Blog

To mark the publication of our Impact Report 2019-20 we continue with our short series of blogs in which colleagues reflect back on some of our achievements from the last 12 months. In this post Ruth Pitman-Jones shares her thoughts on our ESCAPE-pain programme which helped over 1,000 people manage their joint pain and improve their quality of life.

ESCAPE-pain stands for Enabling Self-management and Coping with Arthritic Pain using Exercise. It is an evidence-based, cost effective, group rehabilitation programme for people with chronic joint pain, that integrates educational self-management and coping strategies with an exercise programme individualised for each participant.

In April 2018 we were given the mission to spread the adoption of the ESCAPE-pain programme across all of Yorkshire and the Humber. We had two years to accomplish this task.

This was no small ask as we realised that the flexibility of the programme meant that we could talk to a whole host of organisations about its delivery from NHS Trusts and Clinical Commissioning Groups (CCGs) to council and independent leisure providers.

We could see that the challenge was to find the key person and identify a delivery pathway. This could be purely clinical using NHS physiotherapists, or purely community, using highly qualified sports trainers, or it could be a combination of both.

The best solution to guarantee sustainability for the programme in the future was for this to be included as part of the musculoskeletal (MSK) pathway, however this was not the only approach and indeed it was the hardest to implement.

As a team we worked together to design:

• a support offer to help underwrite the costs of facilitator training for those wanting to deliver ESCAPE-pain
• to support the development of any necessary business cases
• to share learning with support sites during the delivery and roll out of the programme

It was important to identify suitable sites to implement the programme, finalise timescales for delivery and develop a plan for patient flow.

Armed with an old fashioned paper map of the Yorkshire and Humber region and excel spreadsheet, we implemented a tracking system of interest, adoption, numbers of courses and numbers of completed participants.

Our target in the first year was that 330 patients should complete the twice a week for six weeks programme, doubling to 660 in the second year. The cumulative target was therefore 990.

When we started the project in 2018, one community site in Harrogate was piloting ESCAPE-pain on a Sports England funded scheme, and Barnsley CCG had just started providing ESCAPE-pain classes through their community physiotherapists.

On average it took over 6 months from initiating a conversation to a site starting to pilot ESCAPE-pain.

Personal reflections 

At the end of the two year programme, we were very proud to see that we had supported 48 sites from right across the region to deliver ESCAPE-pain programmes.

What was so enjoyable about this project was the people that we met. We felt privileged to work with people with energy and vision who were passionate about supporting people suffering with chronic pain, who recognised the benefits that ESCAPE-pain would bring and who did their utmost to get it implemented.

We also learnt very quickly how very different systems worked, and that what might work for one would not always work for another. The flexibility of the ESCAPE-pain programme helped us to adapt it’s implementation as needed. 

And the best part was hearing about the positive impact that experiencing the programme had made on the lives of participants. There was such great feedback. I think the most moving one was a participant that said that by the end of the programme she could put on her own socks again. 

Outcomes 

By the beginning of 2020 we were thrilled to be on target to achieve our goal of 990 ESCAPE-pain participants. But then COVID-19 struck. Sites immediately stopped delivering ESCAPE-pain because it is a close contact group programme based largely in hospital clinics or leisure centres – absolutely high risk. Trying to predict the final numbers based on what we knew, we thought we would miss the target by a handful which would have been so disappointing. Then came the good news once the official numbers came in that we had actually achieved a total of 1,025 completers. 

What next?

Quite early on, East Riding CCG had supported a very successful integrated pilot with patients being referred from primary care to the programme which was delivered at leisure centres . By the time COVID-19 hit the programme was on a roll. They were not going to stop for any pandemic and decided to try running online classes. Using materials and guidance provided by our AHSN colleagues at the Health Innovation Network (HIN), they continued to deliver ESCAPE-pain and are currently reintroducing socially distanced face-to-face classes. They were also asked to pilot ESCAPE-pain for back pain and this will be offered to East Riding residents as well as ESCAPE-pain for knees and hips. HIN are supporting sites who want to restart the programme, either virtually or face-to-face.

Find out more about our ESCAPE-pain programme

Read our Impact Report