local Improvement Advisor / Organisational
Development team will also be helpful.
Q. How often should the SIG meet?
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Service Improvement Group Resource Pack – September 2013
A. This will be determined by local needs and planned actions. If sub groups are formed to take forward
specific pieces of work, meetings of the executive will be timetabled around these.
Q. What is the best way to contact patients and invite them to take part?
A, Members of your Pain Team may have patients who would be willing to be involved. Most NHS
Boards have a formal Patient’s Forum who have contact details of members. The Third Sector
membership includes disabled people and people who live with long term conditions who may be
interested in taking part.
Q. Should patients be represented in all aspects of the Service Development?
A. Patients and the experiences of people who use chronic pain services will provide valuable insight
into every aspect of the Scottish Service Model and help shape future services. Please remember that
your public partners may require support to fully carry out their role. Speak to your local Patient and
Public Involvement Officer who could direct you to what is available locally, most NHS Boards have a
development programme in place.
The Public
Q. Why is it important to include the public as a partner and share information?
A. Chronic pain is not well known or recognised as a medical condition. Raising awareness of the subject
will improve understanding and increase the chance of people asking questions, being proactive and
looking for more information.
Q. What is the best format and forum to use to achieve this?
A. Regular updates in local newspapers are a good way of keeping people informed.
Does your Board use twitter? Social Media is a great way to get information about to your population.
Consider including a short, succinct explanation of chronic pain in every publication which goes out to
the public.
A contact address will give people the option of asking for more information, offering suggestions and
advice or the offer of help.
Third Sector
Q. Why should representatives from the Third Sector be a partner?
A. The Third Sector offers a wealth of support for people who experience chronic pain. Having access to
this knowledge during planning alongside patient stories and experiences will influence service
provision.
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Service Improvement Group Resource Pack – September 2013
Q. How many organisations should be invited to take part?
A. It is useful to include representation from all of the main voluntary partners – Pain Association
Scotland, Health and Social Care Alliance Scotland (the ALLIANCE) and Pain Concer, as their combined
services offer breadth and choice.
Q. What is the best format and forum to achieve this?
A. Contact local Third Sector organisations in your area and ask if they will share the information with
their members.
Include your local Third Sector interface in all your communications.
Clinicians and Managers
Q. Which clinicians should be part of the main SIG group?
A. Membership should consist of those clinicians familiar with current provision and also clinicians who
will not only be part of the new developed model but who will take an active part in shaping the service,
working with the work streams. This also applies to managers.
Q. How can we keep our Managers and Healthcare Professional colleagues informed about our
progress?
A. The front page of the Intranet is a useful place for information.
Monthly bulletins to Practice Managers and Heads of Department to share at departmental meetings /
add to bulletin boards.
Monthly updates in local newspapers.
NHS magazines.
Piggy back on any circulars which are sent around e.g. Pharmacy updates.
Community Partners
Q. Are there community partners we should be engaging with?
A. Social Care, Employment agencies, Carers networks and the Leisure and Sport industry are some of
the community partners who contribute to the health and well being of people with Chronic Pain.
Involvement at the planning stage will ensure everyone learns what the pathway looks like and will help
community organisations to signpost appropriately.
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Service Improvement Group Resource Pack – September 2013
Pain Association Scotland
Q. I have heard about the pain management courses offered by Pain Association Scotland (PAS) that
teach self management skills to those with chronic pain, what do I need to know?
A. These courses are very helpful in developing and supporting those with chronic pain to play a bigger
role in their lives. They are a partnership between health services and PAS. It is important that you
ensure that your patients understand the benefits and importance in attending. You should encourage
their attendance.
Experience from Boards who have identified attendance as a problem for some patients have added an
extra step to the referral process which has improved compliance. This involves allocating
time to those all referred to allow them to speak to someone who can provide more detailed
information and answer questions.
Data collection
Q. Will all NHS Boards collect the same data?
A. NHS Boards across Scotland will be asked to collect the same data but this will not preclude those
including measures of their own.
Education and Training
Q. Who should be included in the educational component of the Scottish Service Model for Chronic
Painl?
A. Education about chronic pain underpins the Service Model. A training programme for clinicians
responsible for the care of patients at any point in the patient’s journey should be a priority. A multi
disciplinary training programme may suit some NHS Boards.
Training schemes exist to provide assistance and improve confidence for patient groups taking part in
service development and offering opinions.
Resources
Q. Are there any existing resources that we should be considering?
A. A list and outline of local resources will add value to everything offered within the Scottish Service
Model.
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Service Improvement Group Resource Pack – September 2013
Both the Patient and Healthcare Professional section of the website features a number of additional
sources of help and interest
ALISS (Access to Local Information to Support Self Management) is a resource whish will complement
local resources: http://aliss.org/. The ALISS project aims to make it easier to find out what is available
locally. The project had developed online technology that enables people to access information about
local community based activity that can support them to live well and manage their long term condition.
Information sharing and learning from each other
Q. Will there be the opportunity to learn about what other SIGs are doing?
A. A new website is currently under development www.chronicpainscotland.org. It has a patient and
public friendly section which explains chronic pain in a non medical way and offers suggestions about
how to manage chronic pain and provides links to well established Third Sector organisations.
The Healthcare Professional section links to educational resources about chronic pain, teaching
materials, research papers and websites of interest.
There is also be a section on the website dedicated to SIGs offering support, advice and resources and
providing them with the opportunity to share progress, success and challenges.
Getting Help and Support to develop your SIG
Resources and support are available from a variety of sources. Some examples are outlined below:
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National Chronic Pain SIG Network
Local Clinical Effectiveness
Local Organisational Development
Quality Improvement Hub http://www.qihub.scot.nhs.uk/default.aspx
NES www.nes.scot.nhs.uk
Local Patient Experience team
Expert patient service/training e.g. Pain Association Scotland
Voluntary sector; PAS, Pain Concern, Alliance (ALISS project).
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Service Improvement Group Resource Pack – September 2013
Patient Advice and Information
It is important that patients and their carers have access to high quality and consistent advice and
information about chronic pain. To help, an extensive list of potential sources of help and advice are
included in this website in the Living Life with Chronic Pain section all of which have been through a
peer reviewed quality assurance process. You can access these resources here
Healthcare Professionals Advice & Educational Resources
Healthcare Professionals need access to the most up to date information to help them provide the best
quality care to their patients. There is a wide range of advice, information and educational resources for
healthcare professionals in relation to chronic pain some of which feature on this website. To provide a
degree of assurance about the quality of these resources, all have been through a peer reviewed quality
assurance process. You can access these resources here
Measurement and Reporting
Annual Data Collection
Purpose:
Up to date accurate data needs to be collected to provide both a baseline and ongoing view of the
progress of the SIGs as they develop over the next two years. Baseline data will be collated during the
autumn of 2013 and reported on in March 2014. It is anticipated that the Scottish Government will
require SIGs to make further reports of their activity and performance in 2014 and 2015.
Data needs to be provided to establish a view of:
 The NHS Boards progress with implementing the SSMCP: Service Level Data
 Patient level data.
1. Service Level Data
During 2013, this information will be collated via a semi-structured interview conducted by the National
Chronic Pain Facilitators. For 2014 and 2015 submissions, a spreadsheet will be provided for local
completion.
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Service Improvement Group Resource Pack – September 2013
Data required
Explanation
Waiting time to local MSK services
(in weeks)
This is required to provide a wider context to local service
provision and to monitor any impact of the 4 week AHP MSK
HEAT target over time
Numbers referred to specialist CP
service
Total number of referrals to level 2 and 3 services
Description of specialist CP service and
make up including WTE numbers
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Annual Action plan in place?
YES/NO and date of agreement
Any specific challenges?
Short term plans to address?
Waiting time to first specialist CP
service appointment
Date of receipt of referral to date of first assessment
(working days)
Waiting time to second specialist CP
appointment
In working days and by type of second appointment
Information provided to patients
Type and sources used
Medical
Nursing
Physio
OT
Psychology
Other?
2. Patient Level Data
During 2013, this data will be collated from a one month snapshot for period mid October – mid
November. A web based tool will be provided to capture the data. Each Board will be required to
provide the data for all new and return patients seen during this time. All data is anonymised i.e. non
identifiable. We have also produced a paper copy of the data collection sheet that you might find useful.
You can access this here
Patient Consent
Data Protection legislation is clear that patients have to consent to the use of information about them.
It is good practice at all times to ensure they are aware of what happens to the information they
provide. To support this, we have included a suggested consent form that SIGs can customise for local
use. The consent form can be found here
The agreed core data set is provided below. SIGs will be required to provide data that relates to
Essential Measures ONLY to SGHD annually. Those data items contained within the ‘Desirables’ column
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Service Improvement Group Resource Pack – September 2013
denote data that have been recognised as being of potential benefit to local services and can be
supplemented/replaced with any others of local interest.
Patient Level Core Measures
Definition: This dataset relates to users of Level 3 and 4 chronic pain services in NHSScotland.
Exclusion: In Patients, Domiciliary, Non NHS funded, Palliative Care.
Inclusion: Adults and children with Chronic Pain.
Essential Measures (for national use)
Measure
Desirable Measures (for local use)
Definition
Measure
Definition
Male
Female
Other
Physical activity
question
Using PAHA definition
http://www.paha.org.uk/Resource
/scottish-physical-activityscreening-question-scot-pasq
Age
Mean and range
Uptake of other
health services
GP appointments in ?3/12, A&E
attendance, other specialist
referral
Employment
See appendix 1
Prescribing
Review of effectiveness, strong
opioids
Source of Referral
See appendix 1
Body part affected
See appendix 1
Investigations
MRI, CT
Duration of
symptoms
In weeks
Type of pain
IASP definitions – or READ / ICD
Code
Gender
Patient experience
www.careexperiences.com
Brief pain Inventory
BPI
EQ5D
See appendix 1
STaRT Back Tool
http://www.keele.ac.uk/sbst/
Waiting Time
The time that elapses
between receipt of
referral and first clinical
contact, face to face,
telephone or video (In
working days)
Framework for
Measuring Impact
http://www.measuringimpact.org/
Waiting time to
follow up
This includes: Phone
review, GP or
community pharmacist
all ways of improving
patient follow up
Physio, OT, Assessment
for MDT Pain
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Service Improvement Group Resource Pack – September 2013
Management (in
working days)
Number of WTE by
professional grouping
described as x/1000 of
the population covered
by the service
WTE staff
Appendix 1
Body Part Affected
Definition: The region of the body affected by chronic pain OR where the pain originates (if pain in leg
originates from low back pain – select low back pain).
Part
Low Back
Other Spine
Hip
Knee
Foot/ankle
Shoulder
Relates to:
Lumbar Spine, Lumbosacral, Sacral, Sacroiliac Joint, Sacrococcygeal
Head/Skull, Neck, Occipito-atlanto-axial, Cervical Spine, Thoracic
Spine, Cervicothoracic, Ribs,Truck, Abdomen
Hip Joint, Buttock, Thigh, Femur, Pelvis, Groin
Knee Joint, Patello-femoral, Fibula, Tibia, Lower Leg
Ankle Joint, Other Foot Joints, Metatarsus, Tarsus, Toes
Shoulder, Humerus, Clavicle, Scapula
Elbow/wrist/hand
Elbow Joint, Forearm, Radius, Ulna, Wrist Joint, Carpus, Fingers,
Metacarpus, Hand Joints
Head & Neck (Non
spinal related)
Head and/or neck but none of the above
Pelvic
Including gynaecological
Abdominal
Non spinal/pelvic
Thoracic
Non spinal related
Multiple
More than one of the above
Other
Please state
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Service Improvement Group Resource Pack – September 2013
Employment Status
Definition: This term is used to describe an individual’s state of employment.
Values:
 Employed
 Unemployed
 Houseperson
 Student
 Retired
 Registered Disabled.
Related items: Work Status Assessment; Period of Absence.
Work Status Assessment
Definition: Identifies an employed person’s ability to remain in the workforce during a health related
problem.
Inclusions: Self-employed, employed.
Exclusions: All others
Values:
 Absent from work due to the health problem
 Remains at work
 Remains at work with difficulty
 Not applicable
Related items: Employment Status; Period of Absence.
Period of Absence
Definition: The time period the person has been absent from work.
Values:
 Less than 2 weeks
 Between 2-4 weeks
 Between 4-6 weeks
 Over 6 weeks.
 Not applicable
Related items: Employment Status; Work Status Assessment.
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Service Improvement Group Resource Pack – September 2013
Referral Source
Definition: Who made the referral to the service
Values:
 GP
 Hospital Doctor
 AHP
 Nurse
 Self
 Other
Related items: Duration of symptoms, waiting time
EQ5D
Source: (European Quality of Life 5 dimensions)
a) Mobility
Definition: The level of ability to walk about from the patient’s perspective.
Values:
0 - No Problem
1 - Slight Problem
2 - Moderate Problem
3 - Severe Problem
4 - Unable
b) Self Care
Definition: The level of ability to wash & dress from the patient’s perspective.
Values:
0 - No Problem
1 - Slight Problem
2 - Moderate Problem
3 - Severe Problem
4 – Unable
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Service Improvement Group Resource Pack – September 2013
c) Usual Activities
Definition: The level of ability to carry out usual activities (work, study, housework, leisure, family etc)
from the patient’s perspective.
Values:
0 - No Problem
1 - Slight Problem
2 - Moderate Problem
3 - Severe Problem
4 – Unable
d) Pain/Discomfort
Definition: The level of pain or discomfort reported from the patient’s perspective.
Values:
0 - No Pain / discomfort
1 - Slight Pain / discomfort
2 - Moderate Pain / discomfort
3 - Severe Pain / discomfort
4 – Extreme Pain / discomfort
e) Anxiety/Depression
Definition: The level of anxiety and depression reported from the patient’s perspective.
Values:
0 - No Problem
1 - Slight Problem
2 - Moderate Problem
3 - Severe Problem
4 – Unable
f) Health State
Definition: Is a number between 0-100 given by the patient regarding their feeling about the how good
or bad their general health is on the day of the questionnaire. 100 = The best health and 0 = the worst
health. It is often shown to the patient as a visual assessment scale.
Format: maximum 3 numeric characters (not exceeding the number 100).
Related Items: EQ5D Assessment Data
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