Implementing Spinal Cord Stimulation – a priority

NICE Technology appraisal 159 (2008) makes it clear – SCS is clinically and cost effective and mandates commissioning throughout the NHS to selected patients.

Normally a TA results in a dramatic uptake. So why has this not happened for SCS? As usual the cause of failure is manifold. This includes poor identification of those that may benefit in community and other specialist care and poor clinical pathways from referrer to implant centre. This is compounded by the obscurity around who are the healthcare commissioners responsible for SCS – Local commissioning groups or NHS England. The mistaken belief that SCS is a treatment only offered by specialised rather than specialist centres has led to potential SCS patients being starved of resources and unnecessary centralisation of the services. It is for local commissioning groups to ensure that SCS is provided to their population.

So what am I doing to advocate for better SCS access?

At my local level, I have worked hard with local commissioners and NHS England to help them gain clarity in their responsibilities. I have supported the move to the “Zero Cost Model” which means that funding for the devices is now paid for by NHS England rather than local commissioners. The tariff for the episodes of care still remains with the local commissioners. I have written articles and spoken at meetings to fellow pain professionals. I have invented the National Neuromodulation Registry that is now to be compulsory so that all devices and anonymised patients are collected for future analysis. I do clinical research to improve both clinical and cost outcomes and the clinical pathway.

Recently a pan EU group of experts in SCS are working on achieving SCS patient selection clarity to help referrers and SCS centres. This will report later in 2019.

I have seen too many patients with blighted lives secondary to their refractory neuropathic pain whose lives have been transformed following access to SCS. There are many more out there.

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