Mr. John Lindsay:

Deputy Caoimhghín Ó Caoláin asked what the first step would be and Dr. Keaveny has referred to it. It would be ideal if the Minister nominated somebody within the Department of Health or the HSE, preferably the latter, with responsibility for chronic pain services. Preferably, that person would be Dr. Áine Carroll who has responsibility for dealing with long-term conditions.

On Deputy Mary Mitchell O'Connor's question about services elsewhere, we have been studying the national pain audit that has just been completed in England. There is clear evidence that while services in the United Kingdom are hit and miss, they are vastly superior to what is available in Ireland, both acute services and, in particular, community care services. Community care services for people with chronic pain are non-existent here. In the North of Ireland they are working on their pain strategy. Everybody with chronic pain has a right to access a multidisciplinary community care team to help them self-manage their pain. Providing for self-management is very important, if not the most important part of the work we do. To give the committee an example of how effective it is, we had one member who contacted us on Monday or Tuesday of this week to say she had followed her self-management-self-care programme and was off all medication. Her particular medications were costing the State €15,000 a year, a considerable sum of money. There are probably 120,000 people living with chronic pain, at a persistent, severe level. With appropriate community care services, we could probably reduce the State's drugs bill substantially, improve the quality of people's lives which is hugely important and, in many cases, prevent them from entering mental health services which many, unfortunately, do because they are not receiving the appropriate treatment. When one looks at the North of Ireland or the Scottish model, one sees that everybody with chronic pain has access to multidisciplinary teams in the community, which has made a huge difference. We are following a model in Kirklees in Yorkshire where dependency on social welfare has been reduced considerably by developing self-care bundles for each individual. I hope we could follow with something similar in Ireland in the years ahead. We realise the resources are not available to throw millions at the problem, but we honestly believe the Exchequer could save hundreds of millions of euro if appropriate services were put in place, both in acute and community care services.