Statistics from Public Health Scotland reveal that over a seven-year period, approximately 310 individuals suffering from chronic pain passed away while awaiting a first appointment with an NHS pain specialist. This concerning figure has emerged against a backdrop of potential reductions in outpatient pain specialist treatments within NHS Scotland, sparking calls for a comprehensive investigation into the Scottish Government's health policy formulation.
Concerns about the government's consultation procedures have grown, particularly after three prominent disability charities—Inclusion Scotland, Disability Equality Scotland, and the Glasgow Disability Alliance—resigned collectively from the Scottish Government’s Disability Working Group in 2023. In a joint statement, these organisations described their 20-month engagement with the government as an ultimately fruitless process, highlighting unfulfilled promises and a lack of meaningful co-design aimed at tackling pressing issues such as poverty, inequality, the heating crisis, and the wider cost of living challenges for disabled individuals.
The Scottish Government’s 2024 “Participation Handbook” emphasises commitments to "open government," extensive public involvement, and human rights protections. However, the departure of these charities from the collaborative process has cast doubts on the realisation of these principles, particularly given that these bodies had previously received government funding. Independent patient organisations, including the Scottish Parliament’s cross-party group on chronic pain and the charity Action on Pain, have similarly criticised what they see as tokenistic involvement in consultations.
Chronic pain remains a significant health issue across Scotland, impacting over 800,000 people in varying degrees according to official estimates. Long-term conditions and accidents are the primary causes of chronic pain, which is often accompanied by depression and linked closely to poverty. Approximately 20,000 new referrals to NHS pain specialists occur each year, a figure that has been exacerbated by the ongoing impact of long Covid.
The scale of chronic pain-related suffering in Scotland is amplified by delays in treatment. The problem is particularly acute in orthopaedic surgery, where patients endure prolonged waits for hip and knee replacements. Medical surveys have labelled this level of pain and disability as "WTD – Worse Than Death." Lauren Bennie, head of Versus Arthritis Scotland, wrote in a letter to The Herald in October 2024: “Hundreds of thousands with arthritis are being left in debilitating pain, unable to work, their lives on hold and their mental and physical health deteriorating. It is an outrage this has gone on for so long.”
Despite the NHS Scotland budget exceeding £19 billion, chronic pain clinics did not receive additional funding during recent budget allocations or through supplementary funds linked to the Covid pandemic. Behind closed doors, government-appointed advisory “Task Forces” have discussed potential cuts to specialist pain relief treatments, raising alarm among patients concerned about the lack of transparency and the limited involvement of patient voices in these meetings.
The Scottish Government operates hundreds of such advisory groups, which contribute to policy shaping but are not open to public or media scrutiny, nor do they typically include Members of the Scottish Parliament (MSPs). Patients report feeling excluded and unable to obtain essential information due to this secrecy. While new patient referral figures are published, data on waiting times for return patients—where delays are often longest—has repeatedly been withheld by the government. An investigation into return wait times promised by the former Information Services Division was halted without explanation.
Internal guidance at Public Health Scotland reportedly advises caution in releasing data that could provoke “sustained or widespread criticism of the Scottish Government” or compel ministers to make parliamentary statements. This approach has been criticised by the Science Media Centre, which advocates for independent communication of scientific data and evidence separate from government messaging.
Historically, chronic pain has been a focus within Scottish health discussions. Former First Minister Alex Salmond, who shared his personal connection to the issue, supported the establishment of Scotland’s only residential pain service during his tenure. However, campaigners contend that the issue lost momentum under Nicola Sturgeon’s leadership and that of her successors Humza Yousaf and John Swinney. In 2020, Sturgeon indicated a policy shift aimed at “lessening reliance” on NHS pain specialists in favour of “self-management,” a move that prompted concern among patients dependent on specialist treatments such as injections and infusions.
Engagement between government health ministers and the patient community has been limited. Health Secretary Humza Yousaf and deputy minister Maree Todd declined three direct meeting requests from the cross-party chronic pain group, meeting instead with a small group of MSPs. Health deputy Jenni Minto held brief meetings with patients in 2023 and 2025.
Chronic pain significantly impacts other NHS services, contributing to increased demand on GP surgeries, emergency departments, and out-of-hours care. A 2018 government study noted that the majority of pain patients accessed at least one of these services when specialist treatments were unavailable. Public Health Scotland’s latest figures, from March 2025, indicate that over 10% of new patient referrals are waiting more than 52 weeks for a first appointment, a sharp increase from just 0.3% in 2019. Staffing shortages and difficulties covering absences are cited as primary causes.
Certain NHS boards such as Dumfries & Galloway, Grampian, Lanarkshire, and Tayside report the longest waits, while island communities like the Western Isles and Orkney remain without local specialists. Attempts to offer remote advice via “Near Me” services from other health boards have been curtailed due to staffing issues.
The Royal College of Anaesthetists’ Faculty of Pain Medicine has highlighted recruitment crises in specialist pain medicine training and emphasised that implementing Scottish Government pain management frameworks requires significant investment. It cautioned against strictly limiting treatments to those supported by “firm evidence,” noting that clinicians often employ “off-label” therapies, with patient consent, to alleviate pain where standard options fail.
Government-appointed partner charities, such as the Health and Social Care Alliance Scotland, also play a role in policy discussions. The Alliance, which has received millions in government funding, brings together diverse health and social care organisations and people with lived experience to inform service delivery and policy. In response to queries, the Alliance stated: “We are not directly involved in the work of the Chronic Pain Task Force. More generally, we bring together the expertise of our members including people with lived experience, the third sector, and organisations across health and social care. Our goal is to inform and shape policy, improve practice, and enhance service delivery.”
Discussions led by government officials on managing chronic pain, ongoing since June 2022, have now been extended through to 2026—a Scottish election year—prompting concerns about delays in decision-making. John Thomson, a founding member of the cross-party chronic pain group, expressed frustration: “Patients are being treated as outcasts by the Scottish Government under their shameless pretence of involving us. They simply do not care.”
The Scottish Government responded by affirming its commitment to improving the quality of life for those living with chronic pain. A spokesperson told The Herald: “Meaningful and transparent engagement with people living with chronic pain is a priority part of the improvement work set out in our Pain Management Service Delivery Implementation Plan. While we engage regularly with cross-party groups, they are informal groupings of MSPs and other people and groups with an interest in a specific subject which are not part of the formal parliamentary structure for scrutinising Government.”
Source: Noah Wire Services