Ms Cathy Sexton:

I am grateful for the opportunity to engage with the committee today. I represent the Irish Pain Nurses and Midwives Society, a very new specialist organisation representing the 32 full-time nurses working in pain management. These nurses are educated and trained to a very high level. I work in the HSE's north-eastern area, where, apart from my own expertise in this area, there is no service for patients with pain. The same situation applies in 15 inland counties, all of which are trying to access the limited service that exists in the coastal counties. Our focus is on developing a strategic plan for pain management. We cannot work in a vacuum, which is what we are currently obliged to do. It is an ongoing battle to penetrate services that are simply not available to us. We are trying to support patients who are struggling greatly in a service that has very little to offer them. There is no co-ordination between primary and secondary care, which is a real difficulty for us in trying to manage patients on a day-to-day basis.

Our cohort of clinical nurse specialists, CNSs, and advanced nurse practitioners, ANPs, are in a position to add considerable value to primary care services by taking up placements in a co-ordinated manner in communities throughout the State. This would allow us to begin treating pain at a much earlier stage rather than, as Dr. Keaveny and Professor O'Connor described, seeking to provide a service in an entirely unco-ordinated way. At the moment we are each working in pockets on our own and there is no cohesive plan for service delivery. There are only two major multidisciplinary pain centres in Ireland and the majority of people cannot access them. Patients are instead obliged to access a number of different specialties that are outside the pain management remit. We find that significant numbers of our patients are looking to alternative therapists to provide some type of relief from their pain.

As pain is a disease in its own right, there should be a national structure to address it and that structure must come from the HSE. We need to develop a task force which brings together all the stakeholder groups. A national pain strategy must be delivered within a partnership framework, with the necessary resources provided to deliver the service. A hub and spoke model similar to that developed under the paediatric clinical programme must be developed. There are plenty of models we could look to in this regard. None of us can do this alone and, as such, it is vital to put in place multidisciplinary teams. We must provide relevant education and training to patients, health care professionals and the community.

Satellite clinics, with clinical nurse specialists and advanced nurse practitioners, should be provided within communities. We are aware that these types of changes are being considered as part of the strategy for expanding and extending nursing services. It is something we hear about constantly. Now is the time to put the money into the service. Advanced nurse practitioners and other allied health professionals must form a core part of primary care provision, helping to deliver concrete services for patients suffering chronic pain. If we had satellite clinics in GP centres, it would extend and develop the service we currently provide. CNSs and ANPs are also prescribers and represent a huge resource to community services and to specialist services in acute services hubs. Moreover, such a service would be cost effective. We can play a significant role in the development of a national pain management strategy. We hope members will take our views on board and give them due consideration.