The CSAG report noted:

"Specialist palliative care services are usually better organised, with clearer policies and better funding than those for chronic non-cancer pain

For instance, St. Ann's Hospice in Greater Manchester runs the following services:

• Supportive outpatient care includes a range of clinics to support patient and family/carer both physically and psychologically.
• Community services: team of nurses and doctors providing ?respite-at-home services' working in partnership with Primary Care Teams. Specialist Community Team comprises Consultant, SW and Macmillan Nurses. Access by self- referral or professional referral by GP, District Nurse, Specialist Nurse or other professional.
  

The Scottish partnership for Palliative Care (S P A) contributes to national policy, guidelines and standards and underpins improvements at a local level by means of professional support and networking.

The November 2001 10th. Anniversary SPA Conference, which had the overall theme

"Palliative Care for All- Responding to Need not Diagnosis", highlighted "the unmet needs of people with a range of non-malignant conditions"

Key themes included the

"common need for pain and symptom management across a range of diseases"

This demonstrates that there is a strong need for a patient-centred approach rather than a diagnosis-oriented approach.

WHAT ARE THE NEEDS OF THE CHRONIC PAIN PATIENT?

• Immediacy of response
• Information
• Continuity of care
• Competence and compassion
• Avoidance of delay and travel
• Avoidance of secondary problems